They have power to make this decision on the basis of knowledge and experience but I'd argue we are using a lot more knowledge and experience out there in the world because we keep going for as long as possible.
http://news.bbc.co.uk/today/hi/today/newsid_9749000/9749017.stm
However, we are pre-hospital and doctors factor in the time we've been working on a patient before calling it.
Good quality CPR over a long period if necessary is in everyone's best interests but there has to be a time limit, so doctors will need to be given guidelines for ending the attempt, just as we are.
Xf
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- I am a Registered Paramedic, with a degree in Paramedic Science. I work for Central London. I have been involved in pre-hospital care at every level (including the army)since 1992. This diary reflects my daily routine in my own words, as accurately and honestly as possible. It does not purport to reflect the views of my employer. I cannot identify patients or locations and may change certain facts in order to protect patient confidentiality and I hope you understand why that needs to be done. Feel free to join my community and keep reading!
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5 comments:
Nice to have you back!
Are there any interventions, kit or treatments that you don't yet have in the pre-hospital setting that would improve outcomes?
Apart from the classic, Early CPR, Early Defib, etc.
Thanks
I note that this Study ONLY relates to 'in Hospital cardiac arrest'. Rebuttable presumption - they already had significant 'health problems.'
The available "Lancet" abstract contains quite a lot of statistics. I wonder if the 'Best :V: Worst' data might be different if the REASON for them being In-Patients was taken into account?
[http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60862-9/abstract]
After 45 minutes of CPR, I start to think about calling it as:
1. its getting less effective
2. if we cant get them into VF or a shockable rythem we are unlikly to get them back
3. we we dont have a lucas CPR device onboard
4. if we are over 45 minutes away from A&E or we are 'staying and playing'
Anyway nice to see you posting :)
Anon
Nothing special apart from experience, those necessary skills, drugs and faith in what you are doing. As has been pointed out, the outcome for these patients is often down to simple reasoning and the potential for a fair quality of life should they survive.
I think that its worth while to point out that CPR during transport is the least effective period doctors and nurse have the pleasure of adequate beds and top kit available on hand they don't have to pull their patient out of a car and work on them. Its also good to point out there is little emphasis on the rhythm that the patient reverts to (if they do )
:)
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