fiznat Posted December 9, 2008 Posted December 9, 2008 I don't believe that I have to present my educational credentials to you Dust. We're not going to get into a "who's better educated/who's balls are bigger" bullshit argument on the internet. I've been on this forum for years. We've gotten into arguments before, make your own conclusions. Frankly it doesn't matter to me what your assessment is. The point is moot anyways. It doesn't matter how many or c-sections I've seen or how closely I observed them. Physicians go through RESIDENCIES in order to learn how to do this appropriately. They PRACTICE the stuff. Surgery is not something that should be taken lightly, and certainty not something that can be mastered by mere observation and book study alone. So you had a gross lab some undetermined number of years ago. Good for you. You're still not qualified to perform street surgery, and it doesn't make it OK simply because mom is in cardiac arrest. Adequate educational exposure to anatomy and surgery would give you the insight to realise that it is very much within your capability. What really boggles my mind is that this is the same argument you so vehemently argue against when EMTs use it to justify BLS IV starts, EKGs, or other ALS procedures. Just because you have a good idea where the uterus is doesn't mean that you are qualified to start cutting a person open with a scalpel. "Skills" like surgery don't come for free, and the certainly don't come as easy as an A+P class. Someone who so frequently argues the necessity of background and systemic education should understand that. ...Or do we throw it all out the window because the patient happens to be really sick? EMTs in general don't intubate, but according to your logic maybe we should just let them give it a shot on arrested patients because, hey, they're already dead right?
AZCEP Posted December 9, 2008 Posted December 9, 2008 The scope of practice for the DOT curriculum educated paramedic does not include post mortem C-sections. The situation does not determine if it is acceptable or not. True enough the procedure is not all that difficult, but that is a moot consideration when you step that far outside your scope. Something that seems to have been missed in this discussion is the little matter of the infant's survivability. Unless you are working on mom prior to her arresting, and are able to determine precisely when she does, there is no way that you will have a viable patient once you get done talking through the procedure and performing it. The pathology demands that the infant is removed at the first sign of maternal distress, not after she has checked out. Once that happens how long has junior been without oxygen, or adequate perfusion for that matter?
Arctickat Posted December 9, 2008 Posted December 9, 2008 Something that seems to have been missed in this discussion is the little matter of the infant's survivability. Unless you are working on mom prior to her arresting, and are able to determine precisely when she does, there is no way that you will have a viable patient once you get done talking through the procedure and performing it. The pathology demands that the infant is removed at the first sign of maternal distress, not after she has checked out. Once that happens how long has junior been without oxygen, or adequate perfusion for that matter? Maybe they'll listen to you...I'm starting to talk in circles which is my cue to give up.
fiznat Posted December 9, 2008 Posted December 9, 2008 You and me both Arctickat. Thanks for your thoughts AZCEP.
Dustdevil Posted December 9, 2008 Posted December 9, 2008 ...Or do we throw it all out the window because the patient happens to be really sick? EMTs in general don't intubate, but according to your logic maybe we should just let them give it a shot on arrested patients because, hey, they're already dead right? That is exactly the reason why we enjoy the SOP we currently practise on arrested patients. Because they are already dead. Why should it not extend to pregnant victims? The scope of practice for the DOT curriculum educated paramedic does not include post mortem C-sections. DOT minimum standard curriculum should in no way be confused with a Scope of Practice, unless it is specifically and legally adopted as such by your jurisdiction. The situation does not determine if it is acceptable or not. True enough the procedure is not all that difficult, but that is a moot consideration when you step that far outside your scope. The whole "scope" thing is a red herring. The question is, if you enjoyed employment in a system which did not have such a restricted scope (i.e., that is no longer a valid excuse), would you still refuse to do it? Something that seems to have been missed in this discussion is the little matter of the infant's survivability. Unless you are working on mom prior to her arresting, and are able to determine precisely when she does, there is no way that you will have a viable patient once you get done talking through the procedure and performing it. Untrue. There are many, many cases of it happening. You've been in medicine long enough to know better than to ever say "never". I'd bet that the success rate of viably delivered infants is at least as good as the ROSC success rate in the CPRs we work. So why is the baby due less of an effort than our other patients?
AZCEP Posted December 9, 2008 Posted December 9, 2008 The infant may well be viable for a NICU team that is well versed in managing this type of situation, but in the prehospital environment with the limitations of equipment and manpower we are placed in a less than optimal setting with a critically unstable patient that has undergone a prolonged period of hypoperfusion. The current literature supports the application of the procedure if initiated within 4 minutes of the mother's cardiac arrest. If you don't know what the down time is you do not perform it. I'd love to hear from any non-military agencies that follow this guideline.
fiznat Posted December 9, 2008 Posted December 9, 2008 AZCEP, what you're forgetting is whether or not the providers have the GUTS to handle this critically ill neonate.
AZCEP Posted December 9, 2008 Posted December 9, 2008 Nope, not forgetting that just sidestepping the issue of "guts". Poor form to bring it up when talking about this particular procedure.
Dustdevil Posted December 9, 2008 Posted December 9, 2008 The current literature supports the application of the procedure if initiated within 4 minutes of the mother's cardiac arrest. If you don't know what the down time is you do not perform it. Even if you have FHTs?
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