If you come in to my ED after placing a shotgun over your heart and pulling the trigger AND I take the ultrasound probe (pictured here on a very nice sonosite machine) to look for heart activity AND, after taking off the bandage that covers the wound, the ultrasound probe DISAPPEARS into your right and left ventricles, then you are DEAD. No, AngelFlight crew, there were never any pulses even with CPR- you are liars or fools. I hereby dub this the "vanishing probe" sign of death and it should be recognized with other sure indicators of death like rigor-mortis, decapitation, fixed and dilated pupils with asystole in three leads, and vaporization in an atomic blast.
the flight medics/nurses flew a pulseless penetrating trauma... that's practically malpractice... dead on the ground is still dead in the air.
ReplyDeleteUltrasound(tm), it's not just for central lines anymore....
ReplyDeleteIn absence of an ultrasound probe, could you also determine the presence of a "snidely sign" using your fist while performing CPR? I figure many smaller community ED's without ultrasound should have an alternate method to make this important finding.
I'm going to remember that---the snidely sign. (Here in Texas, the doctors with "cuntry" accents call it "daid"....)
ReplyDeleteBy the way, I jealously envy you your "modern" gadgets and technology. Our ER has NOTHING like that. Here in Podunk we're in the dark ages in everything else, too, (hence, the fact that I had to lead the EMT's out of ranch country when my own patient died at home two weeks ago and the poor EMTs had gotten lost on the way there and didn't want to get lost going back---I always have to give the ambulance guys directions...)
ReplyDelete(I'm having a hard time getting over that death---he was a favorite patient...)
And speaking of being in the "cuntry", two days ago on my way to work, I saw a man washing his horse in the car wash. (But it was a white horse, after all, so I guess I can understand...)
in summary:
ReplyDeletethe paramedics said the guy had pulses. liars or fools.
yes, being able to fit your fist in a gsw to the chest would definitely indicate death. it would probably deserve its own name and the 'snidely sign' would be subsumed underneath it's broader reach.
a horse in a car wash? haven't seen that one. some might consider it an omen, but, as you say, it was a white horse. a good omen?
Vaporization in an atomic blast would definitely produce less charting than the others, though. Do they even have an "Atomic Blast" T-sheet?
ReplyDeletegood medics have a motto for the rest of their collegues. "don't embarress the rest of us".
ReplyDeleteqed
Such a high technology device is needed to recognise someone is dead?
ReplyDeleteIt is a shame that some people won't own up to their responsibility...
I tagged you with a meme. (Come on, doc---be a sport!---you're the only doc I tagged.) Give us the scoop.....
ReplyDeleteif you explain what i'm supposed to do with this 'meme' i will do it!
ReplyDeletedear BHR,
ReplyDeletegot it from your site. will do it. don't know if i can tag 8 others but will try. will tag my compatriots here as well.
thanks,
911doc
Thank you, doctor!!! You don't have to tag others if you don't want to. You can just put in a sentence saying something like: "Anybody else who'd like to consider themselves tagged, please do so".
ReplyDeleteThanks again!
All of my medical training comes from episodes of ER or Grey's Anatomy...which qualifies me to identify drama more than trauma, but I'm guessing even I could have diagnosed this one. Hmmm, huge whole where the heart used to be. If I recall correctly, that's one of those important organs.
ReplyDeleteYou forgot the EKG leads on the green, marbled, or skeletonized corpse. I'm never sure what tracing you get when the patient is only bones. DOPA--Dead on Paramedic Arrival.
ReplyDeleteMaybe the paramedics said it to get out of the (messy) pick up, family of the dead guy around or some reason. There's always a reason.
ReplyDeletevery perceptive, mark. there was an element of this at the scene. what is still not clear is why the ground crew called the helicopter to meet them at the nearest landing area or why the crew flew. the guy was dead and helicopters crash. it was a foolish thing.
ReplyDelete