20 y/o Male Ejected

[ambodriver]

And this is another case for an IO drill in every protocol. That way your not screwing around trying to get an IV for ten minutes when there's probably more pertinent issues at hand.

Again, my humble opinion.

Yea I would have 'boarded, get to ambo, look for a quick airway and go. Everything else done in route. 10 mins fishing for an IV seems a bit much. I wasn't there though.

[ERDoc]

I'm pretty much with Kiwi on this one. Clear the ariway to make sure it isn't an airway issue. No pulse? Crack his chest or pronounce.

As for the question of advanced airway, why? If you can adequately control the airway with less advanced methods why make it more difficult than it needs to be?

Drugs? Not going to help here. Remember, with ACLS algorhythms it is assumed that you are resuscitating a person whose main issue is cardiac. Those meds are meant to "restart" (oversimplification) a heart that has stopped due to problems internal to the heart. This is a trauma pt where the issues are external to the heart, so your cardiac meds will usually be of little use.

This guy's brain is scrambled, there is not much anyone can do for him.

[DwayneEMTP]

Agreed on not working this guy longer than necessary to try and correct airway/and verify the PEA. Unless he happened to be ejected onto the ER cot waiting outside of the ER doors, there's nothing to do here most likely. Like Doc said, our drugs are to help correct cardiac/cardiac related issues, this guy has container/neuro management problems. We don't have many tools for that.

Also, there are, I guarantee you, other significant injuries other than the facial trauma. Just your description of blood pouring from the roof of his mouth makes a cranial vault compromise almost certain, and it sounds like in a big way in this kid. It took a lot of force to cause that injury (Intuitively speaking, can't back that up). In fact, I would be willing to bet that the CPR was working like a blender on this fellows internal organs from thoracic injuries as well.

Kudos to you for bringing this here. And kudos as well for wanting the best that can be given for every patient. Both take balls.

Dwayne

Edited July 24, 2011 by DwayneEMTP

[Richard B the EMT]

who knows if the cops actually felt a pulse or not?

I am going to presume the involved crew didn't just take the word of the onscene LEO, and attempted ascertaining for a pulse themselves. If that was mentioned, I admit I missed the notation.

Edited July 24, 2011 by Richard B the EMT

[QIKFire]

Thanks for all the input! It is much appreciated.

Yeah I checked for a pulse upon our arrival... DPS said they felt a weak pulse but my question is, when they found that he went pulseless why didn't they start CCR? Infact no one was by the pt when I got there I had to ask someone to find out where he was.

Anyways thanks again.

[NYCEMS9115]

DNR orders received.... I am not sure what you mean by that... He was 20y/o; driving a car and was ejected. He had a DNR?

[Katiebug]

This is reminiscent of a conversation we had on May 13, 2009 titled, "Would you work this code". A lot of the same opinions voiced there.

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[QIKFire]

DNR orders received.... I am not sure what you mean by that... He was 20y/o; driving a car and was ejected. He had a DNR?

We use that terminology for receiving termination of efforts from the receiving hospital.

[paramedicmike]

We use that terminology for receiving termination of efforts from the receiving hospital.

Just as an aside, that might've been good to say up front. It could have alleviated some confusion.

This is a good lesson in "not everyone uses the same terminology so I/we should present as clearly as possible".

[Richard B the EMT]

We use that terminology for receiving termination of efforts from the receiving hospital.

Aha! There are a number of us use DNR to mean that, due to an advanced directive, or following certain protocols on "obvious death", we make no effort at all to resuscitate. If the order to terminate efforts at resuscitation is issued by On Line Medical Control, every agency has their own wording.