----- 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
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