# SIDS whats your school of thought?



## Emtgirl21 (Oct 4, 2008)

When you run a SIDS death and the infant beyond attempting resiscutation whats your school of thought. Tell the parents there is nothing you can do and let the parents attempt to wrap their head around it and say goodbye or grab the baby and run for the truck?

I recently had a SIDS death.


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## KEVD18 (Oct 5, 2008)

if there are signs inconsistant with life, the code doesnt get worked. 

i dont believe in slow coding for the benefit of family. all you're doing is delaying the inevitable.

sorry but dead is dead.


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## traumateam1 (Oct 5, 2008)

I gotta agree with KEVD18. You are eventually going to have to call it. If they are beyond attempting resuscitation than tell the family there is nothing further you can do.

Was it your first SIDS call?


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## Hastings (Oct 5, 2008)

I was always encouraged - and do - put on a convincing show in the case of SIDS. I know it's not really a popular thing to do in the eyes of some others in the field, but I have found it to be some comfort to the family. Or maybe it's my way of letting the family deal with the loss in the more controlled setting of the hospital where a doctor can sit with the family and explain everything. It's going to be crushing either way. I've gone both ways. These days though, I tend to work the infant at least into the back of the ambulance. Again, not a popular course of action. Sorry.


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## Ridryder911 (Oct 5, 2008)

Do we grab Grandpa and run to the truck? Pretending to work and realizing that it is a foolish and wrong it is unethical as well. Seriously, why give false hopes and ideas to a family as well as demonstrating that you have no idea of what you are doing? All because you  cannot deal with it. 

It burns me to see medics to do such. Yes, I am the one that will have to take the family to the family room and then explain that it had been too late. That resuscitation efforts should had never been made. The undo roughness and performance by the medics were in good faith. Oh by the way, you can also thank the EMS for a undue ambulance and ER bill that should have never occurred. 

What many medics do not understand is that most parents realize it. You are only confusing them. 

Yes, its a horrible tragedy. Yes, it is hard but that is part of our job. It is also usually considered a crime scene until otherwise investigated and proven otherwise. Turn your attention to the family and do what we are supposed to do. Alike in any other situation of the similar circumstances.

*Just remember, if you did not do the same for Grandpa, then you are performing age descrimination


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## Sasha (Oct 5, 2008)

Maybe Im foolish and dumb, but how in the field do YOU determine it was SIDS? There are other reasons babies stop breathing. If they dont have physical finidings inconsistant with life, like rigidity, lividity (Which Im sure I spelt completely wrong.), a missing head etc. you are supposed to work them.

You arent a doctor, it isnt your call to call a patient dead, unless your protocols mandates that you can. We have a protocol here that allows them to be called if they meet certain criteria and not just _baby woke up dead_. They have to have dependant lividity, be missing a major body part needed to live, like the bottom half of their torso, etc

Every single patient deserves your 100% best, it makes my stomach turn to read phrases like slow code and show code. Would you want your baby, daughter, son, mother or father show coded? If you are performing a show code, you are not performing your 100% best and you are not making every reasonable effort to save that persons life.


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## Jon (Oct 5, 2008)

Sasha and Rid are both right.

If the baby is "OBVIOUS" (like many SIDS cases are)... then it shouldn't get worked. If it isn't obvious death, then follow the BLS/ALS protocols... including, perhaps, field pronouncement. Hastings... I've heard what you've said before... even in class. As Rid said... we shouldn't change things because the patient is an infant.

Remember... in a case like this, you've got OTHER patients to worry about - Mom/Dad other family.


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## Ridryder911 (Oct 5, 2008)

SIDS is *only* diagnosed by an autopsy stating they _cannot determine the mode or means of death. _ Hence the reason it is a _syndrome_. 

One does not have to know it is SIDS, neglect, respiratory failure, etc.. for one to call it though. The reason it is known as SIDS is because it is silent... again, majority of the time the parents find their infant dead. I have seen very few times where an infant was workable. 

This is where I become angry. Most of the infants should had never been considered to be worked, yet over zealous EMS personal continue to do so. It is not founded upon clinical symptoms or consideration rather based upon the uneasiness or the inability of the EMT to deal with the infants death. Again, most families are aware it is too late but do not know what to do and yes in psychological shock but we as the professionals should be able to deal with it appropriately, its our job. 

R/r 911


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## VentMedic (Oct 5, 2008)

To determine the cause of *Sudden Unexpected Infant Death(SUID)* is often difficult work for forensic pathologists. Many times there have been assumptions made that led to misdiagnosis or misclassification. Not all infant deaths are SIDS. 

Often the EMS providers are working the code because of their own issues more than the family's. Many have not seen a dead infant and are compelled to attempt everything even if it is the wrong way to get through these situations. At the hospital we may have to spend more time consoling the EMTs and Paramedics instead of the family members. One must continue to maintain professionalism and follow protocols for obvious death regardless of age. The attention should then be directed to the living.


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## Jeffrey_169 (Oct 5, 2008)

I would do all I could...thats just me...I don't ever give up!!!


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## MMiz (Oct 5, 2008)

I really can't imagine not working a pediatric to some extent on scene.  If you can diagnose a SIDS case on scene or at the hospital, we need to talk.  As an EMT you would treat the symptoms, presentation, and condition, and I can think of very few circumstances when my medical director would allow me to call a pediatric on scene.


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## Hastings (Oct 5, 2008)

MMiz said:


> I really can't imagine not working a pediatric to some extent on scene.  If you can diagnose a SIDS case on scene or at the hospital, we need to talk.  As an EMT you would treat the symptoms, presentation, and condition, and I can think of very few circumstances when my medical director would allow me to call a pediatric on scene.



My medical director wouldn't allow for that either. Even as a Paramedic.


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## Bosco578 (Oct 5, 2008)

MMiz said:


> I really can't imagine not working a pediatric to some extent on scene.  If you can diagnose a SIDS case on scene or at the hospital, we need to talk.  As an EMT you would treat the symptoms, presentation, and condition, and I can think of very few circumstances when my medical director would allow me to call a pediatric on scene.



I can't imagine not being able to tell when dead is dead.


