Re: Running strips to confirm asystole

December 8, 2004

According to ACLS you should consider " Pacing. " If pacing is good would

skipping be even better?

Just wondering,

Barry M

In a message dated 12/8/2004 7:39:01 PM Central Standard Time,

wegandy1938@... writes:

The portable monitor/defibrillator was developed during my lifetime.

How did anybody ever get pronounced dead in the thousands of years preceeding

this invention? If you listen to the folks who want to run a strip to

confirm death, maybe those folks who died during the Great Plague really aren't

dead. No strip to confirm it.

This is idiocy at its best. Dead is dead, and you don't need a strip to show

it. If your patient is in asystole, then perhaps you ought to work that

patient. According to ACLS, asystole is a workable rhythm.

GG

December 8, 2004

According to ACLS you should consider " Pacing. " If pacing is good would

skipping be even better?

Just wondering,

Barry M

In a message dated 12/8/2004 7:39:01 PM Central Standard Time,

wegandy1938@... writes:

The portable monitor/defibrillator was developed during my lifetime.

How did anybody ever get pronounced dead in the thousands of years preceeding

this invention? If you listen to the folks who want to run a strip to

confirm death, maybe those folks who died during the Great Plague really aren't

dead. No strip to confirm it.

This is idiocy at its best. Dead is dead, and you don't need a strip to show

it. If your patient is in asystole, then perhaps you ought to work that

patient. According to ACLS, asystole is a workable rhythm.

GG

December 8, 2004

The portable monitor/defibrillator was developed during my lifetime.

How did anybody ever get pronounced dead in the thousands of years preceeding

this invention? If you listen to the folks who want to run a strip to confirm

death, maybe those folks who died during the Great Plague really aren't dead.

No strip to confirm it.

This is idiocy at its best. Dead is dead, and you don't need a strip to show

it. If your patient is in asystole, then perhaps you ought to work that

patient. According to ACLS, asystole is a workable rhythm.

GG

December 8, 2004

The portable monitor/defibrillator was developed during my lifetime.

How did anybody ever get pronounced dead in the thousands of years preceeding

this invention? If you listen to the folks who want to run a strip to confirm

death, maybe those folks who died during the Great Plague really aren't dead.

No strip to confirm it.

This is idiocy at its best. Dead is dead, and you don't need a strip to show

it. If your patient is in asystole, then perhaps you ought to work that

patient. According to ACLS, asystole is a workable rhythm.

GG

December 8, 2004

The portable monitor/defibrillator was developed during my lifetime.

How did anybody ever get pronounced dead in the thousands of years preceeding

this invention? If you listen to the folks who want to run a strip to confirm

death, maybe those folks who died during the Great Plague really aren't dead.

No strip to confirm it.

This is idiocy at its best. Dead is dead, and you don't need a strip to show

it. If your patient is in asystole, then perhaps you ought to work that

patient. According to ACLS, asystole is a workable rhythm.

GG

December 8, 2004

Consider skipping. Don't actually skip. You may meander, lolly-gag, or saunter

though...

R

ultrahog2001@... wrote:

According to ACLS you should consider " Pacing. " If pacing is good would

skipping be even better?

Just wondering,

Barry M

In a message dated 12/8/2004 7:39:01 PM Central Standard Time,

wegandy1938@... writes:

The portable monitor/defibrillator was developed during my lifetime.

How did anybody ever get pronounced dead in the thousands of years preceeding

this invention? If you listen to the folks who want to run a strip to

confirm death, maybe those folks who died during the Great Plague really aren't

dead. No strip to confirm it.

This is idiocy at its best. Dead is dead, and you don't need a strip to show

it. If your patient is in asystole, then perhaps you ought to work that

patient. According to ACLS, asystole is a workable rhythm.

GG

December 8, 2004

Consider skipping. Don't actually skip. You may meander, lolly-gag, or saunter

though...

R

ultrahog2001@... wrote:

According to ACLS you should consider " Pacing. " If pacing is good would

skipping be even better?

Just wondering,

Barry M

In a message dated 12/8/2004 7:39:01 PM Central Standard Time,

wegandy1938@... writes:

The portable monitor/defibrillator was developed during my lifetime.

