SIDS whats your school of thought?

[Emtgirl21]

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.

 

[KEVD18]

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.

 

[traumateam1]

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?

 

[Hastings]

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.

 

[Ridryder911]

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

 

[Sasha]

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.

 

[Jon]

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.

 

[Ridryder911]

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

 

[VentMedic]

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.

 

[Jeffrey_169]

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

 

[MMiz]

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.

 

[Hastings]

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.

 

[Bosco578]

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.

 

[reaper]

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!

 

[KEVD18]

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.

 

[MMiz]

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.

 

[KEVD18]

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.

 

[traumateam1]

A little confused..

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.

 

[KEVD18]

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.

 

[VentMedic]

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.