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## reaper (Oct 5, 2008)

Exactly, We are talking about obvious death!

If you work that or your system requires that you do, then you may want to rethink things.

Crews that work an obvious dead body,have one of two problems. Either they are doing it for practice(hurting the family) or they are afraid to talk to the family, so they decide it is easier to work it.(hurting the family)

It doesn't matter if it is an adult or a peds. If they have obviously been down to long to save, then you are helping no one!


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## KEVD18 (Oct 5, 2008)

i have a question/mini scenario for everybody that would work that code:

your dispatched for the unresponsive infant at say 6am. u/a, parents say the put the baby down at 9pm for the night. there was no crying or what not to awaken the parents, so everybody slept through the night. upon awakening, mommy immediately went to check on/feed baby. for the sake of this argument, the baby dies at 2130, so has been dead now for 8.5hrs. they are stone cold dead. dependant lividity, stiffness, blue, well everything that isn't purple. dead.

now, there's somewhere in the 0.00000000000000000000000000000000000000000000001% chance you could bring this patient back and you darn well know it(and if you don't, please please please turn in your ticket immediately). so you work that code? you're going to instill false hope into the parents, run for the bus, line, ekg(this line doesn't get any flatter), drugs, compression, ventilation, drugs, compressions, ventilation etc etc all the way to the ed. really? i mean really?

the same call could be a 90 year old man. i don't work that code either btw. if that baby dies at 0545, still warm, not really starting to pool yet then yeah, code em all the way in but flogging a decidedly dead baby helps _no one!_

as far as diagnosing sids in the field, we don't and its irrelevant. dead is dead regardless of the cause. that's something for the post to determine.

all you people out there that would show code for the benefit of mommy and daddy, you're not fooling anybody and you're not practicing good medicine. please rethink your thought process and line it up with reality.


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## MMiz (Oct 5, 2008)

You want me to argue with you so we can throw some fuel on the fire and have some EMTLife magic.  It's not going to happen.

I believe that you could work the patient out to the truck where you notify medical control of your situation.

As EMTs we are there to treat not only the patient, but also the needs of the family.  There is no need to put on a show, but there is no need to be a jerk about it.


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## KEVD18 (Oct 5, 2008)

MMiz said:


> You want me to argue with you so we can throw some fuel on the fire and have some EMTLife magic.  It's not going to happen.
> 
> I believe that you could work the patient out to the truck where you notify medical control of your situation.
> 
> As EMTs we are there to treat not only the patient, but also the needs of the family.  There is no need to put on a show, but there is no need to be a jerk about it.



no, i want you to examine your practices and realize that in this type of situation you;re not helping anything by show coding. this is a serious discussion among professionals.

maybe in your state, you need med control to call the code. in ma, we don't. bls can call a code with signs inconsistent with life. doing a song and dance for the parents doesn't help them, it _*adds*_ to the emotional trauma of the event. all the way to the hospital they will build up the chance of this miracle save in their minds till it becomes not only possible but probable. then, they have to crash all over again, this time harder.

i don't see how assessing the situation and making an evidence based decision and then informing the family is being a jerk about it. I'm not saying you take a look at the baby and say "sorry folks, but this ones already in the books. no point in wasting the time here. tough break. I'm going outside to smoke a butt and make a call. somebody will be along to explain things to you shortly". this is a case where tact and diplomacy would be paramount. but giving false hope to people experience arguably the most traumatic event in their lives doesn't fit here.


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## traumateam1 (Oct 5, 2008)

*A little confused..*



			
				Emtgirl21 said:
			
		

> when you run a SIDS death and the *infant beyond attempting resiscutation* whats your school of thought.


Thats where everyone, whether BLS or ALS should "shut er down". If the infant has lividity and rigidity than NO ONE should attempt a resuscitation. Advise dispatch and wait for M.E. Like stated previously, you would not try and resuscitation on an elderly p/t who has lividity and rigidity would you? So what is the difference between the infant and elderly? I am not an M.E. and cannot determine COD, however I can make the call on whether to work the infant or not. If they are cyanotic and still warm than yes I will work.. if they are rigid than, no. I am calling it, sitting the parents down and explaining in the best possible way what is happening.. and expect to be treating the parents.


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## KEVD18 (Oct 5, 2008)

one more thing, when you say work it out to the truck, does that mean you close the back doors and quit right there? its a serious question. im inexperienced with showboating for the sake of showboating.


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## VentMedic (Oct 5, 2008)

KEVD18 said:


> one more thing, when you say work it out to the truck, does that mean you close the back doors and quit right there? its a serious question. im inexperienced with showboating for the sake of showboating.


 
That means you have also abandoned the parents who one the ones that need the care right now...not the baby.


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## KEVD18 (Oct 5, 2008)

VentMedic said:


> That means you have also abandoned the parents who one the ones that need the care right now...not the baby.



good point. even after i said myself that the parents are now the patients, i didnt think of that.


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## MMiz (Oct 5, 2008)

Truth be told, I've never had this happen.  It's a lot easier to deal with old folks kicking the bucket.

I'd follow my protocols:

*Medical reasons not to start CPR include the following:
*A. Patient *without vital signs*, plus
B. Any one of the following are present:
     1. decapitation
     2. gross dismemberment of the body
     3. full thickness, total body burns
     4. body decay and putrefaction
     5. body frozen solid
     6. rigor mortis
     7. lividity
     8. head trauma with brain matter exposed
     9. underwater submersion greater than two hours

If that was the case, I'd probably inform the family and gauge their reaction.  I'm not against working a ped. code even if they meet the conditions to end a code.  At the BLS level I'd have the patient on O2 and continue compressions while I waited for an ALS intercept.  Then they would have to decide.


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## VentMedic (Oct 5, 2008)

MMiz said:


> It's a lot easier to deal with old folks kicking the bucket.


 
No. It is not easier. To see someone's spouse of 60+ years die is just as emotional.


