Adrian Fogarty wrote:
>
> ----- Original Message -----
> From: "Anton van Dellen"
> Subject: Re: Guidelines
>
> > Dear Adrian,
> >
> > We have found that some patient presenting in asystole do indeed survive
> > - unsurprisingly, an unwitnessed arrest is never a good prognostic
> > indicator. We also tend not to move patients until we have achieved an
> > ROSC - and are moving towards ETCO2 in the field to assist with
> > decisions to terminate resuscitation.
> >
> > Anton
>
> But Anton, while the guidelines might make us think about whether to use
> drug x or drug y, my point is we should be thinking much more laterally
> about this subject i.e. should we be resuscitating many of these patients at
> all? Clearly all of the asystoles I see have been moved from the field
> without achieving ROSC. In which case, I do no more for them in the A&E
> department. If you approach the subject from the "medical" point of view
> (i.e. a small chance you will produce a survivor) then there are no limits
> to whom you will subject to needless "resuscitation".
>
> I see it on a regular basis, old ladies from nursing homes, terminal cancer
> patients, etc. I even saw a registrar the other day refusing to discontinue
> a resus in a cancer patient because there wasn't a DNR order! Can you
> believe it? I tried to explain that terminal cancer patients don't need DNR
> orders, as they're not for resus in the first place, but I don't think I got
> through to her. Clearly this model was so alien to her "resus-all-comers"
> view of the world. Clearly people are not allowed to die anymore; it's
> probably not in keeping with some government target.
>
> AF
Dear Adrian,
Yes, there is a world of difference between someone in asystole on
presentation at the road-side and in A&E after the bast part of 30+
minutes resuscitation.
Quite agree about the need for thinking outside the guidelines - we
recommend to the paramedics that they submit an adverse incident form if
they need to work outside the published guidelines - generally, it is
the guidelines at fault, rather than them!!
Anton
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