List Archives

Thu Dec 21 14:28:54 GMT 2006

Oded,
I guess my response is still the same if we are dealing with a patient
who we know is arresting due to his head injury (closed or GSW) as you
originally proposed.  The only question one might add to the prehospital
arrest scenario would be the time factor - ie how long was he down
before and then and how long was he down in arrest after intubation.
Ron

>>> "oded private" <tangentcarrot at hotmail.com> 12/21/2006 3:46 AM >>>
I was talking about a patient arresting in the ED. But we can talk
about the 
option of prehospital or en route arrest as well

>From: "Ronald Gross" <Rgross at harthosp.org>
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: <trauma-list at trauma.org>
>Subject: Re: head injury- termi ation of resuscitative efforts
>Date: Tue, 19 Dec 2006 14:38:28 -0500
>
>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