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## KEVD18 (Oct 5, 2008)

so we're back to show coding. 

in the case i presented, the patient clearly meets your protocols for cessation or withholding resuscitative measures:

- vital signs
+ rigor
+ lividity

so in a effort to understand this mentality, why would you code this patient? they are dead and will remain so, so trying to bring them back cant be it. you know that this will actually cause more emotional trauma to the family, so that cant be it. is it to make yourself feel better about the call? 

im not trying to start an argument. im really trying to understand this thought process.


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## MMiz (Oct 5, 2008)

You're telling me that treating a code with an elderly patient is the same as a pediatric?  You're telling me that you get the same feeling when responding to a call to the nursing home as you feel when getting a call for a pediatric?


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## KEVD18 (Oct 5, 2008)

yup.......

edit: at least in the case of working a code with signs inconsistant with life.


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## VentMedic (Oct 5, 2008)

MMiz said:


> You're telling me that treating a code with an elderly patient is the same as a pediatric? You're telling me that you get the same feeling when responding to a call to the nursing home as you feel when getting a call for a pediatric?


 
Now you are changing my words around but I'll go with that.

If that pediatric is also residing in a nursing home would it be the same? Often their death is a blessing if you consider their quality of life.

Have you even seen an elderly person cry for the lose of their partner? Elderly people have emotions also and deserve the same respect as a young person.

Too few in EMS get any education about dying, death and grieving.


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## traumateam1 (Oct 5, 2008)

*Still confused..*

Sorry MMiz I'm still confused. You said:


> I'd follow my protocols:
> 
> Medical reasons not to start CPR include the following:
> A. Patient without vital signs, plus
> ...



"I'd follow my protocols"
The infant had A and B 6,7

Then you said "If that was the case, I'd probably inform the family and gauge their reaction. I'm not against working a ped. code even if they meet the conditions to end a code. At the BLS level I'd have the patient on O2 and continue compressions while I waited for an ALS intercept. Then they would have to decide."

So first you said you'd follow your protocols. Your protocols state that this p/t *shouldn't* receive any treatments. Then you said that you would work this p/t. Have them on O2 and CPR while you waited for ALS.

So my confusion is this: would you follow your protocol, or work this p/t? :unsure:


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## MMiz (Oct 5, 2008)

I've seen lots of old people cry over losing a loved one.  Their pain is no less real and their lives are no less important.  I do place more value on a child's life than an elderley persons.  

The first code I ever got was a father who brought his limp child into the ER while I was doing my first EMS rotation.  Pt. was a 4 month old male, unconscious, unresponsive, no pulse, blue. Patient rushed into trauma room. they started CPR despite the baby being blue and early signs of rigor mortis. He is intubated.  It's 4 am and the father states the baby was last seen breathing at 2 AM.  Every effort is made to save the baby (Epi, CPR) , but a little more than 15 minutes later they called the code.  The guy ended up saying he was going to go out for a smoke and then got in his car and drove off.  Should they not have worked it?


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## traumateam1 (Oct 5, 2008)

VentMedic said:
			
		

> Too few in EMS get any education about dying, death and grieving.


I could not agree more! Courses focus on treating.. and they don't spend Nearly enough time teaching about dying, death, and grieving. 
I took psychology and while I worked in a funeral home I was able to get a lot more first hand experience and learn a lot more about those three things. Like the 5 stages and what not. I think more EMT-B, EMT-I, and EMT-P should offer more training on death, drying, and grieving.


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## VentMedic (Oct 5, 2008)

MMiz said:


> I've seen lots of old people cry over losing a loved one. Their pain is no less real and their lives are no less important. *I *do place more value on a child's life than an elderley persons.


 
Okay you have just stated the problem.  

It is not your emergency.  This is not your loved one.  The person, old or young, is the loved one of the family members.  This is their emergency.  This is about them and not your issues.


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## MMiz (Oct 5, 2008)

You got me?!  If it's not clear already, I'm fumbling for an answer, and I'm still not sure there is one.  I do not believe that in this situation it's my place to declare the patient dead and cease all efforts.  We can reason this out all we want, but while medicine in a science, I still believe there are few absolutes.


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## reaper (Oct 5, 2008)

MMiz said:


> You're telling me that treating a code with an elderly patient is the same as a pediatric?  You're telling me that you get the same feeling when responding to a call to the nursing home as you feel when getting a call for a pediatric?



Yes!! A code is a code. I treat all Pt's the same way, regardless of age.

As Vent stated, Witness the death of a spouse of 50,60 or 75 years. In a way this is more heartbreaking to me, then a SIDS death. Yes, I feel for the family of a SIDS. That is exactly why I will not give them false hope and expensive bills, that are both unjustified. You as a medical professional have to practice ethical medicine. This means making hard life changing decisions!


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## MMiz (Oct 5, 2008)

I don't know of a single profession that asks a person to remove themselves and act as robots.  We show restraint, sound judgment, honesty, and fairness, but it is impossible for a human being to remain completely objective.


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## KEVD18 (Oct 5, 2008)

MMiz said:


> *strike one:* unconscious, unresponsive, no pulse, blue.
> *strike two:* the baby being blue and early signs of rigor mortis.
> *strike three:* It's 4 am and the father states the baby was last seen breathing at 2 AM.



now, one and three aren't in and of themselves definitive. but if you add them all up, the answer to your question is no that baby should not have been coded.

i understand your reservations about calling the code yourself. the first time i pronounced a patient, it was emotionally challenging. but once you analyze the situation and realize that calling the code is what needs to be done, you just have to do it.


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## VentMedic (Oct 5, 2008)

MMiz said:


> I don't know of a single profession that asks a person to remove themselves and act as robots. We show restraint, sound judgment, honesty, and fairness, but it is impossible for a human being to remain completely objective.


 
No but you do what is best for the patient and the family. Providers with different religious views must also check their emotions and do what is required of their job. There are a lot of conflicts but through education and experience, other professionals are able to perform their duties with the understanding that it is about the patient and families.


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## MMiz (Oct 5, 2008)

KEVD18 said:


> now, one and three aren't in and of themselves definitive. but if you add them all up, the answer to your question is no that baby should not have been coded.
> 
> i understand your reservations about calling the code yourself. the first time i pronounced a patient, it was emotionally challenging. but once you analyze the situation and realize that calling the code is what needs to be done, you just have to do it.