How did anybody ever get pronounced dead in the thousands of years preceeding

this invention? If you listen to the folks who want to run a strip to

confirm death, maybe those folks who died during the Great Plague really aren't

dead. No strip to confirm it.

This is idiocy at its best. Dead is dead, and you don't need a strip to show

it. If your patient is in asystole, then perhaps you ought to work that

patient. According to ACLS, asystole is a workable rhythm.

GG

December 8, 2004

Consider skipping. Don't actually skip. You may meander, lolly-gag, or saunter

though...

R

ultrahog2001@... wrote:

According to ACLS you should consider " Pacing. " If pacing is good would

skipping be even better?

Just wondering,

Barry M

In a message dated 12/8/2004 7:39:01 PM Central Standard Time,

wegandy1938@... writes:

The portable monitor/defibrillator was developed during my lifetime.

How did anybody ever get pronounced dead in the thousands of years preceeding

this invention? If you listen to the folks who want to run a strip to

confirm death, maybe those folks who died during the Great Plague really aren't

dead. No strip to confirm it.

This is idiocy at its best. Dead is dead, and you don't need a strip to show

it. If your patient is in asystole, then perhaps you ought to work that

patient. According to ACLS, asystole is a workable rhythm.

GG

December 8, 2004

>> How did anybody ever get pronounced dead in the thousands of years

preceeding this invention (ECG monitor)?...Dead is dead, and you

don't need a strip to show it. <<

Before Gene was born, there were many documented cases of patients

who were " dead " but somehow became alive again before, during, or

after burial. Perhaps " dead " is sometimes " almost dead. "

>> If your patient is in asystole, then perhaps you ought to work

that patient. According to ACLS, asystole is a workable rhythm. <<

Gene, I hate to argue with you (wait...No I don't), but the AHA does

NOT consider asystole to be a workable rhythm.

The major learning points for the asystole case (page 111 of the

current ACLS Provider Manual) states you should be able to " recognize

that asystole usually represents a confirmation of death rather than

a rhythm to be treated. "

The asystole algorithm itself states (at the bottom of box 1 - page

112) that care providers should evaluate for " evidence that personnel

should not attempt resuscitation. "

For the record, I DO support the concept of not applying the ECG

monitor to patients with obvious signs of irreversible death. But,

keep it real my brother.

Love,

Kenny Navarro

December 8, 2004

>> How did anybody ever get pronounced dead in the thousands of years

preceeding this invention (ECG monitor)?...Dead is dead, and you

don't need a strip to show it. <<

Before Gene was born, there were many documented cases of patients

who were " dead " but somehow became alive again before, during, or

after burial. Perhaps " dead " is sometimes " almost dead. "

>> If your patient is in asystole, then perhaps you ought to work

that patient. According to ACLS, asystole is a workable rhythm. <<

Gene, I hate to argue with you (wait...No I don't), but the AHA does

NOT consider asystole to be a workable rhythm.

The major learning points for the asystole case (page 111 of the

current ACLS Provider Manual) states you should be able to " recognize

that asystole usually represents a confirmation of death rather than

a rhythm to be treated. "

The asystole algorithm itself states (at the bottom of box 1 - page

112) that care providers should evaluate for " evidence that personnel

should not attempt resuscitation. "

For the record, I DO support the concept of not applying the ECG

monitor to patients with obvious signs of irreversible death. But,

keep it real my brother.

Love,

Kenny Navarro

December 8, 2004

>> How did anybody ever get pronounced dead in the thousands of years

preceeding this invention (ECG monitor)?...Dead is dead, and you

don't need a strip to show it. <<

Before Gene was born, there were many documented cases of patients

who were " dead " but somehow became alive again before, during, or

after burial. Perhaps " dead " is sometimes " almost dead. "

>> If your patient is in asystole, then perhaps you ought to work

that patient. According to ACLS, asystole is a workable rhythm. <<

Gene, I hate to argue with you (wait...No I don't), but the AHA does

NOT consider asystole to be a workable rhythm.

The major learning points for the asystole case (page 111 of the

current ACLS Provider Manual) states you should be able to " recognize

that asystole usually represents a confirmation of death rather than

a rhythm to be treated. "

The asystole algorithm itself states (at the bottom of box 1 - page

112) that care providers should evaluate for " evidence that personnel

should not attempt resuscitation. "

For the record, I DO support the concept of not applying the ECG

monitor to patients with obvious signs of irreversible death. But,

keep it real my brother.

