A complete study material for a good presentation for the subject advance nursing practice in MSc Nursing level. It is presented by Angelina samuel lal.
A detailed presentation on Brain Death and Ongan transplantation.
Criteria for Brain Death are explained in detail. Legislative laws regarding the organ transplant, organ preservation are also explained.
2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdfRobert Cole
(note: This presentation contained videos not included in this slide deck)
Describe the elements of Negligence
Describe the concept of vicarious liability
Describe the role of anchor bias, fatigue, anger and fear in EMS decision making
Review the case of Kyle Vess
Review the case of Paul Tarashuk
Review the case of Crystal Galloway
A complete study material for a good presentation for the subject advance nursing practice in MSc Nursing level. It is presented by Angelina samuel lal.
A detailed presentation on Brain Death and Ongan transplantation.
Criteria for Brain Death are explained in detail. Legislative laws regarding the organ transplant, organ preservation are also explained.
2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdfRobert Cole
(note: This presentation contained videos not included in this slide deck)
Describe the elements of Negligence
Describe the concept of vicarious liability
Describe the role of anchor bias, fatigue, anger and fear in EMS decision making
Review the case of Kyle Vess
Review the case of Paul Tarashuk
Review the case of Crystal Galloway
Introductory/onboarding training for Video Laryngeoscopy, specifically for the MacGrath VL.
NOTE: This is meant to be part of a larger educational endeavor including online, hands on, and team based training.
2018 Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiop...Robert Cole
Bag-mask ventilation (BMV) is a less complex technique than endotracheal
intubation (ETI) for airway management during the advanced cardiac life support phase of
cardiopulmonary resuscitation of patients with out-of-hospital cardiorespiratory arrest.
It has been reported as superior in terms of survival.
1963 COWLEY Clinical Shock: A study of the Biochemical Response in Man.pdfRobert Cole
Accession Number: AD0427998
Title: CLINICAL SHOCK; A STUDY OF THE BIOCHEMICAL RESPONSE TO INJURY IN MAN
Descriptive Note: Annual progress rept. 1 Jan-31 Dec 1963
Corporate Author: MARYLAND UNIV BALTIMORE SCHOOL OF MEDICINE
Personal Author(s): Crowley, R. A.
Report Date: 1963-12-31
Pagination or Media Count: 226.0
Abstract: Traumatic shock is associated usually with severe injury and characterized principally by inability to maintain an adequate circulation. This study focuses on the total problem - the reaction of the body to injury, maintenance of life, and repair of injury. Studies currently in progress and those proposed are aimed primarily to understanding the biochemical response to injury in man. Provisions have been made for careful metabolic studies in the shocked patient without interfering with obvious life saving measures. Such extensive studies have required the assembly of a considerable staff - professional and technical - to support a C.S.U. on a 24-hour basis. Experimental problems relevant to establishment of such a unit evolved from two major factors 1 original nature of the study a scientific study of shock in man and 2 an unprecedented design of this study. Solutions to these problems are described. Since inception of the contract January, 1962, some 200 patients have been studied as they have undergone resuscitation measures. Final organization of the unit now permits more complex studies into the physio-biochemical response to injury in man.
Descriptors: *ENDOTOXIC SHOCK BACTERIA ENZYMES METABOLISM AMMONIA THERAPY HYPOXIA PHYSIOLOGY WOUNDS AND INJURIES IMMUNOLOGY CARDIOVASCULAR SYSTEM HYPOTHERMIA TOXINS AND ANTITOXINS HEMORRHAGE BLOOD COAGULATION
Subject Categories: Stress Physiology
Distribution Statement: APPROVED FOR PUBLIC RELEASE
Proposal to establish a new training center for Multi Agency EMS Training v1....Robert Cole
Vision
The Joint Emergency Medical Services training Center (JEMSTC) is a multi-use campus
and facilities dedicated to the provision of EMS and public safety education in the Ada
County-City Emergency Medical Services System. It would serve as a locus of collaboration and
effort in EMS education, providing not simply classroom space, but a relevant, dynamic,
realistic, and effective learning capacity, ultimately affecting the provision of all EMS services in
a positive way.
The JEMSTC would provide facilities for 24 /7 EMS education, vehicle operation, skills
practice, and credentialing. The facilities would be able to accommodate both EMS and Fire
apparatus in all climates for a diverse array of educational activities. This JEMSTC would meet
all the EMS (and related operational) training for the ACCESS system.
