16 y/o mvc

[Medic Tim]

Taking any chest trauma and the buggy landing on the pt I would still call it. Asystole after being ejected from an mvc with a basal skull fracture and rigor setting in. Pretty clear cut that this pt is dead and there is nothing we or anyone else can do.

 

[Akulahawk]

Where did you see high rate of speed? If you have this in your report and the officer has "unknown speed" in his report as it says in the original post and it went to court you would get f'ing hammered on the stand.

Personally I wouldn't write "high rate of speed" but I would likely write something to the effect of "patient was ejected from, and rolled on top of by dune buggy. Patient and dune buggy were found in a ditch. PD stated they found patient face down in the ditch, rolled the patient over and did not find a pulse, started CPR. (If known) Down time is xx minutes prior to PD arrival, and xx minute prior to our arrival on scene."

Somehow, I doubt documenting that particular call like that would probably not get me hammered in court. Why? That would be because I am specifically highlighting the very reasons why I had determined death in the field.

 

[Darwin]

Misread the OP and I highly doubt I would get "f'ing hammered" if for some reason this call went to court.

Yes you would...

First off it would put your credibility into question and bring doubt to anything else you testify to or that you have in the report.

And if you made a determination to withhold treatment based on an MOI that included a rate of speed that you assumed, and there were other possibilities for survival presented, then yes...hammered.

If you misread the OP, how many times have you misunderstood an on-scene report in the same manner?

 

[chaz90]

Man, I'm trying to resist the urge to pile on here. This has really been covered pretty well by Akulahawk, Aidey, and everyone else who has posted.

Blunt trauma arrests do not survive. Yes, you can carry on and bring up some anecdotal story of a miracle save that you once heard happened when the stars aligned and it was a full moon on the third Thursday of a month. Overall, this is not a salvageable patient. I have nothing against working a code, and I resent the suggestion that determining a patient is not viable represents any kind of laziness. Don't mistake knowledge and pragmatism for ignorance and laziness.

To suggest that this arrest may have been caused by anything else other than the severe blunt trauma is patently absurd. Healthy 16 YOF was out riding dune buggies when she was ejected at high speed and one fell on top of her, and she is now pulseless, apneic, and asystolic. A leads to B, and looking around for some kind of bizarre zebra makes no sense at all.

Working a non viable code because not doing so would mean "not giving it your all" or "taking away whatever chance they have" shows a huge misunderstanding of what has happened here. This patient (body) no longer has a chance. Quite honestly, they would probably be dead from this injury if they were lying in an OR with a team ready when an ATV fell from the sky and produced these same injuries.

 

[DesertMedic66]

Yes you would...

First off it would put your credibility into question and bring doubt to anything else you testify to or that you have in the report.

And if you made a determination to withhold treatment based on an MOI that included a rate of speed that you assumed, and there were other possibilities for survival presented, then yes...hammered.

If you misread the OP, how many times have you misunderstood an on-scene report in the same manner?

I don't make any determinations based solely on MOI as it is an unreliable indicator.

How many times have you accidentally said something? Small mistakes like this happen especially since I am doing multiple things right now and not just focused on typing (when I write ePCRs that is all I'm doing).

Also to add in you might want to drop the personal attacks before this thread gets closed down by a Mod.

 

[ffemt8978]

I'd suggest some people take a few moments, step back from this thread, and take a deep breath before their attitudes get them in trouble here.

 

[Darwin]

Taking any chest trauma and the buggy landing on the pt I would still call it. Asystole after being ejected from an mvc with a basal skull fracture and rigor setting in. Pretty clear cut that this pt is dead and there is nothing we or anyone else can do.

Chest trauma? Where do you see this? I only see it where everyone else is jumping to conclusions.

I will give on the rigor but it didn't start until after treatment was started and noticed it "starting" after attempting to establish an airway. That is the only obvious sign of death but a question for the OP, was it there when you started working this pt?

 

[DesertMedic66]

Chest trauma? Where do you see this? I only see it where everyone else is jumping to conclusions.

I will give on the rigor but it didn't start until after treatment was started and noticed it "starting" after attempting to establish an airway. That is the only obvious sign of death but a question for the OP, was it there when you started working this pt?

As 2 protocols (the 2 that were posted) stated asystole on a blunt trauma arrest is an obvious sign of death.

 

[Akulahawk]

Yes you would...

First off it would put your credibility into question and bring doubt to anything else you testify to or that you have in the report.

And if you made a determination to withhold treatment based on an MOI that included a rate of speed that you assumed, and there were other possibilities for survival presented, then yes...hammered.

If you misread the OP, how many times have you misunderstood an on-scene report in the same manner?

Something that you should remember is that it takes a fairly significant amount of energy to eject someone from a vehicle. Typically that means the vehicle is either going at a fairly significant speed or the vehicle is rolling at a fairly significant rate, which is usually indicative of either a pretty good fall down a ledge of some sort or it required some sort of acceleration like perhaps the vehicle was going at some speed >0 at the time of rollover and subsequent ejection from the vehicle. This is regardless of whether or not the patient was wearing a seatbelt.

As others have indicated, including myself, mechanism of injury is a poor predictor of actual injury, but it is a very good predictor of where to look for it. When you have an ejection from a vehicle, with evidence that the vehicle rolled on top of the patient, no vital signs, significant head trauma and neck trauma, rigor mortis is starting to occur, with asystole on the monitor, that is a pretty good indicator that the patient is well and truly dead. I would further imagine that the cervical area swelling that was observed is simply a large hematoma that occurred subcutaneously and is due to the same mechanisms that caused the massive head trauma with all of the hemorrhage and airway obstruction that occurred with that trauma.