Love,

Kenny Navarro

December 9, 2004

The saying saved by the bell comes from England where they would bury people

thought to be dead. A thin rope was provided attached to a bell. If the

person cam eback they would ring the bell.

Re: Running strips to confirm asystole

>

> >> How did anybody ever get pronounced dead in the thousands of years

> preceeding this invention (ECG monitor)?...Dead is dead, and you

> don't need a strip to show it. <<

>

> Before Gene was born, there were many documented cases of patients

> who were " dead " but somehow became alive again before, during, or

> after burial. Perhaps " dead " is sometimes " almost dead. "

>

> >> If your patient is in asystole, then perhaps you ought to work

> that patient. According to ACLS, asystole is a workable rhythm. <<

>

> Gene, I hate to argue with you (wait...No I don't), but the AHA does

> NOT consider asystole to be a workable rhythm.

>

> The major learning points for the asystole case (page 111 of the

> current ACLS Provider Manual) states you should be able to " recognize

> that asystole usually represents a confirmation of death rather than

> a rhythm to be treated. "

>

> The asystole algorithm itself states (at the bottom of box 1 - page

> 112) that care providers should evaluate for " evidence that personnel

> should not attempt resuscitation. "

>

> For the record, I DO support the concept of not applying the ECG

> monitor to patients with obvious signs of irreversible death. But,

> keep it real my brother.

>

> Love,

> Kenny Navarro

>

December 9, 2004

How will this help?

Randell Pitts

<agfltmedic@yahoo

.com> To

12/08/2004 09:32 cc

PM

Subject

Re: Re: Running

Please respond to strips to confirm asystole

@yahoog

roups.com

Consider skipping. Don't actually skip. You may meander, lolly-gag, or

saunter though...

R

ultrahog2001@... wrote:

According to ACLS you should consider " Pacing. " If pacing is good would

skipping be even better?

Just wondering,

Barry M

In a message dated 12/8/2004 7:39:01 PM Central Standard Time,

wegandy1938@... writes:

The portable monitor/defibrillator was developed during my lifetime.

How did anybody ever get pronounced dead in the thousands of years

preceeding

this invention? If you listen to the folks who want to run a strip to

confirm death, maybe those folks who died during the Great Plague really

aren't

dead. No strip to confirm it.

This is idiocy at its best. Dead is dead, and you don't need a strip to

show

it. If your patient is in asystole, then perhaps you ought to work that

patient. According to ACLS, asystole is a workable rhythm.

GG

December 9, 2004

Actually, the term is " dead ringer. "

>>> ewalsh@... 12/9/2004 7:18:06 AM >>>

The saying saved by the bell comes from England where they would bury

people

thought to be dead. A thin rope was provided attached to a bell. If

the

person cam eback they would ring the bell.

Re: Running strips to confirm asystole

>

> >> How did anybody ever get pronounced dead in the thousands of

years

> preceeding this invention (ECG monitor)?...Dead is dead, and you

> don't need a strip to show it. <<

>

> Before Gene was born, there were many documented cases of patients

> who were " dead " but somehow became alive again before, during, or

> after burial. Perhaps " dead " is sometimes " almost dead. "

>

> >> If your patient is in asystole, then perhaps you ought to work

> that patient. According to ACLS, asystole is a workable rhythm. <<

>

> Gene, I hate to argue with you (wait...No I don't), but the AHA does

> NOT consider asystole to be a workable rhythm.

>

> The major learning points for the asystole case (page 111 of the

> current ACLS Provider Manual) states you should be able to

" recognize

> that asystole usually represents a confirmation of death rather than

> a rhythm to be treated. "

>

> The asystole algorithm itself states (at the bottom of box 1 - page

> 112) that care providers should evaluate for " evidence that

personnel

> should not attempt resuscitation. "

>

> For the record, I DO support the concept of not applying the ECG

> monitor to patients with obvious signs of irreversible death. But,

> keep it real my brother.

>

> Love,

> Kenny Navarro

>

December 9, 2004

Ding! Ding! Ding!