For who?  Shouldn't the patient at least be seen by a higher level of care than an EMT-Basic?  Heck, I thought the first patient I ever treated on my own was having a stroke... until the police officer behind me corrected me and told me to give him some oral glucose.  It's easy for me to look at the big picture, google, and pull out my SOPs from the comfort of my leather $49 office depot chair, but EMS is the real world, and I'd sure hate for a patient in the real world to rely on my six weeks of training for definitive medical care.


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## KEVD18 (Oct 5, 2008)

this isnt field diagnosing a cerebral infarct. the guy who retrieves the carriages at the local walmart could be taught the few simple things needed to decide whether or not to work a code.

from your protocols:

Medical reasons not to start CPR include the following:
A. Patient without vital signs, plus
B. Any one of the following are present:
1. decapitation
2. gross dismemberment of the body
3. full thickness, total body burns
4. body decay and putrefaction
5. body frozen solid
6. rigor mortis
7. lividity
8. head trauma with brain matter exposed
9. underwater submersion greater than two hours

none of that requires and rn or md. or a medic or a basic ticket for that matter. much of that is common sense. "oh, i can see his brain. i thinks thats probably bad" or "gee, hes been floating facedown in that pool for a few hours now. im pretty sure he;s dead. yup, he;s dead".


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## reaper (Oct 5, 2008)

Matt,

 I understand what you are saying. But, If you choose to work the streets as an EMT-B, Then these are decisions you have to make. It all comes with time and experience.


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## MMiz (Oct 5, 2008)

reaper said:


> Matt,
> 
> I understand what you are saying. But, If you choose to work the streets as an EMT-B, Then these are decisions you have to make. It all comes with time and experience.


I agree.  I wouldn't be willing or able at this point to work in a setting where I did not have a higher level of care on scene.


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## Ridryder911 (Oct 5, 2008)

Jeffrey_169 said:


> I would do all I could...thats just me...I don't ever give up!!!



So; do you work the code for you or the patient? Let's be serious.. n-e-v-e-r? 

So you rather be unethical, cause a hospital and EMS bill (approx. from $5,000 to $10,000) dollars to a family that will be guaranteed to have to purchase a funeral policy (>$10.000). 
Nice going... All because, one has can not deal with death or do their job. 

Yeah, a real hero. You demonstrated your caring......

Get some exposure and study more about pediatric arrests. 

R/r 911


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## mikie (Oct 5, 2008)

I'll just jump right in...

I'd work the baby if some signs of life where there...especially if the call came in as stopped breathing (witnessed) or the 'know-abouts' of the baby were known (parent: "i just left the room for 10 minutes!")

Could a hysterical enough parent 'force' you to do something?  -make you do CPR and Tx?


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## KEVD18 (Oct 5, 2008)

mikie said:


> I'll just jump right in...
> 
> I'd work the baby if some signs of life where there...especially if the call came in as stopped breathing (witnessed) or the 'know-abouts' of the baby were known (parent: "i just left the room for 10 minutes!")
> 
> Could a hysterical enough parent 'force' you to do something?  -make you do CPR and Tx?



thats a whole nother story. now your talking about a regular run of the mill code, not trying to revive a corpse


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## mikie (Oct 5, 2008)

KEVD18 said:


> thats a whole nother story. now your talking about a regular run of the mill code, not trying to revive a corpse



I was speaking of the latter, (which I guess I failed to include in my last post)...if you had an infant which you decided not to work because of obvious signs of death.  could you be put into a situation where you 'have to' work them?


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## reaper (Oct 5, 2008)

In a single word NO!


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## Emtgirl21 (Oct 6, 2008)

I believe it is less traumatic to wrap the baby in his/her favorite blanet or with their favorite stuffed animal and to calmly explain to their parents that you are very sorry but that their baby is gone and let them rock it or whatever and say goodbye. Just time to wrap their head around it and work thur it. Sure its going to be a long road to healing but I dont think me ripping their infant out of their arms and running for the truck is going to do anything but provide false hope and emotional trauma. 

My husband is a firefighter and he works all pedi codes until an ambulance arrives. He believes that parents need to feel that we did everything we could. But he wouldnt work an adult with a extensive down time or trauma.

I'm  not talking about witnessed arrest or warm babies I'm talking about cold blue babies in warm environments.


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## Hastings (Oct 6, 2008)

I find discussions like this as futile as discussions over whether DIB or SOB is correct terminology. I'm afraid that while I'm open-minded, there is nothing in this thread that has encouraged me in the least little bit to change my action in these circumstances. My personal experiences are what led to this manner of treatment, and I'm going to continue doing it this way.


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## traumateam1 (Oct 6, 2008)

Hastings, you are right, it's *not* a popular choice.. to work an infant in rigor. 1 year old, 30 year old, 80 year old should all be treated the same. If you have an 80 y/o in rigor.. has been dead overnight. Cold and stiff you would hook up the AED start compressions and give appropriate tx according to your level of care? If the answer is No than it should be the same for the infant.

By working the rigor infant you are, as said before, providing a false hope to that parents. Imagine this: you are called to a residence at 06:00 for an "unresponsive infant" you arrive to find the parents freaking out and the dad attempting to breath for the infant. You approach, take over and assess the infant. Cold, stiff, and blue. You ask the parents if they witnessed the baby stop breathing.. they say "no, we put her/him to bed at __:__pm and he/she never cried throughout the night, my wife went in about 10 minutes ago to feed him/her and she/he wasn't breathing!" You have an infant that, by what *you*, a medical professional has seen, is a long dead baby now in rigor. 
So you have two options:
A. Work the p/t - give a false hope that there baby can be revived. You start CPR and hook up the AED, and either call for ALS or transport to the hospital. All along parents hope are rising, thinking they will have a baby they can take back home. Only to have their hopes CRUSHED again by ALS or a Doc. Now they.. again, have to face the fact that their baby is dead (this time of course it will be a lot harder for them) and they then get a major bill in the mail for all your tx's.
B. You like Emtgirl said: wrap the baby up in his/her blanket with a stuffed animal (if available.. don't go searching thru the house), sit the parents down and explain to them there was nothing that could have been done.

