Quick decision at a MVC

[mobey]

Where did you get this legal opinion from mobey? My understanding, per ACP is that if any ALS drugs are given, ALS must monitor them for the duration of transport. Furthermore, what meds specifically are you referring to? Now I know that in actual practice, we do in fact hand off pts who have had analgesics, antiemetics, etc. to BLS crews. Particularly in situations where hospitals will send pts out for BLS transfers, who have recently had morphine or other pain control. However, I think if we are actually following the law to the letter, it is technically not sanctioned.

It is on the AHS website in one of thier forms. I will see if I can find it and email you a copy.

[DFIB]

So how did we end up on the decorticate guy? Is he 90+% likely to recover or not? Mobey posted a great study but other articles ( mainly off the net) seem to indicate the opposite. Do any of you guys know of a different study that shows a good prognosis for traumatic decorticate patients?

Edited November 9, 2011 by DFIB

[systemet]

Mobey's article is a little old (1991 - discussing a cohort of patients from 1983-1974), and it's observational, i.e. there's no intervention being studied / no control group. So it's limited in what information it provides.

It's inclusion criteria is also limited to patients who were admitted to a ICU who had coma following severe head trauma and remained unconscious for > 30 days, and had abnormal motor responses to painful stimuli (posturing or flaccidity). So this is a pretty unique group of patients. Firstly, they've survived long enough to be admitted, which our hypothetical (or Mobey's real?) patient might not, and then secondly, they've remained comatose for a long period of time.

Of 132 patients, 72 regained consciousness following their coma. Patients more likely to recover lacked "extraneural trauma", and were more likely to have exhibited decorticate than decerebrate or no response to painful stimuli in the first week. They were less likely to have SIADH, hydrocephalus, seizures, or abnormal respirations. But it's a little unclear from the paper as to how big these effects were (i.e. odds ratios, confidence intervals), and with what degree of certainty (P values).

But I imagine what Mobey was suggesting was that this group of patients was very sick. They had enough head trauma to be admitted to the neuro ICU, and remain comatose for over a month, and had abnormal motor responses yet despite this severe pathology, a large percentage of the patients with decorticate posturing survived. So we shouldn't assume that just because a prehospital patient is posturing, they're a no-hoper.

At least that's what I take from it.

Edited November 9, 2011 by systemet

[chappy]

If only one Pt can b e transported per truck:

Pt 1 accepts OPA and has a sat of 99 ... BLS and high-flow diesel.

Pt 2 has a neuro deficit, monitor airway, consider fluid replacement, high-flow O2, high-flow diesel

By the way, around here, you should never begin an ALS intervention and pass the pt off to a BLS crew.

[DFIB]

If only one Pt can b e transported per truck:

Pt 1 accepts OPA and has a sat of 99 ... BLS and high-flow diesel.

Pt 2 has a neuro deficit, monitor airway, consider fluid replacement, high-flow O2, high-flow diesel

By the way, around here, you should never begin an ALS intervention and pass the pt off to a BLS crew.

High flow diesel. I like!

[Richard B the EMT]

High flow diesel. I like!

AKA Diesel Drip, Diesel Infusion, Motion Lotion Application...

[mobey]

By the way, around here, you should never begin an ALS intervention and pass the pt off to a BLS crew.

Around here being EMTCity?

[Happiness]

okay i have a question, maybe I missed it but what was the answer to this senerio ?

[mobey]

I don't think there is a right answer.

Just a thought provoking scenario.

[Richard B the EMT]

I have had many occasions when involved in a dual level response, where, after determining that the ALS intervention was not required, I've transported patients, freeing up the Paramedics for whatever next call might be needint their limited resource response. Most times, I offered, only a few where they ordered me to do the transport. I also recall one call where the driving Paramedic requested BLS, just to drive his vehicle while he joined his partner in the back to treat while enroute to the ER. Goes with the territory, and I didn't mind doing it.