Your patient arrests as you pull up to the ER

[tniuqs]

Mind if I say a few things in this dubious "senario" to start with... no mention of what even type of call Cardiac, Trauma, Maternity, Siezure, GI Bleed, Respiratory, Stuck Fart .... HUH ?

No mention of the recieving facility capabilitys rural vs urban ..... ?

Then throw in no exact patient rythum ... arrest only ? shock or not shockable ?

Is even if this ALS or BLS ?

The really a simple answer go back the basics .... call for HELP .... duh.

Phil:

This is now a witnessed arrest & the way i read it we are within sight of the hospital. Local Protocols will dictate what happens next. Defibrillation, if the rhythm is shockable, or straight to CPR. So with this in mind, we are within spitting distance of a hospital, & the patient arrests, where is it more appropriate to be working on the patient? In a hospital or in an ambulance?

Agreed.

But no not good enough for some ... so then lets introduce RNs are idiots and so are MDs and Paramedics are Gods because they know ACLS, why am I laughing again and who said this ? .... well who cares really and they are not a team player, I dont want them on my gut wagon.

SO we somehow manage ROSC ... and are our rates in EMS alone are abismal to start btw and with a 2 man team we can not appropriately provide post resus management in comparison to ANY facility not 3 days but immediate .... the smoke is tickling me butt right now.

Tell me of one facility when the Driver hollers "HELP' From the bay no one will come out of the building ?

Quoting Curse:

I believe this approach to be extremely near sighted. Although certain aspects of arrest management may have common themes and approaches, the clinical spectrum of arrest management is by no means anywhere near that generic. As we have already seen from earlier posts, there are occassions where it is appropriate to treat in the ambulance as well as situations where it is more appropriate to run into the ED. One such scenario, which has been debated so far, specifically centres around whether the pt is in a "shockable" rhythm or not - hence my first question.

Genaric questions get Genaric answers, yours is circle talk only.

But heres even a more challenging point for those that are really cocky .... put the egg before the chicken So if this patient is so close to arrest why have you not taken preemtive action ie RSI to start with and take the WOB (work of breathing) away, oxygenate and ventilate ... before that Patient Arrests !

This is proactive medicine not reactive medicine when will we learn ........

cheers

[Mateo_1387]

All I'm saying is that ACLS, regardless of who performs it, is NOT definitive care.

:bs:

Advanced medications, electrical shock therapy, airway control, CPR, trying to treat the causing factor of arrest.....its sounds like definitive care.

I guess we can take the dead guy back to the street corner so the citizens can just do CPR, since it is not definitive care.

Since it is not definitive care, what do you call it?

Granted, even though Paramedics cannot provide every last thing the hospital can, does not mean we do not provide some level of definitive care.

[Camulos]

Genaric questions get Genaric answers, yours is circle talk only.

I don't know what genAric is however guess you mean genEric. We all have typos - I am certainly not immune to that. However although once can be a typo, twice is amusing!!! Indeed sometimes I even amuse myself.

I would appreciate a more detailed description of what you mean by the above statement - particularly "circle talk".

I am fully cognizant of the fact that I am staying quite non committal on this particular topic and indeed do so with purpose. Rather than BLUNTLY pointing out where I feel Phil is incorrect I am attempting to get him to recognise what I believe is his erroneous statement himself. I feel Phil, and perhaps others, may get more out of it that way.

Getting back to the clinical issue then. What would you do tniuqs if the pt was in a shockable rhythm?

Keen to hear your answer. Hopefully it's not a genAric one!!!

Stay safe,

Curse :evil:

[Quakefire]

BLS treatment here (for me anyway) is simple, I put on the AED (if the pads arnt on already) I do what it says, while it works I can get an opa ready and a bag. I have no IV access no intubation, no drugs that are going to help this patient, only a shock if the machine tells me to and turning his chest into a trampoline. So I get the airway, i get the monitor, I start compressions and I get the patient to a higher level of care

[tniuqs]

Curse:

Well please accept my personal apologies for the spelling error, some how my point was lost as a result, i guess its true some people cannot see the forest for the trees.

Shockable rhythms get shocked rhetorical question's hey, I can even do it on the cot and my monitor fits on it.

EMT-B, EMT-I, EMT-P = Eds Moving and Transport is bottom line in my books.

Most pleased to respond and thank you for providing yet another "circle talk" example :

I am fully cognizant of the fact that I am staying quite non committal on this particular topic and indeed do so with purpose. Rather than BLUNTLY pointing out where I feel Phil is incorrect I am attempting to get him to recognise what I believe is his erroneous statement himself. I feel Phil, and perhaps others, may get more out of it that way.

