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Sun Dec 18 10:57:46 GMT 2011

Thanks for reply, Stephen
I feel the same, but will have  a hard time justifying that when I have a
clinical review (which I WILL have - just a matter of time).

jenny 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Stephen Richey
Sent: Sunday, 18 December 2011 9:54 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: case for comment please

Honestly, I would not have even done as much as you did.  He was in an
agonal rhythm when you found him and was pulseless prior to your arrival.
No reason to work him.

On Sun, Dec 18, 2011 at 5:49 AM, Jenny Moncur <jmoncur at netspace.net.au>
wrote:
> 35 yo male motor bike rider around sweeping bend into a large tree at 
> approx. 100 km/hr.
>
> Bystanders arrive approx. five mins later (pt had overtaken one of 
> them a few miles before that travelling at high speed).
>
> No response, no spontaneous movement, 'snoring' type breathing which 
> stopped a few minutes before paramedic arrival.
>
> They did nothing apart from call emergency services.
>
>
>
> O/A of paramedics pt non breathing, no response to verbal or painful 
> stimulus, no pulse at carotid.
>
> Monitor showed agonal cardiac rhythm of 38 but slowing - asystole 
> after approx. 60 seconds.
>
> Pupils fixed, dilated and non-reactive.
>
> Airway clear, no bleeding or bruising evident around face or trunk, no 
> helmet damage (paramedics removed helmet).
>
> Deep purplish colour on face and upper torso, but pallor over abdo and 
> lower chest (like superior vena cava syndrome, if you know what I mean).
>
> Probably massive pelvic disruption just looking at the way his legs 
> were widely spread - I suspect open book #.
>
>
>
> Treatment - IPPV with bag valve mask - no change in rhythm.
>
> Decompressed both sides of chest - no blood or air.
>
> CPR not performed.
>
>
>
> We called it at that stage.
>
> I honestly do not think we could have done anything for this patient 
> that would have led to any meaningful outcome, as there only two of us 
> and patient was down a steep embankment in a very awkward position, 
> weighed approx 150 kg and closest other crews at least 15 mins away.
>
> Closest level 1 trauma centre 40 mins by air, but air support approx. 
> 20 mins away.
>
>
>
> Should we or could we have done anything else?
>
> Would welcome any comments
>
>
>
> Jenny Moncur
>
> IC Paramedic
>
> Victoria
>
>
>
> --
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--
Stephen Richey
Founder and Chief Researcher/Designer
Kolibri Aviation Safety Research
5174-B Winterberry Circle
Indianapolis, IN 46254
317-985-4740

 "I think the best thing, and the only thing in our infinite inadequacy in
making up for the loss of life, is to say something we have been able to say
in a lot of other accidents to grieving families.  That is 'Those deaths
will not be in vain. We will not let them be in vain. Every one of those
lives will be made to count in terms of making sure that three, four, five
or ten other people do not
die."- John J. Nance
--
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case for comment please