(COVID/ETC CONTENT HERE) China Locks Down 11 Million in Wuhan,

Originally Posted by 26 Inf

From the story:

The Tuesday memo told paramedics to still try and resuscitate cardiac arrest patients as usual, but changed its guidance on what to do if they can't restart the heart at the scene.

If paramedics fail to get a pulse, they should turn the body over to the New York Police Department or its body removal team, the new directive said.

If paramedics on-scene with de-fib equipment and drugs cant get you started, I doubt there is a good chance for survival - kind of agree with Ramairthree on these matters.

We’ve been doing that in the Chicago area for the last three years and Chicago for almost 10 years.


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Originally Posted by flenna

Here we go again. Still in the midst of this pandemic and the crazy ComDems are starting another “Get Trump” committee under guise of “oversight”. Pelosi and her deranged cohorts need to be locked up.

https://www.foxnews.com/politics/pel...subpoena-power

These nutbags don't even know when shit is 100% assuredly going to backfire. Here they go again shooting themselves in the face, ts lunacy at its finest.

PB

Originally Posted by chuckman

Again, not new. Cold? Lividity? Rigor? Asystolic? We'd go on "subject unresponsive" a lot to find DRT (Dead Right There). You don't even start, you just pronounce and move on. Even absent of those, down time + age + significant history, we'd pronounce.

I have to give a cynical laugh here. If the person was an inmate that had these "symptoms" or was cut into 4 separate pieces, we would still have to give life saving techniques until he reached a hospital to be pronounced.

Originally Posted by Pappabear

Why are they not using Prednisolone to treat these patients? Any idea on that? I've not heard anything about that but I have not studied it too terrible much either.

PB

PB

I saw a few articles and guidelines that they are not generally recommended. There is this (https://www.contagionlive.com/news/i...irus-treatment), I will see if I can find the others.

Originally Posted by FromMyColdDeadHand

If you aren’t even going to perform CPR, why even go to the call? Something doesn’t smell right on that one.

I mean dead is dead, we’re not looking to do a Lazarus project here. But to say you’re going To show up and not even attempt CPR sounds a bit odd.

Reading what that guy said, it sounds as if they are triaging in the way that one does for a MCI. If I go to a vehicle incident and two people are ejected, and they are pulseless, I call them dead and work on the rest. Its triage and resource management. If NYC has more pre-hospital patients at any given time than EMS providers, then the same rules are coming into play. I don’t know if its really like that or not.

He sounds like he is expressing concern that they cannot “save” some people that he thinks are viable. Truth is, most aren’t. It is not uncommon for EMT’s and even Paramedics to not understand that, because they think that when they deliver a post cardiac arrest patient to a hospital with a pulse that they’ve gotten a “save”. Its very hard to have the discipline to manage your resources and not try to “save” everyone. Those of us that follow outcomes further than the hospital doors recognize this.

Being pulseless and apneic is super bad for you.


Forgive my poor wording and rambling thoughts. I’m tired and distracted.

Originally Posted by teufelhund1918

I have to give a cynical laugh here. If the person was an inmate that had these "symptoms" or was cut into 4 separate pieces, we would still have to give life saving techniques until he reached a hospital to be pronounced.

If thats my patient, and has injuries incompatible with life or has rigor or lividity, I’m calling him dead and going 10-8. Doesn’t matter who he is. If there’s a rule requiring him to go to the hospital, he’s doing it in a Crown Vic. But, in my area, our coroner goes to jails and prisons, and dead people stay where they are until then.

Originally Posted by teufelhund1918

I have to give a cynical laugh here. If the person was an inmate that had these "symptoms" or was cut into 4 separate pieces, we would still have to give life saving techniques until he reached a hospital to be pronounced.

Same with anyone in the Federal prison in Atlanta.

Nobody dies in the prison, and everyone is transported with iron shackles. Everyone.

Originally Posted by FromMyColdDeadHand

If you aren’t even going to perform CPR, why even go to the call? Something doesn’t smell right on that one.

I mean dead is dead, we’re not looking to do a Lazarus project here. But to say you’re going To show up and not even attempt CPR sounds a bit odd.

I recently left ground EMS and the Agency I worked for had similar standing orders to 1168 and sounds exactly like what chuckman did.

If I arrived and the Pt had obvious signs of death (rigor, dependent lividity, absent pupillary reflexes, incineration, decapitation, or submersion > 2 hours) then we could elect to withhold resuscitation per Medic judgment. There were a few other parameters, but basically dead was dead unless they were extremely hypothermic (think dead homeless in the winter). I only ever transported a person in full rigor once when her grandson came in with a bat and told me I was going to save her. Roger that.

Traumatic arrests had a little more nuance. Blunt force traumatic arrests were not worked unless it either was not safe for the providers, or it was a pediatric Pt. Penetrating trauma required three things; no palpable pulses, absent pupillary reflexes, and no spontaneous movement observed during Pt contact.

I worked nights in Atlanta for 3.5 years. I absolutely withheld resuscitation when it was not clinically appropriate, but if it wasn't safe to do so, I would perform full code CPR...even if someone had their brains ballistically relocated to the front lawn. That was extremely rare and like 99% of my traumatic arrests stayed where they laid. Only exception was the Federal pen- nobody dies in the pen.

The only change we made in light of COVID-19 was the preference to use a supraglottic airway vs intubation on cardiac arrests. Everything else was the same until I left.

Originally Posted by Pappabear

Why are they not using Prednisolone to treat these patients? Any idea on that? I've not heard anything about that but I have not studied it too terrible much either.

PB

PB

It does not appear to help, and may even make things worse, but may be used specific to cytokine storm and related conditions that arise from cytokine storm (1). See latest from The Lancet:

Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury

"Overall, no unique reason exists to expect that patients with 2019-nCoV infection will benefit from corticosteroids, and they might be more likely to be harmed with such treatment. We conclude that corticosteroid treatment should not be used for the treatment of 2019-nCoV-induced lung injury or shock outside of a clinical trial."

https://www.thelancet.com/journals/l...317-2/fulltext

(1) https://www.thelancet.com/journals/l...628-0/fulltext

My non medical thoughts on this topic that suggests a combination approach:

https://brinkzone.com/life-saving-st...complications/

My company has access to PPE, masks and the various meds that seem promising.

If you know government officials that are part of the procurement, shoot me a PM.

I offer this here as a path to get supplies into the correct hands as soon as possible. If you can't put me in direct contact with the government official then don't shoot me a PM.

Brokers and people seeking to make a killing don't PM me. This is to try and ease human suffering and get us back to normal ASAP.

If the powers that be object to this post then feel free to delete it.