This patient is well and truly dead, and has received injuries that are very much incompatible with life. The patient is dead on scene, should be documented as such, and the body should be turned over to the custody of law enforcement so that they can in turn turn over custody of the body to the corner.

 

[Darwin]

Also to add in you might want to drop the personal attacks before this thread gets closed down by a Mod.

There have been no personal attacks. I explained what would happen in court.

I'd suggest some people take a few moments, step back from this thread, and take a deep breath before their attitudes get them in trouble here.

I personally don't see any rage, name calling, or anything outside of an honest debate here.

 

[Medic Tim]

Chest trauma? Where do you see this? I only see it where everyone else is jumping to conclusions.

I will give on the rigor but it didn't start until after treatment was started and noticed it "starting" after attempting to establish an airway. That is the only obvious sign of death but a question for the OP, was it there when you started working this pt?

You were saying in several posts that the pt being crushed by the buggy was uncertain and we cant base calling the pt because of it.I was just pointing out that it really makes no difference in this case. Pt had injuries incompatible with life.

 

[Mariemt]

Yes you would...

First off it would put your credibility into question and bring doubt to anything else you testify to or that you have in the report.

And if you made a determination to withhold treatment based on an MOI that included a rate of speed that you assumed, and there were other possibilities for survival presented, then yes...hammered.

If you misread the OP, how many times have you misunderstood an on-scene report in the same manner?

Her lungs were full....of what? Blood? No matter what the speed, she had traumatic injuries incompatible with life. Bleeding from the ear, nose, mouth. Swelling posterior and anterior c spine.

Injuries incompatible with life. Throw in the rigor and you are working a dead body. Let the child rest.

 

[Carlos Danger]

Obvious signs of death: can you show me where this is listed in any protocol?

This appears in every EMS arrest protocol I've ever seen.

Are you brand new to EMS?

 

[exodus]

Cause of arrest: you are 100% sure based on the information given? You have no doubt at all that it was not airway compromise?

Obvious signs of death: can you show me where this is listed in any protocol?

I do agree with you about the possibility of consulting with medical direction while still on scene. I would be curious what a doc would say if they recv'd a call with this infomation.

Right here, number 9:

http://www.remsa.us/policy/4203.pdf

Dude, just give it up. You *are* wrong here and are just going in circles.

 

[usalsfyre]

Yes you would...

First off it would put your credibility into question and bring doubt to anything else you testify to or that you have in the report.

Unless you're a lawyer of have been "f'ing hammered" on the stand for similar reasons I wouldn't exactly be so sure.

And if you made a determination to withhold treatment based on an MOI that included a rate of speed that you assumed, and there were other possibilities for survival presented, then yes...hammered.

I don't think most people here are really using MOI as "the" deciding factor. Probably more like that pesky little cardiac arrest in the presence of severe blunt trauma.....

If you misread the OP, how many times have you misunderstood an on-scene report in the same manner?

You seemed to have missed the part about "chest rise and fall" which would tend to eliminate the airway obstruction argument. Pot...meet kettle....

I sincerely hope if God forbid this was my child someone capable of making calm and rational decisions responded, not someone who was was ruled by the emotion of serious injury to a child and more concerned with putting the "care" in healthcare than managing a resuscitation appropriately.

 

[Tigger]

I wasn't being rhetorical. Actually give a pediatric trauma score to this patient. Then go look at the mortality rate based on score. That's actual real science, not anecdotal crap.

 

[Wheel]

Just to make sure this is here, I figured it as this.

Weight: over 20kg +2
Airway: unmaintainable -1
Systolic BP: <50mmhg. -1
CNS: unresponsive -1
Fractures: closed or suspected. +1 (none mentioned, but I expect them)
Wounds: major, blood in airway -1
_____________________________________________________________
-1

This is how I figured it according to the document I found (first result in google search.) I supposed you could fudge it and make the number higher, and I made a couple of assumptions that weren't explicitly mentioned in the OP. The site states that a pts of less than 0 is estimated at a 100% mortality rate.

From here: http://www.thechildren.com/trauma/_pdf/en/assessing-trauma-severity.pdf

 

[Tigger]

That's pretty much what I came up with.

 

[VFlutter]

...

So you work and transport this patient...then what? What do you think they are going to do in the ER? Most trauma surgeons wouldn't even touch the patient and would call it on arrival. They may try to keep them alive long enough to get consent for organs, if that makes you feel any better?

You think they are going to open her chest? In an academic trauma center they might but at that point it is not to save the patient but rather a practice run and anatomy lesson.

 

[exodus]

So you work and transport this patient...then what? What do you think they are going to do in the ER? Most trauma surgeons wouldn't even touch the patient and would call it on arrival. They may try to keep them alive long enough to get consent for organs, if that makes you feel any better?

You think they are going to open her chest? In an academic trauma center they might but at that point it is not to save the patient but rather a practice run and anatomy lesson.

Kinda like here: http://vimeo.com/49527742

They got a patient in with a cut in his femoral artery. Homeboy amberlamps to the ER, by the time he's rolled in, he's DOA asystole, not even any blood left in him. Surgeons start compression, crack his chest, do their cardiac workup with bloods and everything and get stable pulses back. Pt is discharged to a facility for rehab. Not sure HOW mentally disabled he is, but the way it makes it sounds, he's alert.