SIDS whats your school of thought?

[KEVD18]

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.

 

[MMiz]

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.

 

[VentMedic]

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.

 

[KEVD18]

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.

 

[MMiz]

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?

 

[KEVD18]

yup.......

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

 

[VentMedic]

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.

 

[traumateam1]

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
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

"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:

 

[MMiz]

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?

 

[traumateam1]

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.

 

[VentMedic]

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.

 

[MMiz]

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.

 

[reaper]

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!

 

[MMiz]

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.

 

[KEVD18]

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.

 

[VentMedic]

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.

 

[MMiz]

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.

 

[KEVD18]

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".

 

[reaper]

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.

 

[MMiz]

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.