This document from • The Centers for Medicare & Medicaid Services shows that refusing to accept reports or parking EMS patients on the wall may be an EMTALA violation.
Hospitals and administrators do not want line EMS providers to know this, but this is ammo against abuse of EMS systems by ER Staff.
Improving Drug Calculation Performance in Paramedics Practicing in an Emergen...Robert Cole
This literature review will examine the scope of the problem and challenges with mathematical proficiency in out-of-hospital care. It will also explore interventions targeted at improving performance in the out-of-hospital environment, and how they may be applied in initial and continuing education models. The author hopes that improvement in drug calculations will result in fewer medical errors and improved patient care.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
2. Administrative
• In the chat box, Type your First/ Last name and agency # (i.e. Ada #).
• If multiple people are watching the same session from the same
location, include all.
• If On Duty, include your “unit”, of off duty, note “Off Duty”
• This is essential to help us issue CE
• Example:
• Medic 18, Joe Snuffy (611), Beetle Baily (644) and Olive Oil (613)
This Photo by Unknown Author is licensed under CC BY-NC
3. Objectives
• Discuss Lazarus Phenomena in EMS
• Review ACCESS criteria for “Determining Death”
• Review ACCESS criteria for withholding resuscitation
• Review ACESS criteria for Termination of Resuscitation
• What we are saving for another time:
• POST/DNR/Comfort One/Advanced Directives
• Death Notification to survivors
4.
5.
6. “Life is a Fatal
Condition with
a 100% chance
of Mortality”
-Anonymous
This Photo by Unknown Author is licensed under CC BY-SA-NC
14. The Lazarus Phenomena
• The Lazerus Phenomenon are situations where patients show signs of
life after being declared dead by medical professionals.
• Described as “delayed return of spontaneous circulation (ROSC)” or
“Auto-Resuscitation”
• True Lazarus Phenomena is extremely rare. Only 32 confirmed
cases since 1982.
• Almost all modern examples are not cases miracles or freak occurrences, but
the result of failure to properly and fully assess the patient.
• Most modern examples involve EMS, though occasionally physicians do this
as well
• One case in Spain where a prisoner was examined by three doctors,and
woke up in the morgue right before his autopsy, subsequently made a full
recovery. He is suspected to have been cataplectic.
• 99.9% of these patients eventually succumb, but the damage to
public trust is irreversible
15. 1968 - “The Harvard Criteria”
• Normothermic
• Not dead until warm and dead
• In the original document this was > 90 degrees F.
• Currently accepted as greater than 95 degrees F.
• Unreceptivity and unresponsitivity.
• No movements or breathing.
• No reflexes.
• Absent Heart tones or Asystole on the EKG
This Photo by Unknown Author is licensed under CC BY-NC-ND
16. 1981 – White Paper to Congress on the Determination of Death by
the “President's Commission for the Study of
Ethical Problems in Medicine and
Biomedical and Behavioral Research”
17. 1981 - Uniform Determination of
Death Act (UDDA)
• Federal Statute
• Defines “Death” legally and
Clinically
• “Clinical Death” (absence
of heart beat and
respiration)
• Irreversible cessation of
circulatory and
respiratory functions
• “Brain Death”
• Irreversible cessation of
all functions of the
entire brain, including
the brain stem.
This Photo by Unknown Author is licensed under CC BY
18. The goal:
• Not to determine only if there is
an absence of life, but if signs of
life will return…or be coaxed
back.
• This requires more than a
casual doorway assessment or 5
second visual inspection.
19. What do the protocols say?
• Appendix 26: “IN-FIELD DEATH/POST/DNR”
• Section II: OBVIOUS DEATH / NON-SALVAGEABLE PATIENTS
• Important points often overlooked
• “The determination that a patient is DOA rests with the EMS
provider on scene.” It is not enough to rely on the word of
the local Law Enforcement, Family, or Bystander
• “In the case of a MCI, this responsibility lies with the triage
team or officer.”
• The following may be used as a guideline to support the
determination that the patient is DOA:
• Absence of Respiratory Effort (MCI only)
• Injury Incompatible with Life
• Signs of Decomposition
20. A special note about
“Fresh” traumatic arrest…
• T-06: The American College of Surgeons and the National
Association of EMS physicians recommend withholding
resuscitation in situations where death is inevitable or
established and in trauma patients presenting with apnea,
pulselessness and without organized ECG activity (asystole).