Yes, B is a lot harder to do. You have to tell the parents straight up that their baby is dead. But it is more ethically correct. 

You and I both *know* that an infant, or anyone for that matter, in rigor is *beyond saving*. We know that, and if you don't you need to go back to school. If you cannot tell the difference between long dead and no hope vs. recently dead and still hope.. than your ticket needs to be pulled and you need to re visit school. Not to be rude or attack you, but this is a serious issue that needs to be corrected. I have learnt things from this site, and I have changed the way I do things because of awesome paramedics in here that have kicked by butt on an issue.

Lividity and rigidity - p/t has no hope. Regardless of age. *Don't* offer a false hope by working this code. Deal with the issue, be a medical professional and tell the parents.

Is it hard? HECK YES! Do I enjoy telling parents that their infant is dead and there is nothing we can do? HECK NO. Will I do it, despite how hard it is because it is the *right* thing to do? HECK YES. Will I allow parents to force me to do CPR and other tx's? HECK NO. If they scene becomes not safe I will leave until a LEO arrives.

Seriously think about what we have been saying and what you do. Don't be offended and put your guard down, and really think about it. Families could really benifit from you possibly changing the way you work a rigor infant.
Take care,
Mitch


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## eric2068 (Oct 6, 2008)

*Sids*

I feel the worst thing a medic can do is give a family "false hope". It doesn't matter if the patient is a infant or grandma, there is always a loss. My advice, if the patient is showing signs that are inconsistent with life, then call it. Yes it sucks to tell a family member that their child is dead, but that is part of life. We see the worst parts of life, we try to protect people from that part, but sometimes you can't. Be there for the family, be kind, compassionate, caring, and when the run is over, have good cry if you want to, and get ready for the next call. Good Luck.


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## triemal04 (Oct 7, 2008)

Best quote of the thread:


MMiz said:


> EMS is the real world, and I'd sure hate for a patient in the real world to rely on my six weeks of training for definitive medical care.



Worst quote of the thread:


Hastings said:


> My personal experiences are what led to this manner of treatment, and I'm going to continue doing it this way.



Clear enough?


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## traumateam1 (Oct 7, 2008)

Welcome to the tribe eric2068!!!

 :beerchug::beerchug:


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## eric2068 (Oct 7, 2008)

Thank you. I really hope to have some great discussions here.


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## traumateam1 (Oct 7, 2008)

Oh you will. Expect to get your butt kicked a few times in here tho. Mine has been kicked quite a bit  lol But I've learnt A LOT from people in here.. so when I get my butt kicked I'm also learning something new ^_^ I love this place.. It's awesome


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## KEVD18 (Oct 7, 2008)

triemal04 said:


> Best quote of the thread:
> 
> 
> Worst quote of the thread:
> ...



its only makes it clear that you dont understand the issue at bar.


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## Ridryder911 (Oct 7, 2008)

Actually the only thing I see clear is one that one wants to do it their way, no matter the data, costs to the families, or emotional trauma. Rather what makes them comfortable, irriguardless. 

R/r 911


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## mikie (Oct 7, 2008)

You guys/gals should check out an article I posted in the EMS-Related news...

http://www.emtlife.com/showthread.php?p=98855

About SIDS, figured it might spark an interest, pertaining to this thread.


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## triemal04 (Oct 7, 2008)

KEVD18 said:


> its only makes it clear that you dont understand the issue at bar.


The simple fact that someone (a paramedic no less, someone with a supposed advanced level of education and medical knowledge) is willing to blatantly disregard essentially all data on the subject and continue to do something because of their own "personal experience" is what makes it such a bad thing to say.  Doing something like that for yourself, in this situation, is flat out wrong.  And doing it for no reason other than because of something in your own past is even more wrong.

Not everything should need to be explained; some things should just be a wee bit obvious.

Edit:  Dear god, did it ever cross your mind that people believing this is why EMS has many of the problems it does today?  I mean hey, ignore the books, ignore what studies show, ignore science, ignore everything you were taught and just do whatever you want based on "personal experience!"  That's the way to get things done!  After all, you know so much better than all those silly edjumaketed fools out there!  Please.  Someone saying that they will continue to do something only because of their own experiences when the data does not back them up and, in fact, says the opposite is wrong in almost any situation.  But so many people do it (especially in EMS) that it's almost an accepted idea sometimes.


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## KEVD18 (Oct 7, 2008)

i think you're mistaken as to what side of this argument I'm on.

both of those statements you are wholly inaccurate.

if somebody isn't happy with their level of training and doesn't feel its adequate to do their job they should immediately cease working and either increase their training or quit.

completely ignoring established standards and protocols backed by reams upon reams of data to make yourself feel better about your job is childish, reckless, ignorant and ridiculous.


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## triemal04 (Oct 7, 2008)

KEVD18 said:


> i think you're mistaken as to what side of this argument I'm on.
> 
> both of those statements you are wholly inaccurate.
> 
> ...


No, I get what side of the arguement you're on.  Rather I think you're misunderstanding what I meant.  

The first was a bit of a joke; a basic admitting in a roundabout way that six weeks of education isn't enough to really help a paitent.  Funny.

The second...I agree with you.  That's what I'm saying, and my problem with it, and why it should be posted on the front page as the worst thing a medical professional can EVER say and one of the causes of the degradation of EMS in America.

The fact that Hasting's believed/believes that it is acceptable to say something like that, let alone actually do something along those lines is inexscusable.


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## KEVD18 (Oct 7, 2008)

so we're arguing about agreeing with eachother?


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## triemal04 (Oct 7, 2008)

KEVD18 said:


> so we're arguing about agreeing with eachother?


Well hell yeah!  Is there any other way to do it?:beerchug:


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## Hastings (Oct 7, 2008)

triemal04 said:


> The fact that Hasting's believed/believes that it is acceptable to say something like that, let alone actually do something along those lines is inexscusable.



Rather, what Hastings believes is that it's acceptable to blow off members of this forum occasionally because they'll get after you over anything until you start kissing their *** and telling them that their way is the only acceptable way to do a job that is known for it's critical thinking, different methods, unique situations, and improv.

