Unsuccessful Resuscitation

RocketMedic

RocketMedic

Californian, Lost in Texas
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For all of the successful resuscitations, some seventy percent are unsuccessful. We had one yesterday- down time less than 5 minutes before CPR, initially V-fib, defibrillated 4 times with no conversion, etc. Became asystolic and stayed that way.
 
Any ideas about what the cause was? Sometimes there's just nothing you can do.
 
I've had several ROSCs in the last year... each one died a couple of days later. I've yet to have one leave neurologically intact as far as I know.


I could have had one last night...patient went in to vfib right in front of us, but family said patient had a DNR and they wished nothing to be done.
 
Linuss said:
I could have had one last night...patient went in to vfib right in front of us, but family said patient had a DNR and they wished nothing to be done.
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The family “said” the patient had a DNR? Don’t you have to actually see it/have a physical copy in hand before not treating?
 
planetmike said:
The family “said” the patient had a DNR? Don’t you have to actually see it/have a physical copy in hand before not treating?
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Yep. If they didn't show you one and that family figures out they can sue you then uh oh
 
I am sure Linuss used sound judgement and followed his area procedure. He has been a member of this forum for a long time.
 
Aprz said:
I am sure Linuss used sound judgement and followed his area procedure. He has been a member of this forum for a long time.
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I thought I was seeing a ghost when he started posting again. I also think he is a lawyer... But I can't remember.
 
planetmike said:
The family “said” the patient had a DNR? Don’t you have to actually see it/have a physical copy in hand before not treating?
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Not here. If the family is all the same page and states that the patient would not want any heroic measures done we will certainly call in and request permission to cease efforts.
 
I think it was cardiac. Atraumatic, healthy-looking, looked normal beforehand. He was a mover from another part of Texas and died surrounded by complete strangers and day-one coworkers. We didn't figure out who he was until we called the truck owner.
 
planetmike said:
The family “said” the patient had a DNR? Don’t you have to actually see it/have a physical copy in hand before not treating?
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Our policy is to honor the DNR if they can provide it. If they don't have one present but have non- official (such as advanced directives) or family wishes nothing to be done, we call med control for their thoughts. I called, they said just bag and transport, no ACLS, so that's what we did. It was recorded and was done on good faith.




But believe me, it irks the hell out of me each time. Seriously, just keep the darn legal paper with patient, it avoids headaches all around.
 
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How long did he stay in ventricular fibrillation for prior to going asystole? Was it after 4 shocks? I have been reading about using esmolol, or other beta blockers, in refractory ventricular fibrillation. If it was for awhile, sounds like he may have been a candidate.
 
It was about ten minutes all told, all prior to us arriving. Twenty-five minutes asystolic before we terminated efforts.
 
Aprz said:
How long did he stay in ventricular fibrillation for prior to going asystole? Was it after 4 shocks? I have been reading about using esmolol, or other beta blockers, in refractory ventricular fibrillation. If it was for awhile, sounds like he may have been a candidate.
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Double-sequential defibrillation as well if he was refractory. I can't remember the exact number of shocks, I want to say 5 or 6 before it's considered.
 
By the time we got a second monitor there, he was asystolic.
 
Chewy20 said:
Yep. If they didn't show you one and that family figures out they can sue you then uh oh
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There is no blanket right answer here. Different services, regions , states have different policies and laws.
For example. Where I work we can honor verbal DNRs from pts and from family, we can also accept expired and incomplete DNRs as long as the pts wishes are known to us and it is reasonable. No OLMC needed.
 
="Chewy20, post: 559472, member: 20542"]Yep. If they didn't show you one and that family figures out they can sue you then uh oh[/QUOTE]
Poffle. Medical control exists for this.
 
I've not attempted resuscitation without the DNR several times. Patient's family states they have one but not with them or not sure where it is, quick call to the doc and pronounce right there.
 
Handsome Robb said:
Double-sequential defibrillation as well if he was refractory. I can't remember the exact number of shocks, I want to say 5 or 6 before it's considered.
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Agh, I want to do this so badly. I spoke to my medical director about the likelihood of him granting orders for it if called though and was told it would be no every time :/
 
chaz90 said:
Agh, I want to do this so badly. I spoke to my medical director about the likelihood of him granting orders for it if called though and was told it would be no every time :/
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His rationale?
 
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