EMT DEADLY MISTAKE: CPR or Blood Transfusion-Bullet Torn Up Chest Needs Blood

[asprucetree]

I am a paramedic and an RN, also with a bio/premed BA. I did not see CPR, granted, it was from a far. But there was no chest compressions visible from what i saw. I saw a person periodically holding pressure on what looked like the chest, but it did not seem to be compressions. It is more likely the paramedic or EMT (there is a difference, btw) was holding pressure on the GSW. I generally don't put much stock in untrained opinions.

[asprucetree]

@asprucetree also, you say that "blood transfusion or a oxygen machine" would be better. I don't even know what an "oxygen machine" is, but if you knew the job of an emergency provider you would know that very few systems carry blood for transfusion and they most likely were providing high flow oxygen. Even still, a blood transfusion and supplemental oxygen wouldn't move blood around the body, only a heart does that (or a bipass circulator). CPR move blood around the body when the heart stops.

[redraven23]

Well If you don't administer CPR when it is needed, I'm pretty sure that the patient has a a much higher chance of dying. The Brian tends to die (irreversibly) at a pretty fast rate when not receiving oxygen over a long period of time?

[msiligup]

Also, I could be wrong. But I didn't see any resuscitation efforts at the end of the video.

The video wasn't the best quality, so maybe I am mistaken. However, if the EMT was performing CPR, then we would have seen one person pumping the chest vigorously up and down. I suspect that this patient was conscious or semi-conscious and that the EMT's were controlling bleeding and administering oxygen. But I could be wrong.

[studenlawyer]

Hi, msiligup, I am missing something; how can one control the bleeding of a gun shot wound to the chest. Remember it is not an external wound like cut vein, organs are torn up. No one knows what is the condition of the organ and bleeding. Hand or foot severed, one can hold the vein closer to the wound.

I still believe that boom gun shot, get him to the ER immediately, maybe do the CPR enroute. Let us study this some more.

[msiligup]

But don't forget, studenlawyer, that we must also consider the caliber and type of weapon used, the range the weapon was fired, and the type of bullet that was used.

I suspect that the gun shot wound was superficial, or was deflected, or missed any vital organs. Otherwise those people would have been hauling ass.

And again, I don't think CPR was being performed in this situation. CPR is only performed for victims of cardiac arrest. It is unlikely that this man had an AMI and was shot.

[asprucetree]

@studenlawyer The only way to stop internal bleeding from traumatic injury is surgical intervention. The purpose of EMS is not only to transport to the hospital but stabilize the patient. If the patient isn't stable, the providers will attempt to stop or control what bleeding they can see before moving. Remember, CPR is great for the non-hemorrhaging patient, but if there is no blood to circulate CPR is mote, don't ya think?

[studenlawyer]

The point I am trying ot make; is that if the organs are torn up-stomach, liver, heart, diaphragm etc. There would be no blood to transport the oxygen. Also, he would die quicker from the roughing up of the body. It should be like the suspect of spinal injury, do not move the victim.

CPR is so rough on an injured chest, abdomen that I wonder about any CPR prudence. To me, a quick transport to the Emergency Department is the only hope.

[msiligup]

Another point. If you transport to the ER without working up your patient with CPR, then your patient will die sooner due to brain damage. If you simultaneously control the bleeding and have a partner do CPR, then there is a better hope for the patient to survive. Otherwise, there dead for sure if you just wait to get the ER.

[studenlawyer]

This discussion is progressing very professionally. I am learning from all of you. Thanks a million!

[Streetskirt]

Realistically, if you are in traumatic arrest due to a gun shot or stabbing, you have a VERY poor likehood of any survival. Regardless of blod administration or CPR. Ideally, CPR and bllod could be given, but blood has a shelf life and need to be refrig. Blood administraiont also has huge side effects and is not practical to carry in the field. If this person is transported to the ED, hopefully an emergency thoracotamy can be performed and any major vessels repaired.

[redraven23]

We don't know for sure whats going on on the inside. All we know is what is right in front of us (most of the time) what we would know is whether or not this person has a heart rate and whether or not CPR is needed which in this case

[studenlawyer]

hey CajunMedic101, remember this individual was shot in the chest two or three times. No one knows which organs are torn up. If his lungs and heart are damaged would CPR help?

[CajunMedic101]

i think they were doing CPR due to the individual being in traumatic cardiac arrest. If the individual they were working on no longer had a pulse it would be appropriate for them to begin CPR on this individual, spinal immobilization, 2 large bore IV's, and rapid transport to appropriate facility. I wasn't there to assess the patient so I would have to give the benefit of doubt and say they acted appropriately from what i can see in the video.

NREMT-P

[studenlawyer]

Hey CajunMedic101, remember this individual was shot in the chest two or three times. No one knows which organs are torn up. To be pumping that chest is sort of strange. No sure what should be done but could such cause more damage/bleed out?

[CajunMedic101]

Remember their doing CPR on the individual because his heart isn't beating or isn't beating effectively (pulseless v-tach and v-fib). without CPR this person is dead due to traumatic cardiac arrest. This person without a pulse is clinically dead and yes you want to try to control the bleeding if possible and replace volume already lost but CPR is the most important procedure at this time to do the job his heart isn't doing anymore. could CPR cause more damage?? no CPR is the only chance he has.

[msiligup]

CajunMedic101 is correct. The only reason you do CPR is because there is NO pulse. CPR done correctly often will cause damage, regardless of previous conditions. But, in any case, the patient will die anyways if you don't intervene with CPR. CPR is the only permitted EMT-B technique that will effectively pump blood through the body (25-33% effectively). But, better something than nothing.

[asprucetree]

@studenlawyer If the brain doesn't get blood, the body dies. If no blood, the brain doesn't get oxygen, the body dies. You people are over thinking this. If he is in cardiac arrest, and we are making a 'best effort' for resuscitation, we do CPR, bleeding control, and IV fluids to help fluids move (remember it is blood pressure, not saline pressure). Without a trauma surgeon, we can't do much else, mind screwing a simple trauma will certainly kill him.