• However, neurologically intact survivors initially
presenting in this state have been reported. These are
patients who survived but whom otherwise may have not.
We therefore recommend the following approach:
• Consider withholding resuscitation in traumatic cardiac arrest in
any of the following conditions:
• No signs of life within the preceding 15 min (down time
best estimate) AND asytolic.
• Massive trauma incompatible with survival (e.g.
decapitation, penetrating heart injury, loss of brain tissue).
22. “Injuries Incompatible
with life”
• This is the assessment that most
often results in “Lazarus Syndrome”
• Must document exactly what injuries
are incompatible with life.
• If the injuries are severe, but if the
patient is still breathing, then they are
not “incompatible”
• In 2012, two Australian
Paramedics declared a man dead
with incompatible injuries,
despite documentation agonal
respirations at 4/min.
23. Signs of Decomposition –
Rigor Mortis
• Rigor Mortis: (Latin: rigor "stiffness", and
mortis "of death"),
• Result of exhaustion of ATP and leaking
of Calcium from cells.
• Onset 1-4 hours
• May last 12-36 hours
• Where to assess:
• Small muscle groups
• At least TWO locations- The Jaw and the
hands/wrists
• Nystens Law:
• Rigor onsets in a predictable fashion
from the head to the toes
• Most easily appreciable in the face, jaw,
and neck.
• Then Upper extremities, The torso, then
the lower extremities
• It recedes in the reverse order (toes to
head)
• Pitfalls:
• Seizures “Cataplexy”
• Overdoses
24. Signs of Decomposition – Livor Mortis
• Livor mortis” (Latin: livor – "bluish color", mortis – "of death")
• “Lividity”
By goga312 at Russian Wikipedia, CC BY-SA 3.0,
https://commons.wikimedia.org/w/index.php?curid=9749090
25. Signs of Decomposition –
Algor Mortis
• Not mentioned in protocol but very helpful to note
• Algor mortis: (Latin: algor—coldness; mortis—of death),
• Is the change in body temperature postmortem, until the
ambient/environmental temperature is matched.
• Time
• Initially , body temp may rise
• Slow for first 1-3 hours, then accelerates. Should reach
ambient in 24 hours.
• Where to assess:
• Torso
• Back
• Mouth
• Pitfalls
• Make sure to note type of environment in
• Cold Environments
• Heating Blankets
• Obesity
• Clothing/Coverings
This Photo by Unknown Author is licensed under CC BY-SA
26. Other Signs not
mentioned in protocol
• Putrification
Breakdown of tissue
into proteins and
loss of cohesiveness
• Pallor Mortis (almost
immediate onset)
27. Other useful assessments? 1-
minute rule
• Observe and document any respiratory
effort for 1 minute
• Feel and document an absent radial and
carotid pulse for 1 full minute
• Auscultate and document an absent Apical
Pulse for 1 full minute
• IF an EKG is applied, observe and
document asystole for 1 full minute
28. Listening for an
apical pulse
• To listen for an apical pulse, listen over the
left ventricle. This is usually at the 4th/5th IC
space, in between the left sternal margin
and the mid clavicular line .
29. Do you need an EKG?
Trauma Codes:
“Consider withholding resuscitation in
traumatic cardiac arrest in any of the following
conditions:
• No signs of life within the preceding 15 min
(down time best estimate) AND asytolic.
• Massive trauma incompatible with survival
(e.g. decapitation, penetrating heart injury,
loss of brain tissue). “
This Photo by Unknown Author is licensed under CC BY-NC-ND
30. Whenever resuscitative measures (CPR) are instituted, they should be continued
until arrival at a hospital, until directed by a physician to stop the resuscitation,
or other circumstances dictate, unless the above criteria apply
31. Street tip:
Exam
Respectfully
• Avoid sternal Rubs or “nipple
Pinches”
• Useful for the living, disrespectful
and misconstrued in the dead
• If you expose the patient, cover
them up again.
• Be careful what you say and how
you appear, you may be observed
(and recorded) by family or
neighbors
This Photo by Unknown Author is licensed under CC BY-SA
33. What do the protocols say?
• Appendix 26: “IN-FIELD DEATH/POST/DNR”
• Section V. PATIENTS WHO ARE REFRACTORY TO FIELD
INTERVENTIONS
• Important points often overlooked
• “After extensive ALS interventions without improvement, the
likelihood of survival is minimal or non-existent..”
