Child/Adult Codes

[enjoynz]

This is getting off topic...and my comments were aimed at what AJ had said to me but..........

I know what you are saying Rid and I'm all for all EMS staff getting as much education as possible to benefit the public.
But you know it as well as I do, that if you were to take every volunteer out of the EMS equation tomorrow, in whatever country....
the EMS would collapse.

And for that reason, as I think I've said before, it would be a total lack of resources, money, education
(for those of you that don't know, it's 3 years at university and $50.000 NZ in fees, to become a medic here),
and waste of skills to put a Paramedic on a rural station, that has 4 calls a month average. (like the town I live in).
Much better that they stay in a high call volume area (and maintain their skills) and sit in a chopper for 10 mins to get to us, as the need maybe.
Hence the reason volunteer's are a good resource to start the ball rolling, so to speak.

As far as codes go...I know the out come for most are not good...otherwise I might still have some family member's alive.
In NZ ,the patient's are worked for at least 20 mins before calling it. That's 20 mins for everyone, know matter what their age, unless of course they are hypothermic.
We are not encouraged to work it longer for the sake of the family/parent benefit. As I said before... it's a case by case scenario.

Cheers Enjoynz

 

[Foxbat]

Getting back to the topic...

If nobody mentioned, you have a better chance of resuscitating a 98 year old SNF patient than you do a kid that codes.

Why? I was under impression that kids are more likely to code due to choking than anything else, and that's why pediatric chain of survival is different from adult.

 

[karaya]

Now I ask; have you ever attended a National Curriculum Committee to be told "we have to reduce our current curriculum" to be told "You guys (educators) don't seem to understand; the course is too long and we are loosing them (volunteers); so we need to make it easier and as short as possible"; well have you? R/r 911

Rid, are talking about the new National EMS Education Standards which is replacing the current National Standard Curricula?

 

[CombatMedic140]

Treating A Child

What is the proper response to the following situation.
You arrive on seen to treat a 2 year old child. The child's mother gives consent, but then the father walks and says he does not give his consent to treat the child.

(a) continue to treat the child in the mother presence
(b) Call the police for backup
(c) stop treating the child
(d) Call Child Services for approval

 

[Aidey]

Keep treating and call the police. Same as with an adult who has a DNR that one family member revokes and another wants to uphold.

 

[VentMedic]

Originally Posted by Veneficus
If nobody mentioned, you have a better chance of resuscitating a 98 year old SNF patient than you do a kid that codes.

Getting back to the topic...
Why? I was under impression that kids are more likely to code due to choking than anything else, and that's why pediatric chain of survival is different from adult.

The child is more likely to code but if between a 98 y/o and a child's chances of successful ROSC, my money is on the 98 y/o.

A child's success rate is better but not great if found in a shockable rhythm. Once the rhythm becomes asystole, even if you regain a shockable rhythm back, the odds of a good outcome is very, very poor.

Reasons:
The child has a higher rate of metabolism and whatever O2 and energy stores were available, quickly deplete. Thus a quicker onset of O2 deficit to the organs. This is one of the reasons for the different chain of survival.

98 y/o has a much slower metabolic rate and collateral circulation providing alternate routes of blood flow throughout more organs than just the heart.

 

[Aidey]

But kids have more *"plastic" brains than the 98 year old.


*Sorry, I can't explain it any better than that. Plastic, or plasticity is the scientific term and I'm not good at translating.

 

[Veneficus]

Getting back to the topic...



Why? I was under impression that kids are more likely to code due to choking than anything else, and that's why pediatric chain of survival is different from adult.

As vent mentioned, once a kid codes, it is pretty much over. They burn through all the metaboilc reserves prior to losing a pulse, once they do you are left with pretty much nothing at the biochemical level. That is why the chain of survival is different. Hypoxia is the most likely cause, but it is very importantant to intercede prior to the loss of pulse. You mentioned about the brain insults a little later. the brain does recover better when resuscitation succeeds, but extremely rare is a ROSC outside of an early vfib, torsades, or pulseless vtach.

One day they will find a way to inject ATP without the lethal mag overdose that accompanies it.

 

[MSDeltaFlt]

So, the code thread has got me thinking. I've been noticing that a lot of people feel children deserve more effort into their resucitation.

At the station today I was browsing OCFD's termination of resucitation protocol.




Their protocol is very simple, all guidelines must be met.

• Downtime greater than 20 minutes
• Intial and end rhythm must be asystole
• Worked for 20 minutes
• Two rounds of epi
• Two rounds of atropine
• Asystole must be confirmed in two leads
• ETCO2 read must be 10mmHg or less after 20 minutes of effective CPR

However, it also states that due to age or bystander input a paramedic can decide not to terminate resucitation efforts.

Why do people feel the elderly do not deserve your 100% effort and children do? Is their life any less valuable? That 60 year old woman is someone's mother, sister, etc.

Because, my dear, when people see a lifeless child they might be seeing their own child. And it tends to hit a little close to home. Some might realize it. Some might not. They let their hearts make the decisions and are going off of emotions because this is an innocent "child".

Health care is very humanistic. It is and will always be personal. You're dealing with humans. You're dealing with emotions. You're dealing with human error on both sides of the equation.

Right or wrong, it is what it is.

 

[PapaBear434]

Because, my dear, when people see a lifeless child they might be seeing their own child. And it tends to hit a little close to home. Some might realize it. Some might not. They let their hearts make the decisions and are going off of emotions because this is an innocent "child".

Health care is very humanistic. It is and will always be personal. You're dealing with humans. You're dealing with emotions. You're dealing with human error on both sides of the equation.

Right or wrong, it is what it is.

Well said. It's not logical at all, but nothing human is.

 

[AJ Hidell]

Because, my dear, when people see a lifeless child they might be seeing their own child. And it tends to hit a little close to home.

Not everyone has kids. In fact, most people in EMS are younger and still childless. But everyone has grandparents. You'd think that would hit close to home more often. That's why I said before, a lot of people who don't even know if they have a problem with pedi patients say they do simply because it is what they've heard.