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Fri Jan 12 12:02:24 GMT 2007

Lots of references on PubMed, like this one (hope it pastes properly):
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dop
t=AbstractPlus&list_uids=16934644&query_hl=1&itool=pubmed_docsum
If you're able to connect to it, see also the related links feature on
the right of the page.

Of the patients in the Annals of EM data, there was something like one
chance in fourteen of survival to discharge -- but nearly half of those
cases involved simple airway and breathing issues.  More, if we may
assume that the isolated heads and necks arrested 'cause they stopped
breathing...

Some of the job applying this sort of data will depend on what you mean
by "downtime."  If he was pulseless for 12-15 minutes, I doubt you'll
find any credible reference claiming that he might have survived.

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of John Holmes
Sent: Friday, January 12, 2007 3:05 AM
To: trauma-list at trauma.org
Subject: death after traumatic asphyxia

I've been asked to give a medicolegal opinion to the coroner in a case
where 
a driver was not given attempts at resuscitation by paramedics when
found to 
be in asystolic cardiac arrest.  He was tighly trapped behind the
dashboard 
and was initially talking, but it is likely that cardiac arrest followed

traumatic asphyxia.  Downtime to extrication was around 12-15 minutes.
Post 
mortem showed no signifciant injuries other than two small splenic 
lacerations.

I've been looking for good references to support the paramedics'
decision 
(which I agree with) not to intubate nor commence CPR or ACLS.   Can
anyone 
help with some good references which directly address this scenario?

Thanks,

John

Dr John L Holmes
Director Emergency Medicine
Mater Adult Hospital
Brisbane, Australia

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death after traumatic asphyxia