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Fri Jan 12 12:16:33 GMT 2007

Thanks Pret,

It was 12 - 15 minutes from the time he was observed to "go still" till when 
they got him out by which stage he was then in asystole.  Cardiac arrest 
could have been anything from 0 - 15 minutes (from the case notes I suspect 
the latter).

He was in my opinioin irretrievable at that stage but some clever dick 
"expert" witness will get up and say he should have been given a trial of 
CPR and ACLS.  I just want to be in an irrefutable position when giving my 
testimony.

John

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

>From: "Bjorn, Pret" <pbjorn at emh.org>
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
>Subject: RE: death after traumatic asphyxia
>Date: Fri, 12 Jan 2007 07:02:24 -0500
>
>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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