This isn't a situation where dangerous treatment is being provided that can be medically proven as wrong. This is something that certain people feel one way about and others feel one way about, and neither - I apologize to the old grumpy men of this forum - are wrong in the end. This is one topic where medics can rightfully disagree on which treatment is more appropriate (and factor in individual circumstances and situation), and neither will be wrong.

Sorry, but you heard me. I'm not wrong, and neither are you. You have your way of doing things and I have mine. I was taught one way, you were taught another. Such situations exist in EMS. This IS one of them.


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## Hastings (Oct 7, 2008)

I'm going to break this down really simple and put it to rest in regards to me.

If I get called to a home where the family is huddled over the child, crying, mourning the loss, knowing it was a hopeless situation, I'd check the infant for any signs of life, and then I'd join them, put my arm around them, and attempt to comfort them as they mourn. I'm not going to make a theater show out of that.

But that's not the case 99% of the time. 99% of the time, it's a frantic mother that meets you at the door and throws the kid in your arms, begging you to do something; anything. You are welcome to call me a bad medic. Do it. But at this moment, I am not going to give the baby back and tell the mother that it's hopeless. There is an expectation there. There is an expectation that you're going to come, and you are going to do EVERYTHING you can do to "fix" the problem. Argue that there is nothing you can do, that's fair. But there are lists of things that a paramedic can do to bring people back from the dead. No matter how hopeless you may think it is, there is that expectation from the parents to do everything you can. And there are things you can do. And it's my job to meet those expectations, in my opinion. I'm going to take the baby, tell the mother that "I'm going to do everything I can, but I'm afraid s/he may have died of natural causes in his/her sleep. It may be too late. I'm going to do everything I can though." And I am going to work that child as the mother expects from the paramedic that she called for, and because it's my job.

It's my job to do everything I can. It's the expectation when I'm called for. It is what I feel is the right thing to do.



Emotionally damaging to the family? It is regardless. I've never heard of a parent blaming a medic for working a hopeless case on their child. They were thankful they did everything they could. I have however seen several instances where a medic told a family it was hopeless and refused to work it. Guess how that went over.


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## KEVD18 (Oct 7, 2008)

I'm sure it didn't go over all that well at all. as medical practitioners we are sometimes called upon to inform people that things have gone bad. if someone cant handle it, they are in the wrong business.

apparently you're one of the people not willing to examine your practices from an objective standpoint. that's fine. I'm not fundamentally concerned with how you handle your patients. if you can sleep at night then so be it.


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## Hastings (Oct 7, 2008)

KEVD18 said:


> I'm sure it didn't go over all that well at all. as medical practitioners we are sometimes called upon to inform people that things have gone bad. if someone cant handle it, they are in the wrong business.
> 
> apparently you're one of the people not willing to examine your practices from an objective standpoint. that's fine. I'm not fundamentally concerned with how you handle your patients. if you can sleep at night then so be it.



Again, if it were something that were harmful to the patient, or if it were something with a true right answer, you'd find me more than willing to re-evaluate. This is not one of those cases. 

Ironically, YOU are the one being close-minded. Not me.


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## KEVD18 (Oct 7, 2008)

Hastings said:


> Again, if it were something that were harmful to the patient, or if it were something with a true right answer, you'd find me more than willing to re-evaluate. This is not one of those cases.
> 
> Ironically, YOU are the one being close-minded. Not me.



i was hoping you would phrase your response juts like that.

the baby is dead and will remain so. your patient is no longer the baby, but the parent(s)/family and giving them false hope and raising their spirits only to crush them again is exceedingly harmful. this is without a shadow of a doubt one of the cases you seem to think it isn't.


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## Ridryder911 (Oct 8, 2008)

Hastings said:


> *But that's not the case 99% of the time. 99%* of the time, it's a frantic mother that meets you at the door and throws the kid in your arms, begging you to do something; anything. You are welcome to call me a bad medic. Do it. But at this moment, I am not going to give the baby back and tell the mother that it's hopeless. There is an expectation there. There is an expectation that you're going to come, and you are going to do EVERYTHING you can do to "fix" the problem. Argue that there is nothing you can do, that's fair. *But there are lists of things that a paramedic can do to bring people back from the dead.* No matter how hopeless you may think it is, there is that expectation from the parents to do everything you can. And there are things you can do. *And it's my job to meet those expectations*, in my opinion. I'm going to take the baby, tell the mother that "I'm going to do everything I can, but I'm afraid s/he may have died of natural causes in his/her sleep. It may be too late. I'm going to do everything I can though." *And I am going to work that child as the mother expects from the paramedic *that she called for, and because it's my job.
> 
> It's my job to do everything I can. It's the expectation when I'm called for. It is what I feel is the right thing to do.
> 
> ...



Wow! Someone been watching too much Rescue Me! Kinda filled up with the hero syndrome huh? 

Now let's discuss facts.. not a television series .. nor a dream vision, okay?  Unless, you are one in the hundredth thousand that has ever seen an infant resuscitated from SIDS then I suggest you notify _,JEMS, American Academy of Pediatrics, The National SIDS Foundation_ because they will want a picture of you and your story!... 

Let's look at the real facts, according to one study (Phila. JAMA; 2008) there is < than a 0.06% chance of sucessful resucitation with infants that was found in aystole. Again, remember that *we* are the medical professionals (or supposed to be) and again people call us *BECAUSE THEY DO NOT KNOW WHAT TO DO!* be it to resucititate or not. Again, if the infant is DEAD (signs of levidity, pooling, rigor mortis) it is OUR JOB to inform them that the infant has died. Tragic as it be, that is what your job is. PERIOD. Let's quit the "Cowboy medicine" ...  

I believe many need a good reality check. Paramedics very, very seldom bring people back from the dead. Does ACLS work, yes, but is very seldom and the rarity of it especially in a pediatric arrest is more uncommon. That is not anectedotal wishing or "emotional thinking" that is cold hard facts, no matter where you are. 

