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Sun Dec 18 11:01:57 GMT 2011

I would have had a tougher time justifying working him during our
clinical reviews back when I still worked full time in EMS.  I think
Dr. Mattox will probably have a thing or two to say about the futility
of resuscitation in the face of unwitnessed blunt traumatic arrest.

On Sun, Dec 18, 2011 at 5:57 AM, Jenny Moncur <jmoncur at netspace.net.au> wrote:
> 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
>>
>>
>>
>> --
>> trauma-list : TRAUMA.ORG
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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
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/

-- 
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