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Home > List Archives

blunt traumatic arrest pharmacotherapy

Gideon Chilton gidjam60 at live.co.uk
Sun Dec 13 12:56:03 GMT 2009


Hi Dr Forrest,

I read your e-mail with great interest - I work for an Ambulance Trust in 
the UK and am both a paramedic and a clinical operations manager. For those 
of you who are not aware of the system used in the UK, Ambulance Trusts use 
a set of guidelines agreed by the Joint Royal Colleges Ambulance Liaison 
Committee (JRCALC) as a basis for assessment, treatment and drug protocols. 
Medical Directors have the right to decide whether a Trust will use 
individual guidelines or not and so there is some variance throughout the UK 
as to specific treatment and/or drug regimes.

The JRCALC guidelines on cardiac arrest; it's recognition, treatment and 
cessation of resuscitation is derived from the Resuscitation Council (UK) 
guidelines of 2005. The Resus Council specifically mention lay persons and 
health care professionals with a duty to respond and many of the 'new' 
protocols have been designed to aid the lay person. If one reads the full 
protocol (not just the flow charts) there is information that is more 
specific to health care professionals and much of this information is 
missing from JRCALC.

In JRCALC there is no definition as to what is meant by 'abnormal breathing' 
apart from a brief reference to agonal gasps. Supportive breaths are covered 
in the dyspnoea section.  Although the update analysis states that the 
circulation check has been removed it states in the BLS guidelines that 'it 
may be difficult to be certain that there is no pulse' which some may take 
to indicate that checking a pulse is expected!

As to the 'unresponsive' patient getting chest compressions - there is a 
comprehensive section dealing with the unconscious patient which all 
ambulance personnel should be following (unless local procedures have been 
put in place by the MD). Likewise there is a section that explains when 
resuscitation should be undertaken and when efforts can cease.

You ask how to resolve the problems that you have noted. There is only one 
answer - education. My understanding is that JRCALC is undergoing a review 
(? due 2011/12) and it is at that level that future decisions will be taken 
as to the direction that pre-hospital care will take and therefore it is at 
that level that representation needs to be made.

Finally lets all remember that, whatever our profession, there will always 
be some that are more pro-active and responsive to change than others. What 
we must ensure, regardless of our individual title or ideology is that our 
actions are designed to ensure the best care for our patients.

Regards,

Gideon Chilton Para

--------------------------------------------------
From: "MARK FORREST" <atacc.doc at btinternet.com>
Sent: Friday, December 11, 2009 10:56 PM
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Subject: Re: blunt traumatic arrest pharmacotherapy

> Hi Ron
> I have been following this with great interest as we have recently been 
> having a real dilemma with a new training manual for UK firefighters and 
> firearms officers. 90% of their work will be trauma related, however they 
> may still attend some cardiac arrests. We have tried to produce a manual 
> and treatment algorithm that brings together trauma and cardiac care into 
> one simple process but whilst this has been fairly straight forward to 
> sell to our trauma care providers and medical Faculty, the UK paramedics 
> that have reviewed the manual just cannot get ALS out of there head and 
> will not accept pulse checks, supportive ventilation for resp rates less 
> than 8 and worst of all, they expect all 'unresponsive' patients or with 
> abnormal breathing to get immediate chest compressions, as thats what BLS 
> says!
>
> We want to ignore this and to reach our guys to assess the casualty 
> further in terms of conscious level, pulses,  CRT etc but the 'cardiac 
> ALS' guys just wont have it and say that this introduces delays and does 
> not fit ERC guidelines.
>
> They also insist that ALS includes trauma!!! God knows why we all do ATLS, 
> ATACC etc if that is the case!!!
>
> How do we resolve this for these guys.....do we just accept CPR in every 
> unresponsive victim??
>
> Regards
> Mark
>
>
> Dr Mark Forrest
> Consultant in Anaesthetics & Critical Care
>
>
>
>
>
>
> ________________________________
> From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
> Sent: Friday, 11 December, 2009 11:30:33
> Subject: RE: blunt traumatic arrest pharmacotherapy
>
> Not me.  Over 8 minutes of CPR with a tube in place and I "treat" with 
> Subxiphoid FAST view and a call to the ME.
>
> Ron
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of caesar ursic
> Sent: Friday, December 11, 2009 12:08 AM
> To: Trauma-List [TRAUMA.ORG]
> Subject: blunt traumatic arrest pharmacotherapy
>
> Who among you treats victims of blunt traumatic cardiac arrest with "ACLS
> protocol" drugs?  I'm referring to the blunt trauma patient brought in to 
> ER
> with closed chest compressions in progress and no palpable pulses with
> wide-complex bradycardia.  Who gives boluses of 
> epinephrine/atropine/sodium
> bicarbonate to these patients?  What is the role for these drugs in the
> treatment of obvious blunt traumatic arrest?
>
> CM Ursic, MD
> g. surg.
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