• Examples include:
• Patients who have been without any vital signs for at least 20
minutes (confirmed) with ongoing ALS interventions.
OR
• Patients who are in Asystole (confirmed in two leads) for at least
10 minutes and have received appropriate ALS intervention.
OR
• Any other unforeseen circumstances where the likelihood of
survival is minimal or non-existent and aggressive ALS measures
have been attempted.
In this case the paramedic should contact medical control for
permission to stop resuscitation efforts. Document thoroughly.
34. What do the protocols say?
• Protocol C-01
• “Outside of the POST/Comfort One/DNR
situations (see Appendix 26), once ALS
intervention is initiated; Medical Control
should be called prior to ceasing efforts. In
addition, BLS interventions, an advanced
airway, and at least 20 minutes of rhythm-
appropriate therapy should have been
performed prior to considering termination
of efforts. “
35. When should we go
beyond 20 minutes?
• Paramedic discretion. Common
considerations:
• Persistent shockable rhythm
• Good ETCO2
• Quality of CPR performed
• Age < 65
• Quality of life considerations
• Family/Patient’s wishes
• Special Circumstances (i.e.
Hypothermia)
This Photo by Unknown Author is licensed under CC BY-SA-NC
36. Quality of Life?
• “Healthcare professionals generally agree that a person’s quality of
life is at least as important as his mere ability to sustain a pulse”
• Wake County Study:
• The number of survivors dropped after 20 minutes of ACLS, those who did
survive had comparable neurological survival as those in the < 20 minute
group.
• Many of these “prolonged resuscitation” had CPR in excess of 40 minutes.
• Key Point: Wake County adheres to High Performance CPR
concepts and data tracking.
• Real World Impact: In the Wake County Study: In 7 years of data,
100 neurologically intact people would have not survived if
resuscitation had stopped at 25 minutes
37. Wrapping up
• Determination of death requires a consistent, clinically
based approach and assessment.
• The decision to withhold and terminate resuscitation also
requires a consistent, clinically based approach and
assessment.
• Most failures are the result of disregarding these principles
Editor's Notes
https://www.ems1.com/ems-management/articles/6-responders-on-leave-after-man-mistakenly-declared-dead-ftA23jlgLO6TAYVP/
Paramedics pronounced a gunshot victim dead and left the scene, but it turns out the victim was still alive. The 911 call came in just after 3 a.m. A 30-year-old man at a townhome on 735 Tulip Grove Road in Hermitage had shot himself in the head. After Paramedics arrived, paperwork shows they called a Vanderbilt doctor and reported the patient had injuries that were quote, "incompatible with life."
https://www.clickondetroit.com/news/local/2020/08/24/woman-found-alive-at-detroit-funeral-home-after-being-declared-dead/
At 7:34 a.m. on August 23, 2020, Southfield Fire Department paramedics arrived at a home in Southfield on a call for an unresponsive female. When paramedics arrived, they found a 20 year-old who was not breathing. The paramedics performed CPR and other life reviving methods for 30 minutes. Given medical readings and the condition of the patient, it was determined at that time that she did not have signs of life.Emergency Crews said she was showing signs of medication, transported to the funeral home, and then again showed signs of life later AT THE FUNERAL HOME. EMS was again called and she was transported to the hospital.
uscle fibers, which in life move because of sliding filament theory, rely on the conversion of ATP to ADP. After death, when respiration ceases, the intracellular pH decreases due to the production of lactic and pyruvic acid. The anaerobic glycolysis of glycogen in the muscles causes glycogen depletion and thus reduced ATP concentrations. Also calcium leaks into the sarcomere, where the protein filaments of actin and myosin are present in an alternating arrangement, where calcium then binds allowing for a cross-linkage to occur between the filaments. This causes a pulling motion along the length of the muscle causing it to become shorter and more rigid. In a living individual, ATP would be used to dissociate the cross-linking in the fibers and as a result the rigidity associated with the change would be reversed, whereas it becomes fixed postmortem (Powers, 2005).
Place the diaphragm or bell of the stethoscope over the apex of the heart (normally located at the fifth intercostal space left of the midclavicular line)
I do not think an EKG is mandatory on all DOAs, but is on fresh trauma codes. If you have one in place for anbother reason, you are kinda obligated to use it and document. The question is what do you do if you place one and a pacemaker is causing EMD? Requiring an EKG makes this an ALS only determination, wich would cause system overload.