List Archives

Tue Jan 23 12:58:29 GMT 2007

John
Tough.  I also agree with the paramedics - but...

I would look at the data from field cardiac arrest and outcome after blunt trauma which is essentially zilch.

________________________________

From: trauma-list-bounces at trauma.org on behalf of Ronald Gross
Sent: Mon 1/22/2007 7:35 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: death after traumatic asphyxia

John,
Just got back from EAST, and picked up this thread....The man was dead, and would have stayed dead.  Use what Pret gave you, and when you testify, just cite the facts.  As to the assumption that you are gonna loose, well I would imagine that for every whore that would argue the case against the prehospital providers, there will be a (sort of) sane and (? ethical) lawyer who will put him/her in the right place.........
Good luck, and well done!
Ron

>>> "Thomas Anthony Horan" <thoran at sarah.br> 1/12/2007 9:39 AM >>>
dear John,
The reason why your side will loose is the uncertainty of when the patient became asystolic. The time factor could not have been acurately measured from last words to extrication. even the number you have given us  has an error of 25% built in to it. you will get bogged down in estimates of how long apnea and asystole lasted.  The lawyer will not have to be smart to fry the medic for not trying. They will argue succesfully that potential errors in measurement of and  uncertainty in timing of events demanded an attempt.
Tom

> ----------
> From:         trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on behalf of John Holmes[SMTP:docjohnholmes at hotmail.com]
> Reply To:     Trauma &amp; Critical Care mailing list
> Sent:         sexta-feira, 12 de janeiro de 2007 06:05
> 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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