# Sids



## certguy (Sep 15, 2007)

Guys I have a question that's been bugging me for years . I once had a SIDS baby that even in the ER , intubated , and with good compressions , never pinked up. The skins stayed ashen gray the whole time . The closest ER was a DR on call  community hosp. that didn't have adequate staff to handle the code and thier other pt. load , so my partner and I assisted for a couple hours till the Children's Hospital CHET team arrived and called him . THis has always puzzled me . Any ideas ???????


----------



## Summit (Sep 15, 2007)

are you confused about the short staffing or that lakc of pinking?


----------



## MMiz (Sep 15, 2007)

What's your question?


----------



## PArescueEMT (Sep 15, 2007)

I'm guessing that it has to do with the Cyanosis... if that's a correct assumption, it could be 2 things...

1. The baby was too far gone to make any save
2. The tube was incorrectly placed

If it has to do with staffing.... i can't help you on that one


----------



## SwissEMT (Sep 15, 2007)

Or are you asking about the pathophysiology of SIDS?
:wacko:


----------



## Ridryder911 (Sep 15, 2007)

Infant deaths are complex. The etiology of SIDS is unknown..hence why it is still called a syndrome, although; there are a lot of theories out there.

The profound cyanosis can be caused by multiple reasons as well, like PArescue described improper tube placement, or the child had been down too long, as described. Other reasons maybe associated with congenital problems such a pulmonary/arterial mismatch, arteriosus ductus non forming, an couple of hundred other reasons.. no matter, it was tragic and very reasonable nothing could be done. I have only seen one SIDS type incidence in 30 years that was ever sorta-of resuscitated. The child was resuscitated to a veggie state, and truthfully some of ones I regret. 

You did the best you could do and chalk that up with experience. I personally no-longer even attempt resuscitation measures on an infant that has any morbidity signs, or has not had active history within > 30 minutes. Personal opinion, it only gives a gives a false hope, and a large medical bill. For this is another debate. 

R/r 911


----------



## Gbro (Sep 16, 2007)

I give you and your Crew A+ for your effort to save a little one in such a tragic event. 
My 1st run with a SIDS was 25 years ago and on 12/26  and its still with me, because it is so difficult. time dose make things better, but we in the EMS "can and DO" grieve. 

Bottom line, if the baby was healthy prior to the SIDS, If baby has been down too long before CPR, the heart has nothing to pump, It has lost its prime.

On my 1st one the baby was monitored for SIDS.
I'll never forget taking the baby out of the Mothers arms. 
My youngest was very close in age, I held her for hours that evening.
Its OK to feel for your Pt's
I never want to get to where it doesn't bother me.


----------



## certguy (Sep 16, 2007)

*sids , con't*

Thanks guys , 
    I've just always wondered about the skin color . That was my first sids and one of those calls you never forget . Total time was 7 min. from when we got the call to ER. When we got on scene , a firefighter met us at the curb with baby in his arms doing CPR . The info we got was that he wasn't down long and showed no signs of morbidity . That was also the first  time I'd gotten to see Children's Hospital's emergency transport team in action and the first time I'd seen an IO put in . Gotta admit , I'm glad the baby couldn't feel it . I cringed . It was rough but a good learning experience . 

                                     CERTGUY


----------



## Airwaygoddess (Sep 17, 2007)

I think it is important to do some follow up counselling for this type of call, I agree with everyone here that a SIDS call will be one of the hardest one you will ever run on.  My thoughts are with you today.......-_-


----------



## Airwaygoddess (Sep 17, 2007)

I think this would be a good subject for all of us to review on, any takers?  (Paging VentMedic and RID!)


----------



## Ridryder911 (Sep 18, 2007)

I personally understand that SIDS cases at first makes us become " human " in the response that it touches our emotions more than most calls. Families are the innocent victim of a tragic event, that a sweet angelic life was taken way before its prime. Yes, one can question life considerably. 

I as well believe that discussing the problem with some "senior" members or trusted staff is invaluable. As well, more and more hospital chaplains are specially trained in dealing with grieving families, and yes helping medical providers cope with such bad situations. 

