Your patients asks you "Am I going to die?"

Well, the only one I've ever seriously had ask me that was some guy at the local college that got wasted as everything and the etoh convinced him that it'd be a good idea to, for no reason, break a window with his face- at 8 in the morning, mind. He was fine for the most part- had a pretty decent gash on his scalp, which had been stopped with at least 5,000 2x2 gauze pads held in place with some roller gauze by the fire department by the time we got there. Patient had no notable change in vitals, was no longer bleeding, and still had a respectable amount of alcohol both in his blood and on his breath. Well, he was a sad drunk, and all the way to the hospital, he commenced to asking the medic for life help and whether or not he was going to die. Good times.

On a more serious note, if it's something that could go bad or is actively heading south for the ever, I typically try to respond with a classic sideways answer: "We're doing our best." Everything I've read on survival (life or death scenarios, lost in the woods, whatever) indicates that morale plays a huge part in it, and the last thing I'd want to do is skew somebody's odds by blowing apart their morale.
 
If they are not I say "no you'll be fine". If they are or they're is a good chance I say "I will do all I can to help you but you gotta to keep your head up. Lets fight this one together" Humor can work too depending on the patient so I'll sometimes say "you can't die in this ambulance its against regulations. this ambulance isn't set up for dying patients its only set up for saving patients"
 
I usually say "Yes you will, but not now." And for some reason, it seems to calm them down.
 
Don't have a set thing to tell them. Just try to keep their spirits up. What is worse than someone asking if they are going to die is to have an accident victim that is in bad shape look at you and calmly tell you that they are dieing. That will really get the adrenaline flowing.
 
TomB said:
I say, "Sorry, not in my ambulance. It's not allowed."
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That Is the Perfect answer ill say, because it shows the patient that you know what you are doing and that you will do anything in your abbilaty to help that patient... respect for that answer TOM B
 
Pietie said:
That Is the Perfect answer ill say, because it shows the patient that you know what you are doing and that you will do anything in your abbilaty to help that patient... respect for that answer TOM B
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Why when its a lie? Never lie to the patient. If they are definitely dieing be honest. If its bad but not sure then use the we're doing all we can to keep it from happening.
 
"you are in good hands and we are trying our best. Hang in there"
 
Be honest but tactful. We tell our patients we are doing everything we can. (Then you might want to turn around and tell your driver to test if your unit has a govenor or not)^_^
 
Sasha said:
I've never had someone ask that, because I do IFT! Most of my patients are stable. We do get a few Non-DNR patients who try to die while you're not looking, though.
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Those IFT patients are sneaky, gotta watch out. :ph34r:

rhan101277 said:
We don't want people dying in our ambulances either. We do cpr and bagging until we get to the hospital. Unless they are DOA and the funeral home can't come get them.
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Unless you have long transport times, If you've made the decision to transport a patient that is coding, I'd certainly hope you'd continue working the patient until you get to the hospital. (Keep in mind I live in the suburbs, transport time to a hospital is about 5 minutes, 7 minutes to a level I)

BossyCow said:
This belief system really confuses me.
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Feel free not to believe.

281mustang said:
Even just telling them they're going to die is an imcompitent thing to do. If the professional they trust to save their life is telling them they're going to die many of them will lose their will to survive.
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So we should just spit sunshine at them?
 
TomB said:
Okay, playing Devil's Advocate, how is it given to us to know that a conscious and talking patient is most likely going to die (from this emergency)? Let me guess! Like something from the movie "Signs" with Mel Gibson? As soon as the object is lifted, then the patient dies? Okay.... I suppose it's remotely possible. If it's possible to know that a patient is most likely going to die, then yes, you let that person know in case he or she has any last words, which should be carefully recorded.
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That's more than remotely possible saw a guy on FT Hood pinned up against a tree with a Bradley... He didn't die immediately after extrication but it was under 5minutes.
 
Afflixion said:
That's more than remotely possible saw a guy on FT Hood pinned up against a tree with a Bradley... He didn't die immediately after extrication but it was under 5minutes.
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10 points to the person that can name the reason a person pinned against a tree for an extended period of time might die shortly after being freed.
 
Crush injury leading to tamponade.

Just my guess...

The pinning object would impede blood flow to the legs (or whatever is crushed) creating tamponade, keeping the BP stable in the "non injured" trunk/head.

As soon as you remove the pinning object, the "beneficial" occluding aspect is gone, BP plummets and the pt dies from hypovolemic shock.

Am I on the right track?
 
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Crush Syndrome...

When a pt. is trapped, damage is done in the cellular level, causing Hydrogen Ions to be released from the damaged cells, causing catastrophic damage to the healthy cells. The environment becomes extremely acidic and the cells are releasing K+ from them, so when you relieve the pressure the H+ and K+ and other waste (ie... Rhabdomyolysis, etc... ) is allowed to rush back into the trunk, causing widespread septic conditions and electrolyte imbalances....

If they don't die immediately, they will die of MODS within the next few days. Not an easy way to die...
 
SoCal said:
Crush Syndrome...

When a pt. is trapped, damage is done in the cellular level, causing Hydrogen Ions to be released from the damaged cells, causing catastrophic damage to the healthy cells. The environment becomes extremely acidic and the cells are releasing K+ from them, so when you relieve the pressure the H+ and K+ and other waste (ie... Rhabdomyolysis, etc... ) is allowed to rush back into the trunk, causing widespread septic conditions and electrolyte imbalances....

If they don't die immediately, they will die of MODS within the next few days. Not an easy way to die...
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pH problems can also occur, acidosis in particular.
 
stephenrb81 said:
I usually have 2 answers for that question

Serious answer for the frantic/upset: "We're doing everything we can to try and keep that from happening" I'll then pop off a few "small-talk" type questions that don't require my full attention if I'm in the middle of treatment so they aren't AS focused on the situation (Trying to deter their 'emotional freak-out' as best as possible)

If they are trying to remain proud/act tough then I may throw in some humor, something along the lines of "I sure hope not, the guys won't ever let me live it down" with a smile. Then give them my serious answer above.

Real example for my humor response: Had a pt that was stabbed with a regular kitchen/dinner fork. Fork still in LUQ just below rib cage on our arrival. Pt was in good spirits on the scene and once in the ambulance asked "Am I going to die?" I couldn't answer No because its a piercing abdominal trauma and I wasn't going to answer Yes or It's Possible because I didn't want the patient to get hysterical. So with eye contact I replied "I'll tell you what, We will do everything we can to keep that from happening *IF* you promise me you'll research how to properly eat with a fork"




I won't ever lie to a patient but I want to stay away from the answer "Most likely". My ultimate goal is to keep them as calm *as possible*, whether its trying to get them focused on small talk or make them smile with a little humor.
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Great minds think alike ^_^
 
SoCal said:
Crush Syndrome...

When a pt. is trapped, damage is done in the cellular level, causing Hydrogen Ions to be released from the damaged cells, causing catastrophic damage to the healthy cells. The environment becomes extremely acidic and the cells are releasing K+ from them, so when you relieve the pressure the H+ and K+ and other waste (ie... Rhabdomyolysis, etc... ) is allowed to rush back into the trunk, causing widespread septic conditions and electrolyte imbalances....

If they don't die immediately, they will die of MODS within the next few days. Not an easy way to die...
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I agree, not a way I'd want to die.
 
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