Lonnie

Re: Re: Running strips to confirm asystole

Sooooo, putting the ECG on the obviously dead patient is in essence

checking to see if they will ring the bell and come back???? LOL

Jane

--------- Re: Running strips to confirm asystole

>

> >> How did anybody ever get pronounced dead in the thousands of years

> preceeding this invention (ECG monitor)?...Dead is dead, and you

> don't need a strip to show it. <<

>

> Before Gene was born, there were many documented cases of patients

> who were " dead " but somehow became alive again before, during, or

> after burial. Perhaps " dead " is sometimes " almost dead. "

>

> >> If your patient is in asystole, then perhaps you ought to work

> that patient. According to ACLS, asystole is a workable rhythm. <<

>

> Gene, I hate to argue with you (wait...No I don't), but the AHA does

> NOT consider asystole to be a workable rhythm.

>

> The major learning points for the asystole case (page 111 of the

> current ACLS Provider Manual) states you should be able to " recognize

> that asystole usually represents a confirmation of death rather than

> a rhythm to be treated. "

>

> The asystole algorithm itself states (at the bottom of box 1 - page

> 112) that care providers should evaluate for " evidence that personnel

> should not attempt resuscitation. "

>

> For the record, I DO support the concept of not applying the ECG

> monitor to patients with obvious signs of irreversible death. But,

> keep it real my brother.

>

> Love,

> Kenny Navarro

>

December 9, 2004

Ding! Ding! Ding!

Lonnie

Re: Re: Running strips to confirm asystole

Sooooo, putting the ECG on the obviously dead patient is in essence

checking to see if they will ring the bell and come back???? LOL

Jane

--------- Re: Running strips to confirm asystole

>

> >> How did anybody ever get pronounced dead in the thousands of years

> preceeding this invention (ECG monitor)?...Dead is dead, and you

> don't need a strip to show it. <<

>

> Before Gene was born, there were many documented cases of patients

> who were " dead " but somehow became alive again before, during, or

> after burial. Perhaps " dead " is sometimes " almost dead. "

>

> >> If your patient is in asystole, then perhaps you ought to work

> that patient. According to ACLS, asystole is a workable rhythm. <<

>

> Gene, I hate to argue with you (wait...No I don't), but the AHA does

> NOT consider asystole to be a workable rhythm.

>

> The major learning points for the asystole case (page 111 of the

> current ACLS Provider Manual) states you should be able to " recognize

> that asystole usually represents a confirmation of death rather than

> a rhythm to be treated. "

>

> The asystole algorithm itself states (at the bottom of box 1 - page

> 112) that care providers should evaluate for " evidence that personnel

> should not attempt resuscitation. "

>

> For the record, I DO support the concept of not applying the ECG

> monitor to patients with obvious signs of irreversible death. But,

> keep it real my brother.

>

> Love,

> Kenny Navarro

>

December 9, 2004

Ding! Ding! Ding!

Lonnie

Re: Re: Running strips to confirm asystole

Sooooo, putting the ECG on the obviously dead patient is in essence

checking to see if they will ring the bell and come back???? LOL

Jane

--------- Re: Running strips to confirm asystole

>

> >> How did anybody ever get pronounced dead in the thousands of years

> preceeding this invention (ECG monitor)?...Dead is dead, and you

> don't need a strip to show it. <<

>

> Before Gene was born, there were many documented cases of patients

> who were " dead " but somehow became alive again before, during, or

> after burial. Perhaps " dead " is sometimes " almost dead. "

>

> >> If your patient is in asystole, then perhaps you ought to work

> that patient. According to ACLS, asystole is a workable rhythm. <<

>

> Gene, I hate to argue with you (wait...No I don't), but the AHA does

> NOT consider asystole to be a workable rhythm.

>

> The major learning points for the asystole case (page 111 of the

> current ACLS Provider Manual) states you should be able to " recognize

> that asystole usually represents a confirmation of death rather than

> a rhythm to be treated. "

>

> The asystole algorithm itself states (at the bottom of box 1 - page

> 112) that care providers should evaluate for " evidence that personnel

> should not attempt resuscitation. "

>

> For the record, I DO support the concept of not applying the ECG

> monitor to patients with obvious signs of irreversible death. But,

> keep it real my brother.