I am fortunate, my hospital chaplain (whom now is my minster) is great! The hospital mandates grieving training and updates for all staff members. From the housekeeping to physicians. Especially, those in critical areas such as ER and ICU, that sees death and horrible events on a daily basis. 

It is nice to have an non-judgemental ear sometimes.... 

With that saying, and not trying to hijack this interesting thread, I believe SIDS and pediatric calls are still way misunderstood. So many times, the treatment and how we perform is not in reference to the patient. Our focus is really upon our uncomfortableness and dealing with a horrible situation.

What is the difference in pronouncing an 80 year old versus an 8 day old, if conclusive signs of death was present? Again, not trying to be cold hearted rather fully seeing the whole picture. As I become more experienced, a code is a code, if I make the determination that get 100% or nothing. This is why I request field termination on many. Realistically, resuscitation is very futile except on a very few. Again, as we discussed those with certain criteria. 

I believe we will see more exact criteria as the ethical dilemma is addressed more and narrowed down in specific criteria and guidelines. Even AHA and American Pediatric Physicians have agreed upon some new criteria as delivered in the Neonatal Resuscitation Program (NRP) . 

R/r 911


----------



## Gbro (Sep 18, 2007)

> What is the difference in pronouncing an 80 year old versus an 8 day old


A statement like that just cannot be made without some ice on it.
We need to have compassion in us, our patients lives depend on it.

Remember, a SIDS case is so much like a FBOA, in that we do what we can with the best of our abilities(this is where some of us differ). The outcome isn't ours to determine. That is the Lords call.


----------



## Ridryder911 (Sep 18, 2007)

I believe the Lord uses us as instruments to make those decisions. Some human form makes the final determination. Do you still work a patient in rigor or patients in traumatic arrests? 

Why would one want to bring the hopes of a grieving family up knowing that in reality we are just "performing" for them as well increasing their financial bill to several thousands of dollars? I believe this is unethical and grossly negligent. 

Just because the healthcare provider own emotional status is challenged, does not mean the care and treatment should be altered. Again, it is about the patient, not the provider! There is a difference between empathy & sympathy. 

We should not be in EMS to make ourselves feel good. That is great, if it occurs, but our main mission should be about the patient and their associated loved ones. When the patient has expired, the family immediately becomes our patient. Our care should be directed on obtaining appropriate grief counselors, and making sure all is taken care for them as possible. It should be immediately turned over to the appropriate authorities.

Every patient is important, one should not be valued more than another.... if one does, do they not discriminate? 


R/r 911


----------



## BossyCow (Sep 18, 2007)

I think part of what influences us is not just wanting to 'put on a show' for the parents, but an unwillingness to accept that an infant has died.  We like reasons.  The 80yo has 80 years of roads traveled with all the accompanying side effects.  We can see what's killing the 80 yo, but not a seemingly healthy infant.  

Part of the problem is that so little is known about SIDS and what may be causing it.


----------



## triemal04 (Sep 19, 2007)

Sorry, but SIDS is nothing like a FBAO.  At all.  

As far as working a code on a sids baby...that will have to be based on the medic's (or EMT if they are allowed to make that determination) assessment; if the down time has been very prolonged, which is common...resucitation may not be warranted, and now there are 2 more pt's for you to take care of.  If the pt has only been down for awhile...that's a no brainer.  There really isn't a catch-all answer as the down time and initial presentation can be different each time.  This is where using your clinical judgement, training, education, experience and knowledge come into play.

Pediatric calls, especially codes can often be very emotional, but you can't let that change how you treat your pt.  Ever.  Do what is right for them, and then do what is right for the family.


----------



## Gbro (Sep 19, 2007)

> Sorry, but SIDS is nothing like a FBAO. At all.



Please;

All i was referring to; In BLS*("that is the forum") *We do our protocols, 

We don't make the decisions on who gets treated based  on outcome in "BLS".(unless of course there are very obvious signs).
We use our ALS intercepts. They can make the call. 
That is the way it is. 

