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Emergency Medicine
Woman alive at funeral home after being declared dead
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<blockquote data-quote="southerndoc" data-source="post: 22102543" data-attributes="member: 39345"><p>[USER=42770]@Groove[/USER] This is location dependent. Where I serve as medical director, they do not initiate CPR/resuscitation on blunt trauma patients without a pulse unless they have a shockable rhythm or no external signs of trauma. Likewise, we do not have many of the criteria you have listed (I know, only one needs to be met). For instance, we do not require airway management (especially given Wang's studies and other studies indicating worse neurologic outcome and overall survivability with pre-hospital intubation in OHCA patients), we do not list TCP as a requirement at all, etc.</p><p></p><p>Our field termination protocol for non-traumatic OHCA mirrors that of the NAEMSP position statement:</p><ul> <li data-xf-list-type="ul">Arrest was not witnessed by an EMS provider (family witnessed arrest doesn't count),</li> <li data-xf-list-type="ul">No shockable rhythm identified by AED or other electronic monitoring,</li> <li data-xf-list-type="ul">There is no ROSC prior to EMS transport.</li> </ul><p>If all criteria are met, they are candidates for field termination of resuscitative efforts. We require online medical control for termination. Usually they call my cell phone, but I've been pushing them to call the third year residents lately to get them experienced in it.</p><p></p><p>Although not technically a requirement, we encourage the paramedics to perform ACLS and administer 2 rounds of epinephrine. This is not a requirement though and was specifically left out of our official protocol to allow for termination of resuscitation in patients who police, bystanders, etc. start CPR on but who are obviously dead or non-salvageable.</p><p></p><p>There are sometimes where patients are transported when they are excellent candidates for field ToR. This usually occurs due to bystanders. One incident comes to mind where police started CPR on a blunt trauma patients with about 30 people standing at the scene witnessing everything. Under our protocols, this patient would have field ToR under traumatic arrest policy immediately unless he had a shockable rhythm. Stopping CPR in front of 30 people would be a PR nightmare. So they transported.</p></blockquote><p></p>
[QUOTE="southerndoc, post: 22102543, member: 39345"] [USER=42770]@Groove[/USER] This is location dependent. Where I serve as medical director, they do not initiate CPR/resuscitation on blunt trauma patients without a pulse unless they have a shockable rhythm or no external signs of trauma. Likewise, we do not have many of the criteria you have listed (I know, only one needs to be met). For instance, we do not require airway management (especially given Wang's studies and other studies indicating worse neurologic outcome and overall survivability with pre-hospital intubation in OHCA patients), we do not list TCP as a requirement at all, etc. Our field termination protocol for non-traumatic OHCA mirrors that of the NAEMSP position statement: [LIST] [*]Arrest was not witnessed by an EMS provider (family witnessed arrest doesn't count), [*]No shockable rhythm identified by AED or other electronic monitoring, [*]There is no ROSC prior to EMS transport. [/LIST] If all criteria are met, they are candidates for field termination of resuscitative efforts. We require online medical control for termination. Usually they call my cell phone, but I've been pushing them to call the third year residents lately to get them experienced in it. Although not technically a requirement, we encourage the paramedics to perform ACLS and administer 2 rounds of epinephrine. This is not a requirement though and was specifically left out of our official protocol to allow for termination of resuscitation in patients who police, bystanders, etc. start CPR on but who are obviously dead or non-salvageable. There are sometimes where patients are transported when they are excellent candidates for field ToR. This usually occurs due to bystanders. One incident comes to mind where police started CPR on a blunt trauma patients with about 30 people standing at the scene witnessing everything. Under our protocols, this patient would have field ToR under traumatic arrest policy immediately unless he had a shockable rhythm. Stopping CPR in front of 30 people would be a PR nightmare. So they transported. [/QUOTE]
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Woman alive at funeral home after being declared dead
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