I’ve Been Rogue Medic’d!

Right now, I feel like a minor internet celebrity.  I’ve been Rogue Medic’d.  That’s right, Tim Noonan, the Rogue Medic, has read one of my posts and posted a reply to it as one of his entries in his blog.  It all started last week when I shared my post as a comment to something he put up in regards to working a CPR with a LUCAS device and the relation of using epinephrine in cardiac arrests.

The entry that I referenced was one that I posted a few months back about organ donation and how while not every ROSC will walk out of a hospital, we might produce the opportunity for organ donation for that patient.  While one life could be lost, others could be saved.

Tim makes some excellent points in his reply to my comment.  Obviously, the job of every paramedic and EMT out there when working a cardiac arrest is to save our patient.  We want them to walk out of the hospital.  We want that chance down the road to meet them.  If that is even going to happen, we first need to achieve ROSC.

My advocacy for epinephrine revolves around personal feelings based on my experience, I believe that the use of epi in cardiac arrests produces a higher ROSC rate.  More specifically, I feel that the effects of epinephrine produces ROSC in patients that we would not have gotten ROSC in.  I am mainly talking about those asystole patients and patients in an unexplained PEA.  Due to the fact that these people that are saved might not have been brought back otherwise, their long term outlook is poor.

This differs from those patients that we encounter in v-fib and v-tach without pulses.  Those patients, again, in my opinion, should not get epinephrine.  The focus there should be solely on high quality CPR.  This part of my opinion is actually supported by studies. It was easy enough for me to find one from 2013 that states that while more trials are needed, detrimental effects post-cardiac arrest were greatest in patients who received epi and were in v-fib or v-tach.  So on that side, I fully support Tim’s repeated arguments to do away with epinephrine in cardiac arrest, or more specifically in v-fib and v-tach codes.

My reason for writing that post was largely driven by a level of apathy that I have seen in some providers (not all) when it comes to cardiac arrests that they feel are futile.  That might seem like a harsh assessment of my peers, but I don’t feel like enough of them have been educated enough to know better.  I am talking mainly about those arrests that are in that grey area between pronouncement and a viable patient.  I have seen, and been part of, so called “show codes” at different parts in my career, and I feel that there needs to be a better overall focus on working a cardiac arrest.  Simply put, we need to work at 110% intensity for every patient, every time.

My reason for writing that post also was to give some people hope that their efforts were not in vain because their patient did not walk out of the hospital.  That arrest might not have been a failure.  I have a friend who works in organ donation, and I feel she said it better than I ever could: “This can create positivity in a tragic situation, and who are we as paramedics to take that opportunity away from them and the 120,000 people who are waiting for those gifts?”

Make no mistake, Tim is way smarter than I am and than I will ever be.  I love reading his stuff, and I make it a point to check his blog weekly.  I agree with some of his points, and I disagree with others.  The beauty of the Rogue Medic is he always sticks to his guns and advocates his point, which makes me feel that he does the same for his patients, and for that, I applaud Tim.

I feel though, that he needs to look at this issue on a broader spectrum.  His points on epinephrine and cardiac arrest and people having poorer outcomes after receiving epi can be supported.  But personally, I feel that without epi we would have a lower ROSC rate and we cannot have post-hospital outcomes without ROSC.

So to sum up my view point: don’t work an arrest with the thought of, “maybe this could be an organ donor.”  Work the code with the attitude of, “I need to do everything that I am capable of to try and achieve ROSC for this patient.”

Thanks for reading, Tim!