Hello, I was hoping you can put my overthinking mind at ease. I responded to a traumatic vsa. Single stab wound to the chest with the knife still impaled. Single stab wound to the lower left side of his chest(left of his nipple). He was asystole, very rigored at the jaw but no other obvious signs of “ Obivously Dead Criteria” My question is technically can we deem that enough to not continue resuscitative efforts? Or do they need gross rigor mortis at the extremities or lividity to call it? We decided to run the call as we did not feel comfortable calling it with just rigor at the jaw. Removed the knife as it was impending CPR, applied an asherman seal, rhythm analysis revealing asystole, double NPA with two handed seal and adequate ventilations with equal chest rise and fall with good air entry(did not needle decompress), end tidal of 20-22, IO access and transported. Arrival at the ER, got odd looks from ER team and got questioned why we transported someone who was rigored at the jaw and explained to them that we did not have enough to pronounce them on scene. Hoping you can give some clarification on this challenging scenario and whether I could’ve done that call differently. Thank you!

When giving Epinephrine for anaphylaxis is it expectable to delay administration of diphenhydramine following the first dose of Epinephrine if it is getting close to the 5 minute dose interval for the second dose of Epinephrine and the patient is requiring the second dose of Epinephrine? My understanding is that Epinephrine in anaphylaxis is the priority medication and I could use clarification as to whether or not it is okay to delay administration of diphenhydramine until after the second dose of Epinephrine if the patient requires a second dose and we were not able to administer diphenhydramine in between the required 5 minute dose interval for the second dose of Epinephrine.

I was hoping to get some clarification as to what a penetrating trauma under FTT guidelines is considered to be? I’ve seen many definitions that will define it as a breaking of the skin resulting in an open wound but wouldn’t a laceration fall under that definition? For example you attend a patient that has fallen resulting in a deep laceration to their head. Would that injury be considered penetrating and thus fall under FTT guidelines?

My question is in regards to our traumatic TOR protocol – more specifically, why is a trauma TOR ALWAYS contraindicated for penetrating trauma to the torso or head/neck when the LTC is <30mins away? I am looking for clarification and rationale on this because this contraindication seems to be all-encompassing without taking other clinical factors into account (ie. extent of injuries, pts age, complications of resuscitation, presenting rhythm, medical hx, etc.) For example: I attended a traumatic VSA, <30mins from the LTH. Pt was 90yo with a suspected self inflicted gsw to the head. In this incident there was no definitive time of arrest and the pts presenting rhythm was asystole. Entry wound identified to the head, no exit wound and no gross distortion of anatomy (did not meet any obviously deceased standards). The initial crew was unable to secure/maintain the pts airway due to bleeding in the pts airway - indicating that there was no oxygenation/ventilation during the initial resuscitative efforts. I may be wrong but I believe that this pt arrested due to anatomical injuries rather than exsanguination. This pt sustained grievous injury not conducive to life for which there is no definitive tx. This pt is an extreme case; pt was elderly, on blood thinners, sustained irreversible injury, asystolic arrest with complications during care. However, none of these clinical factors are applied to our trauma TOR. I am reaching out for clarification/rationale as to why this pt should not be routinely considered for a trauma TOR.

I need some clarification on the updates to the trauma arrest algorithm. With a patient with penetrating trauma in asystole with LTH less than 30 minutes are we to transport to the lead trauma hospital as we do with PEA? Also, if the lead trauma hospital is greater than 30 minutes, I am assuming we transport to the closest ED with both asystole and PEA with penetrating trauma.