>

> Love,

> Kenny Navarro

>

December 9, 2004

I contribute the following nursing home scenarios:

Scenario I:

On the way back from a call, while still 20 miles out of town, we get a

dispatch to the local nursing home for a cardiac arrest. We crank it up and

run

Code 3 to the NH. On arrival, we are shown to the room of a patient who is

sitting up in bed and obviously not dead. She talks to us and answers

questions appropriately. So I say, " What happened? " She tells me that she

was

eating breakfast when she felt a little faint and possibly passed out. The

I asked the nurse what happened. She replied, " She had a little cardiac

arrest while they were feeding her breakfast. They gave her some orange juice,

and she recovered. "

I have asked our medical director to add orange juice to our protocols for

cardiac arrest.

Scenario II:

We are called to the NH for a patient who fell. On arrival we find an 86

year old female sitting in a chair, obviously dead. We declined to run a

strip, since she was cold and exhibiting the classic signs of death that have

been

observed for thousands of years. I suppose that we screwed up by not running

a strip. She may be alive and trying to escape from her casket.

Scenario III:

We arrive to find a patient who fell, but she is now lying in bed. We ask,

" How did she get in bed? " Answer: " Well, we picked her up and put her

in bed. " I note that she's in considerable pain and her right leg is

shortened and laterally rotated. It is entirely possible that she has a

femoral fx,

commonly called a " hip fracture. " I ask, how long did she lie on the floor

before you found her? Answer: Well, she was seen 4 hours before, but we

don't know exactly when she fell. I restrain myself. Just take care or your

patient, I remind myself. Don't make waves.

Patient tells me enroute to the hospital that she thinks she laid there for

at least 6 hours. She exhibits no signs of impaired mental capacity. She

relates everything that happened.

Why do EMS people hate nursing homes and those who work there? Guess.

GG

>

> I thought a " dead ringer " was a nursing home patient who pressed the nurse

> call system 742 times asking for a second nitro. The first clinical finding

> the nurses noted in their assessment was dependant lividity. They then had a

> 10-minute meeting as to whether to call the doctor. Then, they got

> permission from the doctor to call the ambulance. A fairly standard chain

> of events in my career.

>

> E. Bledsoe, DO, FACEP

> Midlothian, TX

> http://www.bryanbledsoe.com

>

> Re: Re: Running strips to confirm asystole

>

> Actually, the term is " dead ringer. "

>

> >>> ewalsh@... 12/9/2004 7:18:06 AM >>>

>

> The saying saved by the bell comes from England where they would bury people

> thought to be dead. A thin rope was provided attached to a bell. If the

> person cam eback they would ring the bell.

>

> Re: Running strips to confirm asystole

>

> >

> > >> How did anybody ever get pronounced dead in the thousands of

> years

> > preceeding this invention (ECG monitor)?...Dead is dead, and you

> > don't need a strip to show it. <<

> >

> > Before Gene was born, there were many documented cases of patients

> > who were " dead " but somehow became alive again before, during, or

> > after burial. Perhaps " dead " is sometimes " almost dead. "

> >

> > >> If your patient is in asystole, then perhaps you ought to work

> > that patient. According to ACLS, asystole is a workable rhythm. <<

> >

> > Gene, I hate to argue with you (wait...No I don't), but the AHA does

> > NOT consider asystole to be a workable rhythm.

> >

> > The major learning points for the asystole case (page 111 of the

> > current ACLS Provider Manual) states you should be able to

> " recognize

> > that asystole usually represents a confirmation of death rather than

> > a rhythm to be treated. "

> >

> > The asystole algorithm itself states (at the bottom of box 1 - page

> > 112) that care providers should evaluate for " evidence that

> personnel

> > should not attempt resuscitation. "

> >

> > For the record, I DO support the concept of not applying the ECG

> > monitor to patients with obvious signs of irreversible death. But,

> > keep it real my brother.

> >

> > Love,

> > Kenny Navarro

> >

December 9, 2004

I contribute the following nursing home scenarios:

Scenario I:

On the way back from a call, while still 20 miles out of town, we get a

dispatch to the local nursing home for a cardiac arrest. We crank it up and

run

Code 3 to the NH. On arrival, we are shown to the room of a patient who is

sitting up in bed and obviously not dead. She talks to us and answers

questions appropriately. So I say, " What happened? " She tells me that she

was

eating breakfast when she felt a little faint and possibly passed out. The

I asked the nurse what happened. She replied, " She had a little cardiac

arrest while they were feeding her breakfast. They gave her some orange juice,

and she recovered. "

I have asked our medical director to add orange juice to our protocols for

cardiac arrest.

