Algorithms in theory vs. in practice

The patient still had a pulse. While the CT Scan might have been a little extreme it did show non survival injuries. Sometimes doctors have to make tough calls and want something concrete to back them up. Had the physician stopped while this patient still had a pulse without confirmed evidence of the massive nonsurvival injuries, there probably would have been a discussion about that also. There are many examples of those who were thought to have non survival injuries but somehow survived. Watching the World Series in San Francisco there was mention of Brian Stowe and his life changing events. Some probably thought they went to extremes to save his life also. He and his family seem glad they did.

Sometimes it is very difficult to feel a pulse even on those who are very much alive. Many EDS now have portable ultrasound to assess cardiac function or lack of rather than relying just on finding a pulse and a possible PEA.

Some hospitals are teaching their own ACLS designed specifically for their team members and their patient population. AHA ACLS is guidelines which are generally appropriate for unknown patients. Guidelines are not concrete. You need to check your hospital's protocols to see if the AHA ACLS guidelines are followed exactly or what amendments or additions have been made per the Critical Care and ED medical directors and confirmed by the medical staff board.

I know it has been several days since this thread had any activity, but I had to come back to share this post that I stumbled upon. It comes from an EMS blog, and it talks about ST and how to treat it. It covers some of those "nuances" I referred to in a previous post. If you decide to check it out, be sure to read the comments that follow the post, as well. Of course, this may be old-hat for lots of you, but as I alluded before, I still feel spankin' new when presented with ACLS scenarios in real life, because I simply haven't had very many encounters with patients who are unstable due to acute CV illness/injury. As long as y'all are still ok with a relative newbie asking "stupid" questions, I will probably keep coming back.

Here's the post: The Trouble with Sinus Tachycardia | EMS 12 Lead

@GrannyRRT:

Thank you. "Guidelines are not concrete" is quite the succinct answer to the theory vs. practice question.