Honestly, unless it was a witnessed event that lead to being clinically dead (what you described) with a very short response time, odds of resuscitation and a normal outcome are extremely low.
Even patients that have been clinically dead for several minutes and are returned to spontaneous circulation often die soon after in the ICU. Hollywood and egotistical Paramedics will disagree, but that's a statistical fact.
So, to answer your question. In my 10 years of experience, it depended on the situation and system. I was asked by law enforcement to confirm death on an obviously fatal suicide and at a vehicle collision by confirmation of no electrical activity on EKG. The rest of the time, in a rural setting with long response times, we seldom initiated treatment beyond confirming death and contacting medical control.
I successfully resuscitated an elderly woman at a nursing home that had experienced a witnessed cardiopulmonary arrest, response time less than 5 minutes. She had coded due to pulmonary edema and was bradycardic on the monitor with no pulse. I treated the obvious problems and she was awake going out the door. She did well for days later (although never fully regained consciousness) and eventually died in the ICU.
As a student I watched a supposedly legendary Paramedic perform the worst ACLS treatment on a man that had been spotted hanging half way out of his car door, in the snow, for 40 minutes. Mr. Cocky Medic was pleased with his actions until the ER attending chewed him a new one for bringing him an obviously deceased patient, citing the cost that the family will now incur and for wasting his time. Don't be Mr. Cocky Medic.
Quick Check for contra indications to CPR such as Rigor Mortis, Postmortem staining.
If no contra indications quick check airway, C-spine, and then commencement of CPR, secure airway and ventilate continue CPR.
Call for advance life support drugs at earliest convenience.
Attach defib and check if there is a shockable rhythm, if there is then shock.
Check for pulse if there is a sinus rhythm output, if not continue cpr
It used to be ABC(air,breathing,circulation) now it's CAB(circulation,airway,breathing). In other words, begin CPR at a rate of 100 beats per min, or 30:2 (depending on whether you have help or not). If 100 beats, that 10–15 breaths per min. (30:2 means 30 compressions 2 breaths). Next, establish a patent airway either via 'cannulas' or intubation and attach, oxygen at 100% 15l/ bag-valve-mask procedure. As a paramedic, ECG would also determine what course of medications should be administered.. in this case would be 1 of 4 readings PEA, asystole, ventricular tachycardia or ventricular fibrillation or sub reading of one of these. Either way, there is a course of treatment.. and hope for the best but don't take it personal if it doesn't work.
Check for responsiveness. Assuming that I have assessed for indications of a dangerous environment, and found none, treatment (if indicated) will begin there.
A person who is unresponsive, pulseless, and apneic (not breathing) is considered to be dead. Is there a DNR (Do Not Resuscitate) order, a POLST (Physician Orders for Life-Sustaining Treatment), a living will, or some other legal document that indicates how the person wants to be treated in these circumstances? If there is, contact medical command to get permission to pronounce the patient dead, or to cease chest compressions (if the state regulations require EMS to ignore the valid legal document expressing the patient's wishes.
If there is a reason to believe that the person would want to be resuscitated, then resuscitation would begin with continuous chest compressions (add in ventilation, but only add ventilations if there is an indication that the cause of death is respiratory). Connect a defibrillator (automated or manual) to look for a shockable rhythm. The only thing that has been shown to be better than continuous chest compressions is defibrillation, but only when defibrillation is indicated. Then it is a matter of following protocols and contacting medical command as indicated.
If initial assessment shows that the patient is clearly dead, talk with family on scene and see what they want done. If family are not in favor of continuing/initiating resuscitation efforts, contact the patient's doctor to see if there is something that has been missed and whether the doctor is willing to sign a death certificate without further medical examination, contact medical command to get the patient pronounced dead (consistent with the EMS rules of the state), contact the medical examiner to determine if the medical examiner wants the body held for autopsy. Usually, if the patient's doctor is willing to sign the death certificate, the medical examiner will agree to have the family/representative call a funeral home, or make whatever other arrangements for the body.
No comments:
Post a Comment