Steel-Man Rules for this Debate
- Any time you want to contradict the other discussant, you must first restate the views they have just stated and confirm with them that you are understanding correctly. If you can bolster their point even more strongly before contradicting, this is even better.
- No ad-hominem attacks (i.e. attacks on the person, not their views. Feel free to politely destroy the views)
- Logical fallacies should be pointed out
- Try to state whether a viewpoint is based on evidence, and what quality or based on your clinical practice
Accepted as Given?
- We are dealing with Adults
- Asytole without signs of life should be run and terminated in the field
- There are EMS services and EDs where EMS does a better job running the arrest than the ED, in those venues EMS should run almost all codes to field termination
- There are some venues where nothing (nothing!) additional gets done in the ED beyond what EMS can do, in those venues EMS should run almost all codes to field termination
- What is a public health view of EMS vs. a medical view?
- What is the best approach to <75 y/o vfib/vtach/PEA patient without end-stage comorbidity?
- Can we safely get these patients to the ED?
Cardiocerebral Resuscitation (CCR)
- Watch Ben Bobrow's vid
- Search for Pit Crew CPR to see amazing coordination and perfect, continuous hand cpr
Beam Me Up Scotty?
if we had teleporters…
Can We Safely Transport?
Take Out 1-2 Shocks from the Field Success Rates
and everything changes!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
why is this cheaper?
Things I Can Do in the ED
- Arterial Lines
- Multiple Antidysrhythmics for Electrical Storm
- Cath Lab
- Pericardial Drainage
3 Scenarios for when a Resus Center can make a difference
Vfib shocks to Sinus and then Regresses
these patients almost always have a coronary lesion and there is NOTHING the field management can offer these patients. Even if they don’t you don’t have the monitoring to keep these patients in sinus. multiple pressors/varied pressors
there is nothing the field is going to accomplish in these patients
- what you can fix—hypoxemia
- what you can’t accurately diagnose
- tension pneumo
- what you can’t
- pericardial tamponade
- what you sort of can
- toxicology in most protocols
Please tell us what you think in the comments section below
Now on to the Podcast…
- EMCrit Wee – Webinar I Gave to Pulm/Crit Care Fellows on Avoiding Intubation and Initial Ventilation of COVID19 Patients - April 4, 2020
- EMCrit 269 – Rationing of Critical Care and Ventilators in COVID19 with Reub Strayer - March 31, 2020
- EMCrit Wee – Stop Kneejerk Intubation with the EMCrit Crew - March 30, 2020