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Mon, 16 Dec 2002 16:22:30 -0500

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I have had a patient come into the trauma center where I work, receiving
CPR, s/p MVC, the trauma team performed open cardiac massage after
"cracking the chest", the patient went to the OR.  The patient survived
the OR, went to rehab, and walked into the ER to visit us a few months
later, no deficits.  Unfortunately, I do not know any information past
that point.  The pt was a 40-something year old male, FYI.

Michelle Jones, RN
Emergency Dept.
University Health Systems Eastern North Carolina

-----Original Message-----
From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]
On Behalf Of meredith mcbride
Sent: Sunday, December 15, 2002 8:33 AM
To: trauma-list@trauma.org
Subject: CPR in blunt trauma

What about folks with medical reasons for cardiopulmonary arrest who
subsequently crack their cars up? I think we've probably all cared for
trauma patients whom it became evident had suffered an MI or stroke as
the cause, rather than effect, of the accident. I've got a family member
with Wolff-Parkinson-White. If he goes into SVT, becomes hypotensive,
drives off the road, smashes his face and cracks a few ribs, I hope that
some first responder will provide CPR long enough to get him into the
hospital for cardioversion. I'm certain success in either of these
situations would fall out of a statistical analysis, due to the very low
numbers. 
Although these scanarios sound far fetched, my mind returns
uncomfortably again and again to the MANY times that I have seen CPR
intiated without genuine arrest existing, usually due to difficulty
assessing vital signs. If the absolute rule in 'no CPR in blunt trauma'
I can't help but think that a few - so few that they may not be
demonstrated on analysis - potential survivers will tragically be lost.
I agree, cost-benefit analysis won't support fighting for those few, but
that's a different topic for discussion. First we must settle whether or
not a few survivors have and will be saved. 
There are many years of experience on this board. Anecdotally, who has
seen ANY blunt trauma patient arrive after CPR and ultimately survive?
And what was the outcome?

  _____  

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<div class=3DSection1>

I have had a patient come into the =
trauma
center where I work, receiving CPR, s/p MVC, the trauma team performed =
open
cardiac massage after &#8220;cracking the chest&#8221;, the patient went =
to the
OR. &nbsp;The patient survived =
the OR,
went to rehab, and walked into the ER to visit us a few months later, no =
deficits.&nbsp; Unfortunately, I do not know =
any
information past that point. &nbsp;The pt
was a 40-something year old male, FYI.<o:p></o:p>

<p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:navy'><br>
</span></font><st1:PersonName><st2:GivenName><font size=3D2 color=3Dnavy
  face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;color:navy'>Michelle</span></=
font></st2:GivenName><font
 size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;
 color:navy'> </span></font><st2:Sn><font size=3D2 color=3Dnavy =
face=3DArial><span
  =
style=3D'font-size:10.0pt;font-family:Arial;color:navy'>Jones</span></fon=
t></st2:Sn><font
 size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;
 color:navy'>, </span></font><st2:nameSuffix><font size=3D2 color=3Dnavy
  face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;color:navy'>RN</span></font><=
/st2:nameSuffix></st1:PersonName><font
size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;
color:navy'><o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:navy'>Emergency =
Dept.<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:navy'>University Health Systems =
</span></font><st1:place><font
 size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;
 color:navy'>Eastern North Carolina</span></font></st1:place><font =
size=3D2
color=3Dnavy face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;
color:navy'><o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:navy'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
face=3DTahoma><span
style=3D'font-size:10.0pt;font-family:Tahoma'>-----Original =
Message-----<br>
<b><span style=3D'font-weight:bold'>From:</span></b> =
trauma-list-admin@trauma.org
[mailto:trauma-list-admin@trauma.org] <b><span =
style=3D'font-weight:bold'>On
Behalf Of </span></b></span></font><st2:GivenName><font size=3D2 =
face=3DTahoma><span
 =
style=3D'font-size:10.0pt;font-family:Tahoma'>meredith</span></font></st2=
:GivenName><font
size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;font-family:Tahoma'> =
</span></font><st2:Sn><font
 size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;font-family:Tahoma'>mcbride</span></font></st2:=
Sn><font
size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;font-family:Tahoma'><br>
<b><span style=3D'font-weight:bold'>Sent:</span></b> =
</span></font><st1:date
Month=3D"12" Day=3D"15" Year=3D"2002"><font size=3D2 face=3DTahoma><span
 style=3D'font-size:10.0pt;font-family:Tahoma'>Sunday, December 15, =
2002</span></font></st1:date><font
size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;font-family:Tahoma'> </span></font><st1:time
Hour=3D"8" Minute=3D"33"><font size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;
 font-family:Tahoma'>8:33 AM</span></font></st1:time><font size=3D2 =
face=3DTahoma><span
style=3D'font-size:10.0pt;font-family:Tahoma'><br>
<b><span style=3D'font-weight:bold'>To:</span></b> =
trauma-list@trauma.org<br>
<b><span style=3D'font-weight:bold'>Subject:</span></b> CPR in blunt =
trauma</span></font></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'><o:p>&nbsp;</o:p></span></font></p>

What about folks with medical reasons for
cardiopulmonary arrest who subsequently crack their cars up? I think =
we've
probably all cared for trauma patients whom it became evident had =
suffered an
MI or stroke as the cause, rather than effect, of the accident. I've got =
a
family member with Wolff-Parkinson-White. If he goes into SVT, becomes
hypotensive, drives off the road, smashes his face and cracks a few =
ribs, I
hope that some first responder will provide CPR long enough to get him =
into the
hospital for cardioversion. I'm certain success in either of these =
situations
would fall out of a statistical analysis, due to the very low numbers. =
<o:p></o:p>

Although these scanarios sound far fetched, =
my mind
returns uncomfortably again and again to the&nbsp;MANY times that I have =
seen
CPR intiated without genuine arrest existing, usually due to difficulty
assessing vital signs. If the absolute rule in 'no CPR in blunt trauma' =
I can't
help but think that a few - so few that they may not be demonstrated on
analysis - potential survivers will tragically be lost. I agree, =
cost-benefit
analysis won't support fighting for those few, but that's a different =
topic for
discussion. First we must settle whether or not a few survivors have and =
will
be saved. <o:p></o:p>

There are many&nbsp;years of experience on =
this board.
Anecdotally, who has seen ANY blunt trauma patient arrive after CPR and
ultimately survive? And what was the =
outcome?<o:p></o:p>

<p style=3D'margin-left:.5in'><font size=3D3 face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt'><o:p>&nbsp;</o:p></span></font></p>

<div class=3DMsoNormal align=3Dcenter =
style=3D'margin-left:.5in;text-align:center'><font
size=3D3 face=3D"Times New Roman"><span style=3D'font-size:12.0pt'>

<hr size=3D1 width=3D"100%" align=3Dcenter>

</span></font></div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3D"Times New Roman"><span
style=3D'font-size:12.0pt'>Do you Yahoo!?<br>
<a =
href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002-December/3D"http://rd.yahoo.com/mail/mailsig/*http:/mailplus.yahoo.com">Yahoo=
!
Mail Plus</a> - Powerful. Affordable. <a
href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002-December/3D"http://rd.yahoo.com/mail/mailsig/*http:/mailplus.yahoo.com">Sign =
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