Non committal, with purpose, to point out, you disagree with Phil and others GET to more of your opinion ?

Sorry, with all the flowers something got lost me in the presentation, I am quite simple minded that way.

I agree with Phil as stated prior, his opinion is in my mind far more realistic and in my world good educators lead through encouragement, provide tangible realistic examples, and be supportive.

Look to Timmys senario re: Cowgirls .... a very nice presentation to amplify my point, very clear, consise, truely just asking for advice. These "what if" situations rarely lead to anything positive and lead to guessing games only. As IF any experianced provider respected on this forum site has never had an arrest on the ramp. My last one of note was a ruptured ectopic pregnacy and no possible way one can treat that in the back of a gut wagon nor even the ER, fortunatly we had a surgical resident with balls on that night, and she popped in a sub clavian line and we were pressure infusing blood asap, 2 large bores didnt hurt either en route.

ps she lived, a good history taking was what really saved her.

Curse but you have now hijacked this thread and completely lost MY point and you failed to address proactive vs reactive Paramedicine, but then again how could you without proper information with such just a genaric query.

cheers

[tniuqs]

turning his chest into a trampoline.

Quake mind if I use that ?

te he

[Camulos]

Curse but you have now hijacked this thread and completely lost MY point and you failed to address proactive vs reactive Paramedicine, but then again how could you without proper information with such just a genaric query.

cheers

I don’t know how I lost YOUR point. I personally thought you did a pretty good job losing it yourself.

I am sorry you feel that I have HIJACKED this thread. But that is the way YOU feel and I have no real control over that. It was certainly not my intention to HIJACK here and I just wanted Phil to be able to recognise his earlier statement was near sighted. Or do you agree that an arrest, is an arrest, is an arrest? :roll:

Getting back to this original post – would I stop and treat or continue and run?

Give me the clinical picture of the pt and I’m happy to provide my answer. I guess that is what I was alluding to when I wanted further info initially before committing to an answer.

I love the forest and the trees it is made up of. Unfortunately in an attempt to get through the forest I think you must keep walking into the tress as you are making the SAME mistake.

but then again how could you without proper information with such just a genaric query

– it’s genEric for god sake!!!!! I’m am of course joking when I write this stuff. Spelling mistakes are a part of life. I just find some spelling mistakes amusing – especially when repeated. As I said sometimes I even amuse myself.

Stay safe,

Curse (AKA Hijacker) :evil:

[CTXMEDIC]

:bs:

Advanced medications, electrical shock therapy, airway control, CPR, trying to treat the causing factor of arrest.....its sounds like definitive care.

I guess we can take the dead guy back to the street corner so the citizens can just do CPR, since it is not definitive care.

Since it is not definitive care, what do you call it?

Granted, even though Paramedics cannot provide every last thing the hospital can, does not mean we do not provide some level of definitive care.

i hear ya screamin but its either 'definitive' or its not, theres no in between. what we do is give the patient a chance to get to definitive care and give the docs someone warm to work on. until im allowed to cath coronary arteries in my truck, im going to transport to definitive care.

[vs-eh?]

In general the correct answer will be:

Start CPR

Analyze ASAP (this is witnessed by you)

Do whatever machine says

Continue CPR

Manage airway with BLS

Enter ER

You are in a hospital now. Now, unless you normally take part in a lot of patient care in hospital (giving drugs, doing procedures, etc...), you hand off your patient to the hospital and assist if needed (generally with airway prior to intubation and CPR). Paramedics here generally do not take part in "advanced care" (i.e. what they may do in the field), in hospital. I have never started an IV, given a drug, intubated a patient, etc.... while in a hospital room.

Patient care while on offload on the other hand...

[Mateo_1387]

i hear ya screamin but its either 'definitive' or its not, theres no in between. what we do is give the patient a chance to get to definitive care and give the docs someone warm to work on. until im allowed to cath coronary arteries in my truck, im going to transport to definitive care.

:bs:

So, a paramedic gives a patient IV Dextrose, and brings said patient out of insulin shock. A very life threatening condition, that if left untreated, will be sure to lead to death. Now, and EMT Basic, who cannot give IV Dextrose must take said patient to 'definitive care'. When the patient arrives at said "definitive care" the patient will be given IV Dextrose.

Lets look at the equation.

IV Dextrose = Definitive Care.

Paramedics administer IV Dextrose.

So with the rule of substitution, we can conclude that...

Paramedics administer definitive care.