List Archives

Tue Dec 19 19:38:28 GMT 2006

As I recall, the patient had a cardiac arrest s/p TBI.  The patient
arrived without an airway and in PEA.  If you want to do CPR (assuming
that someone was doing so en route without ET intubation) then continue.
 Bag in the guise of "preoxygenation", place leads and do an epigastric
FAST view.  If there is no cardiac activity, stop, and proceed where I
left off on my last e-mail......take care of the family, etc.

>>> <rwolfer at aol.com> 12/19/2006 1:20 PM >>>
I would do a code. Nothing heroic.  I agree about organ donation.  I
have actually gotten a couple of donations  because of this. The family
always seems to "feel better" that everything was done and donation
occurred.  They state " atleast something good will come of it"   

Rebecca Wolfer, MD, FACS, FCCP
Associate Professor, Marshall University School of Medicine
Dept of Surgery
Director Thoracic Surgery
Director, Surgical Critical Care Cabell Huntington Hospital
Director, Trauma Cabell Huntington Hospital

-----Original Message-----
From: Rgross at harthosp.org 
To: trauma-list at trauma.org 
Sent: Tue, 19 Dec 2006 12:18 PM
Subject: Re: head injury- termi ation of resuscitative efforts

I treat the family.  The patient is dead, and will stay dead,
regardless
of what you do.  Now is the time to help the family honor the
patient's
wishes, if known, and to call the organ donation service in your
region.
 Lastly, thoracotomy IS indicated - to procure the heart and lungs for
transplantation. (so there - I did come forward and admit it!)

Take care,
Ron
>>> "oded private" <tangentcarrot at hotmail.com> 12/19/2006 11:47 AM >>>
Hello list

I'd like to hear your opinion about deciding to terminate treatment
for

isolated TBI resulting in cardiac arrest.

What if the pateint is still in PEA? Will you attempt to defibrilate
VF, if 
it happened for some reason?

If you do treat him- what will you do?  ET intubation and ventilation
alone? 
CPR? Does anybody here practice thoractomy in the scenario and is
ready
to 
"come forward" and admit to it?

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head injury- termi ation of resuscitative efforts