Scenario II:

We are called to the NH for a patient who fell. On arrival we find an 86

year old female sitting in a chair, obviously dead. We declined to run a

strip, since she was cold and exhibiting the classic signs of death that have

been

observed for thousands of years. I suppose that we screwed up by not running

a strip. She may be alive and trying to escape from her casket.

Scenario III:

We arrive to find a patient who fell, but she is now lying in bed. We ask,

" How did she get in bed? " Answer: " Well, we picked her up and put her

in bed. " I note that she's in considerable pain and her right leg is

shortened and laterally rotated. It is entirely possible that she has a

femoral fx,

commonly called a " hip fracture. " I ask, how long did she lie on the floor

before you found her? Answer: Well, she was seen 4 hours before, but we

don't know exactly when she fell. I restrain myself. Just take care or your

patient, I remind myself. Don't make waves.

Patient tells me enroute to the hospital that she thinks she laid there for

at least 6 hours. She exhibits no signs of impaired mental capacity. She

relates everything that happened.

Why do EMS people hate nursing homes and those who work there? Guess.

GG

>

> I thought a " dead ringer " was a nursing home patient who pressed the nurse

> call system 742 times asking for a second nitro. The first clinical finding

> the nurses noted in their assessment was dependant lividity. They then had a

> 10-minute meeting as to whether to call the doctor. Then, they got

> permission from the doctor to call the ambulance. A fairly standard chain

> of events in my career.

>

> E. Bledsoe, DO, FACEP

> Midlothian, TX

> http://www.bryanbledsoe.com

>

> Re: Re: Running strips to confirm asystole

>

> Actually, the term is " dead ringer. "

>

> >>> ewalsh@... 12/9/2004 7:18:06 AM >>>

>

> The saying saved by the bell comes from England where they would bury people

> thought to be dead. A thin rope was provided attached to a bell. If the

> person cam eback they would ring the bell.

>

> Re: Running strips to confirm asystole

>

> >

> > >> How did anybody ever get pronounced dead in the thousands of

> years

> > preceeding this invention (ECG monitor)?...Dead is dead, and you

> > don't need a strip to show it. <<

> >

> > Before Gene was born, there were many documented cases of patients

> > who were " dead " but somehow became alive again before, during, or

> > after burial. Perhaps " dead " is sometimes " almost dead. "

> >

> > >> If your patient is in asystole, then perhaps you ought to work

> > that patient. According to ACLS, asystole is a workable rhythm. <<

> >

> > Gene, I hate to argue with you (wait...No I don't), but the AHA does

> > NOT consider asystole to be a workable rhythm.

> >

> > The major learning points for the asystole case (page 111 of the

> > current ACLS Provider Manual) states you should be able to

> " recognize

> > that asystole usually represents a confirmation of death rather than

> > a rhythm to be treated. "

> >

> > The asystole algorithm itself states (at the bottom of box 1 - page

> > 112) that care providers should evaluate for " evidence that

> personnel

> > should not attempt resuscitation. "

> >

> > For the record, I DO support the concept of not applying the ECG

> > monitor to patients with obvious signs of irreversible death. But,

> > keep it real my brother.

> >

> > Love,

> > Kenny Navarro

> >

December 10, 2004

We've all heard just about everything regarding NH staff but Gene - the

orange juice story goes to the top of the list. There's another

classroom story for sure. But...on the other hand - maybe these folks

know something we don't know and we're just trying complicate things

through all of our " ACLS " . Maybe it's be far more simple than we think!

Orange juice IS very healthy.

Another " monitor to confirm death " story I witnessed from a dispatch

desk view years ago was a crew in Denton County (old Westgate Hospital

EMS days) and we listened as they begged for police assistance after a

near-riotous crowd were threatening them. They had placed the paddles on

a young man's chest who had been killed outright in a car-MC accident.

When asked by family members if he was going to be okay (the rural road

area he was killed on was all residents who were the young man's

relatives) and the crew naturally advised them that he was dead - they

immediately accused them of killing him with " that machine " . They had to

scramble to their truck fearing for their lives and the sounds of an

angry crowd were heard in the background of the radio transmission.