In the rural setting CPR is started on many that are "way gone", We don't have the authority to call a code, Fortunately we have Intercepts and the Medic's can make that call.


----------



## TheDoll (Sep 26, 2007)

what is FBAO?


----------



## Onceamedic (Sep 26, 2007)

triemal04 said:


> Do what is right for them, and then do what is right for the family.



Now this is an interesting point.  What is right for the family that you as a paramedic can or should do?  Do you help them make phone calls?  Do you sit down and talk to them?  What do you do?  What have you done?


----------



## eggshen (Sep 27, 2007)

Being a man without a cross so to speak I am not sure about the "Lord's call" as you put it but my method of looking at it has become this; as long appropriate measures are taken by competent personel that is the way things were supposed to go and regardless of who showed up, that is that. I think that may be along the same lines right? There is no worse call out there than a pediatric death (transport or not) and I'm sure everyone will agree. I personally find it hard to deal with school age children, regradless of the nature of illness or injury, although murder seems to be the topper. When I quit the job I will be able to identify the motivation down to the day and alley. 

Getting to the "what do you do?" question I have done it all. Made meals, rolled around in the dirt, called VA and so on. Whatever you end up doing will depend on you and how the notification goes. Telling everyone great grandpa is a gonner is far and away from informing mom and dad that their second grader did not fair so well. You have to roll with what comes along and accept that RIGHT NOW that might be the best thing that can happen.

I am fully down with Rid as fas as whether or not to work them so to speak. I think a lot of systems work way too many arrests. I tend to be quite liberal as to who I will and will not work. An eggplant is not a "save". Dead is dead..... 8 or 80. 

Sorry to hijack anything if I did. Between booze, drugs and "psycholotrists" I have spent a lot of time of this topic.


Cheers 
Egg

Oh yea, FBAO: foriegn body airway obstruction....did I get it right?


----------



## Ridryder911 (Sep 27, 2007)

+ 5 points for correct identify FBAO..

In any decease patient the family, loved ones is NOW your patient. Dependent upon the system, time will allow you to perform any tasks. I know of many EMS systems that are only allowed a certain amount of time, and especially for non-transport so they can respond to another emergency. Understandable, but also a shame. 

I personally make phone calls to a Chaplain, Minister or friends. Allow them to grieve and listen.. A personal comment on my sympathy and maybe a cup of coffee, Kleenex, etc.. 

Family will remember kind words, empathy facial expressions, much more than resuscitation efforts you might had performed. 

R/r 911


----------



## eggshen (Sep 27, 2007)

Word

Cheers
Egg


----------



## TheDoll (Sep 27, 2007)

eggshen said:


> Oh yea, FBAO: foriegn body airway obstruction....did I get it right?


thank you!


----------



## triemal04 (Sep 30, 2007)

Kaisu said:


> Now this is an interesting point.  What is right for the family that you as a paramedic can or should do?  Do you help them make phone calls?  Do you sit down and talk to them?  What do you do?  What have you done?


Yes and yes.  You go and talk with them.  Ask what you can do, if there is someone you can call, answer the questions they have about what will happen next.  And yes, I've done it.  (not that it's that special; everyone who is a medic OR EMT has done this, or should have)

It will depend on the person though.  Some need someone to comfort them and hold their hand for awhile, and some just want you out.  A lot will depend on how they react to the death; if it's a brand new baby...gonna be bad.  If it's grandpa who has been on death's door for 6 months and they were allready prepared...not gonna be as bad.

You can't ever forget, no matter what your EMT cert is or how much experience you have, after the death of a loved one, the people left standing will need you.  Even if it's only to ask if you can do anything, that'll still be some comfort.


----------



## Emtgirl21 (Sep 30, 2007)

The area where I started in EMS, if we could calm the family down to a lower level of histeria we would wrapp the baby in one of its blankets and tell the family that there is nothing that can be done and ask them if they would like to say goodbye to their baby. Just let them rock the baby and say goodbye privately. If the situation was just kinda "off" and things didnt seem right then it was handled differently. If the family was just going bonker we would transport without family.


----------

