Quote from: "voiceforthesilent"Thank you, Ladymedia, for giving insight into something that you have training in. You can write this in your blog or just answer below but I have a few questions that I've wondered about. I'd appreciate your thoughts on these questions below...
1) How many people outside of the medical staff could ride in the ambulance and how many is there room for? It appears that there was at least one or two others besides the medics in the ambulance.
2) At the hospital there was one view where it looked like someone was putting on a jacket at the back of the ambulance? Any thoughts on this? It just looked so casual and unhurried yet supposedly they were in a state of emergency (I would assume). Why would someone take the time to put on a jacket?
3) The person in the ambulance was receiving compressions. I think a person giving the compressions is told not to stop that once they've started (correct?). How is it that they were able to stop once they got to the hospital? Wouldn't someone have continued with the compressions until more sophisticated equipment was hooked up?
4) Same goes for the intubation - wouldn't that be visible in the view of the patient being wheeled into the ED? I say that because someone would need to be holding it in place to make sure it doesn't shift, right?
5) If the patient is intubated, wouldn't they also be monitored with pulse oximetry or other device? Does this show that he did have that attached in the ambulance or while being wheeled into the ED?
6) The IV was supposedly administered in the left jugular. Do you see that IV on the person being wheeled into the hospital Room doors? If not, what happened to that?
7) The nasal cannula - If Dr Murray had this on Michael at the house it would have probably been hooked up to oxygen at some point. It doesn't appear that the person being wheeled into the ED is on oxygen - at least I can't see any oxygen tanks. Is it safe to say that if it really is a cannula that the oxygen was no longer hooked up? If not, why keep the tube there - it would only be in the way, right?
Thanks again for all of your insight. Blessings.
Absolutely!
1. In a box ambulance, you can comfortably fit 4 people, but in most calls, you want 2 or 3. In a cardiac arrest, you'd want 3 or 4.
2. This is purely opinion, but I saw the video from the other side of the ambulance, and I see it as a bodyguard holding his arms wide open with his jacket to block cameras from taking pictures/video from the other side of the ambulance. Because of that, I don't believe anyone is pulling a jacket over their head.
3. It's not easy to get the height and leverage to do compressions while moving on a stretcher. And for someone who has been asystolic for about an hour, there is essentially no chance of survival (that's not opinion, that's been proven again and again through numerous studies). But sometimes we do "ride the rail". That's if we consider it a viable patient. Otherwise, we'll try to do some sort of one handed compression while walking. Ultimately, though, if you can't get good compressions on the chest, you're not doing much.
4. Absolutely someone would be holding it. It would be held by the person at the head of the stretcher, however it would be RIGHT up to the patients face.
5. Yes. They would be monitored with end-tidal CO2. This is shown in the ambulance picture. It gives you someone called capnography, which shows you that you're in the right place (in the trachea vs. the esophagus), and (loosely) the effectiveness of ventilations.
6. I did mention this is my blog post :)
7. This is why I'm confused by the cannula. There would have had to be oxygen for the BVM, and this was probably between the patient's legs or at the foot of the stretcher, as you have no room on the back of the stretcher for an O2 tank in a code (because they're lying flat). If they were using it in the ambulance, they would have means to hook up both the cannula and BVM. However once out, it is far more important that the BVM is hooked up to O2 than the cannula. So going into the ED, the cannula would not have O2, however it's not likely they'd remove it even if there was no O2. It'd just be a waste of time to take it off. But again, I'm still confused by it, so I'll see what I can find out :)