Now, let me see if I can break this down where you might be able to understand it. Your informing others you practice your way regardless of the studies, modalities of treatment, etc., not the national or proven ways. I really do doubt that you were taught such, if so; your school and instructors are lacking. 

No one desribed not to attempt treat an infant that has became apneic or went into an arrest; however those that have SIDS are usually found past the point. It has been greater than 15-30 minutes since the infant was last seen. Usually pooling (levidity) has occurred and death had occured past the agreed time limits. 

Stating "regardless" upon how this is going to effect the family goes to my point that you are doing for yourself, not the patient. You are not a hero, nor a life saver, your a just a Paramedic with a job to do (be it calling the code or working one). 


R/r 911


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## triemal04 (Oct 8, 2008)

This has become (as happens many, many times) a pointless thread; someone has decided that what they do is the appropriate course of action (despite what the FACTS and EVIDENCE say) and decides that they will continue to do what they want no matter what.

But as a final comment, Hasting's, I gotta know...does this mean that you work ALL codes?  And I do mean ALL of them (trauma, elderly with/without rigor/lividity, decomp, decapitation, etc etc) because in each case, since we are paramedics there is an expectation that "you are going to come and you are going to do everything you can to fix the problem?"  I'm betting the answer is no, and, as you admit, you will only work pediatric codes that shouldn't be worked because of personal reasons.

I hope you can see the problem with that.  For someone who seems to like increased education for EMS, who seems to want EMS to move forward, it's odd that instead you would adopt the attitude and actions that are holding EMS back.

When the original patient is dead and beyond help, they are dead and no longer need your attention.  The ones who do, and are now your patients are the survivors, be it a 90 year old husband/wife, are a 20-something set of parent's.

Why do so many new paramedics think that they know best and know so much more than anyone else!?


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## Hastings (Oct 8, 2008)

triemal04 said:


> Why do so many new paramedics think that they know best and know so much more than anyone else!?



Lol.

+10 Lolz.


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## volparamedic (Oct 8, 2008)

*SIDS Calls*

I found every situation is different. Most of the time it is possible to explain to the parents it's too late. When your life is in grave danger you bls to the truck and call it there. I haven't had to do the bls thing. I usually explain that even if we did everything medically there would be 0% chance they could be revived. You'll know if there's something fishy going on. A true SIDS case the family will be destraut. I usually let the mother hold the infant wrapped in a blanket if it feaseable. Being a mother of 3 and what I've seen on SIDS calls the best medicine for the mother you can give her is allowing her to hold her baby one more time at home. You'll have to gain some experience in feeling each call and making a judgement call when it occurs on how to handle it.


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## triemal04 (Oct 8, 2008)

Hastings said:


> Lol.
> 
> +10 Lolz.


Absolutely, I agree, very funny.  (but you didn't address any of the points in my previous post...why?)  But I'm thinking it's also very true (if it's not then you'll get the fastest apology ever and as an added bonus I'll do 5 laps around my house while naked) based on many comment's that you've posted and your refusal to ever say how long you've been a paramedic for, both here and elsewhere (I'm gonna say around a year on one side or the other).  Of course, this isn't neccasarily a problem; everybody started out fresh once.  But it can be.

It's not just people who have been doing something for 20 years that become set in doing something a certain way and are a problem; it's also people who have been doing something for 20 days and won't listen to someone else's opinion on how something should be done.  Based on your responces here and in other threads, that does sort of describe you; when you are told that what you are doing is wrong, or could be done differently, or better, or such, you immedietly go on the defensce and refuse to even consider doing it differently.  Why?  There are thousands of paramedics who have been doing this for decades...do you really think there is nothing that you can learn from them, or that you know better in every case?  Being so close-minded that you refuse to listen to another's idea of why and immedietly discount it as wrong will only create problems for you, especially in medicine, which can change at a rapid rate.  This situation is a perfect example:  you are doing something not because it is medically appropriate, or because it is the best thing for the family, but because you want to, because it's for YOU.  So inappropriate.  The reasons why are listed, but apparenty, you know better.  So be it.

Good luck with your career.


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## Ridryder911 (Oct 8, 2008)

Hastings said:


> Lol.
> 
> +10 Lolz.



Personally, I didn't see anything funny or humorous...

R/r 911


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## Hastings (Oct 9, 2008)

triemal04 said:


> It's not just people who have been doing something for 20 years that become set in doing something a certain way and are a problem



Let's take a moment to address that problem then.



triemal04 said:


> it's also people who have been doing something for 20 *years* and won't listen to someone else's opinion on how something should be done.



Fixed.


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## Hastings (Oct 9, 2008)

And even though you've turned me off completely from responding in a serious manner, I can agree that I would not be working an infant in rigor under any circumstances. But at that point, most families already know what's going on.

Any other situation, and I will try everything I can. And you're right. Infants are no different than anyone else. I'd work anyone else not in rigor too.

But Rigor, you have my agreement. Thankfully - and surprisingly - of the three I've been called for, neither was at that point. All three were worked. Zero survived.


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## KEVD18 (Oct 9, 2008)

hastings, are you running for president?


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## Hastings (Oct 9, 2008)

It's called being a Paramedic and taking the initiative to do research, learn. 

Afterall, is that not what you were trying (and failing) to promote?

Granted, none of you helped to promote anything besides locking up and becoming unresponsive to the posts here with more attacks (see above post). But again, as a paramedic, I felt it was necessary to go out and seek the articles that the others neglected to post here. I read, I re-evaluated, and I - well on my own - have gained more information that may alter my treatment plans.


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## karaya (Oct 9, 2008)

Hastings said:


> It's called being a Paramedic and taking the initiative to do research, learn.
> 
> Afterall, is that not what you were trying (and failing) to promote?
> 
> Granted, none of you helped to promote anything besides locking up and becoming unresponsive to the posts here with more attacks (see above post). But again, as a paramedic, I felt it was necessary to go out and seek the articles that the others neglected to post here. I read, I re-evaluated, and I - well on my own - have gained more information that may alter my treatment plans.


 
Can you provide us with some articles that support this?

Ray


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## Hastings (Oct 9, 2008)

Which part? To do CPR unless infant is in rigor?