Fortunately for them DPS was nearby. We could see the fear in the eyes

later when they returned to the hospital. The anger stage of grieving

can be very extreme.

Don Elbert

Tyler

PS. The terms " dead ringer " and " saved by the bell " are both original

(supposedly) to the same source.

>>> wegandy1938@... 12/10/2004 3:07:53 AM >>>

I contribute the following nursing home scenarios:

Scenario I:

On the way back from a call, while still 20 miles out of town, we get a

dispatch to the local nursing home for a cardiac arrest. We crank it

up and run

Code 3 to the NH. On arrival, we are shown to the room of a patient

who is

sitting up in bed and obviously not dead. She talks to us and answers

questions appropriately. So I say, " What happened? " She tells me

that she was

eating breakfast when she felt a little faint and possibly passed out.

The next

thing she remembers is us showing up.

I asked the nurse what happened. She replied, " She had a little

cardiac

arrest while they were feeding her breakfast. They gave her some

orange juice,

and she recovered. "

I have asked our medical director to add orange juice to our protocols

for

cardiac arrest.

Scenario II:

We are called to the NH for a patient who fell. On arrival we find an

86

year old female sitting in a chair, obviously dead. We declined to

run a

strip, since she was cold and exhibiting the classic signs of death

that have been

observed for thousands of years. I suppose that we screwed up by not

running

a strip. She may be alive and trying to escape from her casket.

Scenario III:

We arrive to find a patient who fell, but she is now lying in bed. We

ask,

" How did she get in bed? " Answer: " Well, we picked her up and

put her

in bed. " I note that she's in considerable pain and her right leg is

shortened and laterally rotated. It is entirely possible that she has

a femoral fx,

commonly called a " hip fracture. " I ask, how long did she lie on the

floor

before you found her? Answer: Well, she was seen 4 hours before,

but we

don't know exactly when she fell. I restrain myself. Just take care

or your

patient, I remind myself. Don't make waves.

Patient tells me enroute to the hospital that she thinks she laid there

for

at least 6 hours. She exhibits no signs of impaired mental capacity.

She

relates everything that happened.

Why do EMS people hate nursing homes and those who work there?

Guess.

GG

>

> I thought a " dead ringer " was a nursing home patient who pressed the

nurse

> call system 742 times asking for a second nitro. The first clinical

finding

> the nurses noted in their assessment was dependant lividity. They

then had a

> 10-minute meeting as to whether to call the doctor. Then, they got

> permission from the doctor to call the ambulance. A fairly standard

chain

> of events in my career.

>

> E. Bledsoe, DO, FACEP

> Midlothian, TX

> http://www.bryanbledsoe.com

>

> Re: Re: Running strips to confirm asystole

>

> Actually, the term is " dead ringer. "

>

> >>> ewalsh@... 12/9/2004 7:18:06 AM >>>

>

> The saying saved by the bell comes from England where they would bury

people

> thought to be dead. A thin rope was provided attached to a bell. If

the

> person cam eback they would ring the bell.

>

> Re: Running strips to confirm asystole

>

> >

> > >> How did anybody ever get pronounced dead in the thousands of

> years

> > preceeding this invention (ECG monitor)?...Dead is dead, and you

> > don't need a strip to show it. <<

> >

> > Before Gene was born, there were many documented cases of patients

> > who were " dead " but somehow became alive again before, during, or

> > after burial. Perhaps " dead " is sometimes " almost dead. "

> >

> > >> If your patient is in asystole, then perhaps you ought to work

> > that patient. According to ACLS, asystole is a workable rhythm.

<<

> >

> > Gene, I hate to argue with you (wait...No I don't), but the AHA

does

> > NOT consider asystole to be a workable rhythm.

> >

> > The major learning points for the asystole case (page 111 of the

> > current ACLS Provider Manual) states you should be able to

> " recognize

> > that asystole usually represents a confirmation of death rather

than

> > a rhythm to be treated. "

> >

> > The asystole algorithm itself states (at the bottom of box 1 -

page

> > 112) that care providers should evaluate for " evidence that

> personnel

> > should not attempt resuscitation. "

> >

> > For the record, I DO support the concept of not applying the ECG

> > monitor to patients with obvious signs of irreversible death.

But,

> > keep it real my brother.

> >

> > Love,

> > Kenny Navarro

> >

December 10, 2004