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AnthonyM83

Unconcious Male At Bus Stop

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Jumping in late here.

I am still pretty quick to pull the Bicarb trigger, so we could push 1meq/kg.

Otherwise, make sure he got some fluids during the code, and that's it.

ASSume he had a big thrombus somewhere, and call police to ndeal with the body.

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Too everyone who says "don't transport unless there is ROSC", the scenario is at a bus stop in the middle of LA. I'm not sure what LA's guidelines are, but generally speaking, it is poor form to call an arrest in the middle of the street. Bystanders are not going to say "well, they did full ACLS procedures, I guess he wasn't viable" if you stop working this person and leave him there. Nope. They're going to say "Those paramedics left that man to DIE! They didn't even take him to the damn hospital!" If it's an obvious death, that's a different story, but generally speaking arrests in public view should be transported off scene. Otherwise it can turn into a PR nightmare.

!

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So everyone's good with terminating resuscitation at this point?

No one would have the curiousity to play with the rhythms and see if you can get anything out of them? Remember, we're only 6 rounds in right now and he's been showing rhythm changes.....

Mobey. You push the bicarb...doesn't seem to help, but doesn't seem to hurt.

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Drugs & electricity until you either empty the drug box or no longer have a shockable rythm. By then your down time should be in excess of 30 minutes without perfusion.

No perfusion = brain death in my book.

We do have the ability to call a code in our protocols if no rosc after running acls.

I do agree with not leaving a body at a bus stop in south central LA. Could get your bus shot at!

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Drugs & electricity until you either empty the drug box or no longer have a shockable rythm. By then your down time should be in excess of 30 minutes without perfusion.

No perfusion = brain death in my book.

We do have the ability to call a code in our protocols if no rosc after running acls.

I do agree with not leaving a body at a bus stop in south central LA. Could get your bus shot at!

I Have transported corpses with obvious signs of death for that reason precisely. I don't like it but safety is first.

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My red neck is showing.

We don't transport corpses, wheather we are doing CPR or not.

Then again, a large crowd here is 5 people.

I suppose if I was on a busy urban street, I would do what is nessesary to maintain post-code dignity of the patient, as well as the audience.

I am not sure I would take my rig out of service for an extended period to do so..... then again, being in-service is a high priority out here where we are the only show in town.

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My red neck is showing.

We don't transport corpses, wheather we are doing CPR or not.

Then again, a large crowd here is 5 people.

I suppose if I was on a busy urban street, I would do what is nessesary to maintain post-code dignity of the patient, as well as the audience.

I am not sure I would take my rig out of service for an extended period to do so..... then again, being in-service is a high priority out here where we are the only show in town.

I have only done it when I know the corpses are cartel workers and their buddies may be watching. Those guys will follow you home if you make them angry.

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There is no role for transporting this patient if he has not achieved ROSC regardless of where he is physically located

If necessary we can move him into the ambulance and work on him there, I've seen that done before

We can grab a couple draw sheets out and get people to hold them up if we're concerned about privacy

Now, if we cease resuscitation and the Police are some time away we have the option of transporting the patient directly to the morgue but the Police generally don't like that so once it's looking like we're going to cease resuscitation one AO generally steps out to call the police on the ambophone to say hey guys start coming

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I'm observing from a possibly dated BLS viewpoint, via NY State and FDNY protocols. Sudden Cardiac Arrests, after the ALS does their "thang", if no ROSC, they contact OLMC for permission to terminate resuscitation.

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I once had to take my unit and myself out of service and take a shower with some very nasty soap because a doctor wouldn't let me call a cardiac arrest vicitim that literally had bugs jumping off of him when we exposed the chest. Why? Because he was in public view. After seeing the way the news media likes to pretty much just make up their own facts when it comes to this type of thing, I would be transporting, even if we were going to transport to the morgue.

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