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## karaya (Oct 9, 2008)

Hastings said:


> Which part? To do CPR unless infant is in rigor?


 
I'm sure regional protocols would define "obvious death" in differing aspects. I'm curious as to what you may be referring to when you state unless they are in rigor you will begin CPR.

Also, there are numerous articles that pooh pooh the concept of doing CPR for the sake of the family. All you're doing is dragging out an already highly emotional and physiological event in which statistically the survival rate is 0%. I agree with other posters here that better training for EMS personnel to communicate with families in such crises is a much better solution than carrying on a futile theatrical effort.

Ray


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## Hastings (Oct 9, 2008)

karaya said:


> I'm sure regional protocols would define "obvious death" in differing aspects. I'm curious as to what you may be referring to when you state unless they are in rigor you will begin CPR.
> 
> Also, there are numerous articles that pooh pooh the concept of doing CPR for the sake of the family. All you're doing is dragging out an already highly emotional and physiological event in which statistically the survival rate is 0%. I agree with other posters here that better training for EMS personnel to communicate with families in such crises is a much better solution than carrying on a futile theatrical effort.
> 
> Ray



Many articles referenced, none linked.

Edit: But at least you're wildly more polite than the others about it.


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## karaya (Oct 9, 2008)

Here's one by Thom ****. I saw another one a few weeks ago which did not reference SIDS but false resuscitation efforts for "comfort". I'll put it up as soon as I find it.

http://articles.directorym.net/CRIB_DEATH-a907041.html


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## akflightmedic (Oct 10, 2008)

Hastings said:


> Many articles referenced, none linked.
> 
> Edit: But at least you're wildly more polite than the others about it.



Interesting thread thus far. I do find it ironic that you are calling out someone for not referencing articles when you did the very same thing a few posts up.

Not an attack, just an observation as it is necessary to provide support to validate your opinion, especially when you state you read a lot of articles that everyone failed to mention which support your point of view. Had you not stated there were articles you had read, and merely supported your argument based on your opinion, you would not be creating the faux pas as evidenced here.

Proper debate rules 101...


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## Hastings (Oct 10, 2008)

akflightmedic said:


> Interesting thread thus far. I do find it ironic that you are calling out someone for not referencing articles when you did the very same thing a few posts up.
> 
> Not an attack, just an observation as it is necessary to provide support to validate your opinion, especially when you state you read a lot of articles that everyone failed to mention which support your point of view. Had you not stated there were articles you had read, and merely supported your argument based on your opinion, you would not be creating the faux paux as evidenced here.
> 
> Proper debate rules 101...



I did not find any need for me to post articles in this thread as I was not claiming to know the answer to a question without an answer. All I've done in this thread is state a personal opinion; a personal way of handling a situation with no right or wrong answer. I demand articles from these other members because they took a different path, insisting that this situation does in fact have a right and wrong approach. The burden of proof is upon them.

I'll go back and review my previous posts, but I don't believe I referenced any articles to back up my opinions until the moment I made an amendment to my opinion above - finding the articles other members failed to produce that supported some of their claims.



I stated I found several articles that supported what THEY had said. I can see how it was unclear now that I re-read the previous post. What I was saying was that I had gone out and actually searched for articles to back up what others had been trying to convince me of here since they failed to post them themselves. I found several articles that did argue against working an infant in Rigor. And as such, I would not work an infant in Rigor. Granted, I wouldn't have anyway, as in a practical manner, that wouldn't fool anyone. But now there is a clear factual reason not to. In other words, I did their work for them. Give your debate advice to them.


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## akflightmedic (Oct 10, 2008)

Hastings said:


> It's called being a Paramedic and taking the initiative to do research, learn.
> 
> Afterall, is that not what you were trying (and failing) to promote?
> 
> Granted, none of you helped to promote anything besides locking up and becoming unresponsive to the posts here with more attacks (see above post). But again, as a paramedic, I felt it was necessary to go out and seek the articles that the others neglected to post here. I read, I re-evaluated, and I - well on my own - have gained more information that may alter my treatment plans.



This is what you implied here...or so the context of your message seems to convey. Am I wrong as are the others in assuming this? If so, my apologies.


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## Hastings (Oct 10, 2008)

akflightmedic said:


> This is what you implied here...or so the context of your message seems to convey. Am I wrong as are the others in assuming this? If so, my apologies.



Again, after re-reading, I can see how it was unclear what I meant. Read above.


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## Grady_emt (Oct 11, 2008)

Dead is dead, regardless of age.

Yes, there are cartain things that a faimily could do to make we work a code...ie: hold a gun to my head and I'm not just standing there waiting on you to pull the trigger.  I do hope that no only have you said goodbye to your baby, your wife, parents, auntie and cuz, because you're in for some time @ the pokey.

For those that have said something to the effect of "let momma hold baby in a blanket and say goodbye" what about considering any suapicious death a crime scene until proven otherwise?  Are you not also obligated for the preservation of crime scenes to a certain extent also, and by allowing this practice, violating the crime scene.  PD is automatically dispatched on all pedi pts down around here.  If the PD unit is onscene and says it's ok for Momma to hold baby, then it's his crime scene and his call, not mine.  

Personally, I try to sit the family down in a controlled enviroment like the den and explain what has happened, what is happening, and what will happen in the near future.  Just like grandma, ask if there is anyone you can call for them.  This is not going to be an quick run, don't try to make it one even if you were supposed to get off an hour ago.

I'm not going to even get into show-coding or working a pt to the truck, or any of that other non-sense.


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## tydek07 (Nov 6, 2008)

*...*



Emtgirl21 said:


> When you run a SIDS death and the infant beyond attempting resiscutation whats your school of thought. Tell the parents there is nothing you can do and let the parents attempt to wrap their head around it and say goodbye or grab the baby and run for the truck?
> 
> I recently had a SIDS death.




I agree with a lot of the other people that have posted on this thread. There is no sense in giving false hope, when you know that there is no chance of getting the kid back. Its best to just tell the parents that there is nothing more you can do. Also, don't expect to walk in, tell them, then leave. Most often they will have questions and will want someone to talk to.

Take Care,


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