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AnthonyM83

Unconcious Male At Bus Stop

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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.....

Don't know what much else we could do here, its a wide complex rhythm, non-perfusing you say? We could also try 1g of calcium chloride IV. This there any evidence of renal problems, i.e. a fistula?

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You push the calcium chloride (though no sign of dialysis access)...next rhythm check you have a sinus looking PEA at 52....

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so old mate is going to run the full senario gammet?

this is worse than a recert school.................

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so old mate is going to run the full senario gammet?

this is worse than a recert school.................

True that shit, at least at recert school (CCE/CTP) you get coffee and snacks

Look it's simple, I don't care what rhythm this guy is in, if he doesn't get ROSC after 20 minutes of me working him I'm calling it right there, he's dead and I'm going back to the station to watch telly

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Alright then...i was interested in your problem solving...ROSC achieved and maintained 50 minutes into code. Good CPR throughout.

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I didn't mean to come across like I'm shitting on your parade dude because I'm not trying to

Cardiac arrest is a tiny percentage of workload (here it's ~0.3%) yet it's something people have put focus on for years and years and years and they tend to go all silly about it. Honestly if there is one thing that EMS (partic in US) "tries too hard" at it seems to be cardiac arrest. It has been held up as one of the "primary indicators" of success of any particular ambulance service when in fact it's really not and gets millions of dollars thrown at it blindly yet despite over 50 years of trying little has changed - and I don't want to hear about the cooked numbers from King County Medic One.

Kiwi's rules of cardiac arrest

1) Overall cardiac arrest survival has not dramatically changed in the last sixty years

2) Resuscitation should only be attempted if it is in the best overall interest of the patient and clinically appropriate; i.e. Nana found in asystole with unknown down time shouldn't be worked it's clinically futile, somebody who will go back to a poor health related quality of life (e.g. end stage CA) if they survive neurologically intact shouldn't be resuscitated

3) If you don't get them back they don't go in the back - don't transport a non ROSC as there is nothing the hospital can do that you cannot except in a few very special circumstances e.g. haemopericardium or > third trimester pregnancy with small down time

5) Cardiac arrest resuscitation is a very undignified way to spend your last half an hour with people jumping up and down on your chest and periodically electrocuting you; who is it really the best thing for; the patient or the people working them because "they did all they could!" and "this is what defines me as a Paramedic! *crank crank crank" .. see #2

6) Can we just get rid of adrenaline in primary cardiac arrest already? The evidence is becoming clearer ... it's just not helpful and is in fact overwhelmingly more than likely harmful

7) Rhythms that degrade into PEA or asystole reflect a dying heart and the survival rate is probably < 1%

8) There is no absolute cut-off when survival is not possible but if you've been working somebody for > 30 minutes you really should stop if they haven't achieved ROSC; see #1 and #5

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Alright then...i was interested in your problem solving...ROSC achieved and maintained 50 minutes into code. Good CPR throughout.

50 minutes into the arrest......well not my problem, as there would be no way I would be on scene by then...either he was dead or he is at hospital and its the doctors problem now........

some senarios can be made too difficult....

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50 minutes into the arrest......well not my problem, as there would be no way I would be on scene by then...either he was dead or he is at hospital and its the doctors problem now........

True that mate > 30 minutes I'm calling it

Edited by Kiwiology

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50 minutes into the arrest......well not my problem, as there would be no way I would be on scene by then...either he was dead or he is at hospital and its the doctors problem now........

some senarios can be made too difficult....

That's right, I guess...it's the patient's problem really.

Different responses to these rhythms can't possibly be "too difficult"....

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Different responses to these rhythms can't possibly be "too difficult"....

But it can be made more difficult than it needs to be

Down under we don't give calcium, bretylium, atropine, lidocaine, magnesium etc for cardiac arrest; for years WA has not given any drugs in cardiac arrest as they don't believe evidence exists of their benefit (it doesn't .. really); one or two places (e.g. AV) still carries sodium bicarbonate but they are very much the exception and NZ is strongly considering removing drugs from cardiac arrest.

Cardiac arrest really is quite simple - if it's in the best interest of the patient and you have a reasonable chance of success have a go but if it's been a half hour and you haven't gotten anything then stop

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