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Sun, 15 Dec 2002 12:10:23 -0800 (PST)

Horse pucky

Compressions are not "feeding the heart" in case there is a
reversible cause of death. Most of the time they are
probably making things worse. If there is a reversible
cause of death it needs to be reversed and chest
compressions are not going to buy you time

R Wigle
LTC USAMC
--- Nick Nudell <emsnick@northerntel.net> wrote:
> Again let's distinguish attempts at resuscitation from
> external chest compressions
> Please reconcile this for us?
> 
> 
> Ok, then think of it this way... one of the reversible
> causes of death is hypoxemia of the myocardium.
> Compressions are going to feed the heart, in theory....
> so that is a reversible cause of death being treated.
> Hopefully the same courtesy would be extended to the
> brain and the other vital organs. Isn't the real problem
> that we can frequently maintain enough perfusion to drag
> out the resuscitation but not enough for survival to
> discharge? 
> 
> In EMS we frequently see the first stages of a
> resuscitation but are not involved in the latter stages,
> that survival to discharge side... in my small town I
> know about my patients that go to a certain hospital.
> They are more likely to die in that hospital then if we
> transfer them to the alternate hospital. That is also a
> measure of survival to discharge. I am involved in all
> these phases, so I know about it. If I did not, then I
> would have had no idea that one hospital saved more
> patients then they killed.
> 
> As for traumatic arrests... for how many years have
> paramedics been told that they 'did the right thing' or
> 'did all they could do' or 'good job' when they arrived
> at the ER with a working arrest? What happens in the ER?
> Don't they get chest tubes, central lines, some kind of
> invasive heroics or other treatment? If so, then the
> blame can hardly be placed on the paramedics who brought
> in a patient who received even further care by a zealous
> ER physician and crew.... what time would you use for
> time of death on the death certificate?
> 
> Just some odd ramblings that may perhaps have some
> profound affect and hopefully are not offensive to anyone
> this time...
> 
> Nick
> 
> 
> 
> ____
> Nick Nudell, NREMT-P, CCEMT-P
> Montana
> nudell@prehospital-perspective.com
> 
> "What we are communicates far more eloquently than
> anything we say, even more than anything we do.." --
> Steven Covey
> 
> 
> 
> 
> 
> 
> 
>   ----- Original Message ----- 
>   From: DocRickFry@aol.com 
>   To: trauma-list@trauma.org 
>   Sent: Saturday, December 14, 2002 1:34 PM
>   Subject: Re: traumatic arrest
> 
> 
>   In a message dated 12/14/2002 1:37:30 PM Eastern
> Standard Time, emsnick@northerntel.net writes:
> 
> 
>     So this means that the patient will either be in PEA
> or a reversible cardiac rhythm initially changing to
> asystole, will have suffered some sort of trauma, may or
> may not have palpable pulses with compressions, will have
> a bunch of IV fluid infused, will be intubated with
> decreasing or zero CO2 offgassing, a bunch of drugs
> infused, maybe have catheters sticking out of their
> chest, may or may not have MAST pants placed, and they
> will not be improving in any way.
> 
> 
> 
>   Sounds reasonable--but recall that the case initially
> presented had none of these--lifeless from the
> beginning--and a large number STILL defended chest
> compressions
>   Again let's distinguish attempts at resuscitation from
> external chest compressions
>   Please reconcile this for us?
>   ERF 

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