Would You Work This Code?

[tniuqs]

The original poster is an EMT. He/She is not questioning his/her medic. He/She is trying to learn something and has asked this forum to help him/her. In the process, a very good discussion has ensued.

Field cessation of effort, as well as declaring dead is within the protocol of our paramedics.

As a 26 year veteran just as Paramedic it is well within my scope/guidelines as well and not the issue here at all, note I left out "protocol"

Did you read the Criteria of Death Harvard ad Hoc committee, the short answer is NOPE !

Want a free education just follow the links provided, besides a historical perspective of Hypocraties view on head injuries, besides some very thought prevoking personal positive anecdotal recollections of positive outcomes despite the protocol factor.

I whole heartly disagree the lack of clarification of clear information is not tangible grounds to discuss or entertain a valid cessation of life support in the field with this pity info and why dust makes legal and the lazy arse comment.

Is it not clear that the OPs post from the onset is less that straight up ? he/she it has brought this dubious scenario to the masses to support he/she/its ..... IN MY OPINION.

I have been asking my coworkers the same question I am asking all of you. I have gotten mixed answers and all have provided reasons for why they would have or would not have worked this full code.

A forgone conclusion the patient WAS worked and given every chance and ODDLY No mention of the actual paramedics explanation or rational thought's ... come on .... a good discussion based on .....

Pupils fixed, (no response back from the OP upon questioning to light)

deviated, hmmm?

no obvious devastating signs other than a possible MOI.

A possible pulse ?

A possible PEA and no rate?

No Time considerations, response or transport ?

Ands No follow up answers to questions.

BUT I have learned something .... I should stop bothering to get involved with stupid scenarios lacking enough criteria to decide to wipe my arse because it could be a fart or a double coiled dump.

I would not work this one.

Edited May 16, 2009 by tniuqs

[Kaisu]

I guess that's one of the problems with discussions in internet forums. Without the addition of facial expressions, body language and the give and take of "in the flesh" exchanges, these things become difficult. I did not read what you did - not to say that your impressions may not be correct - I just didn't read it that way.

Can you provide some links to the information you cite - I would be interested.

[Diazepam618]

NO, this guy is DEAD!!!!!!

[akroeze]

NO, this guy is DEAD!!!!!!

A few more !!! and your point would have been more clear.

[Diazepam618]

well maybe, but not too sure.

[Just Plain Ruff]

NO, this guy is DEAD!!!!!!

Another fine addition to this thread.

The guy is not dead yet, sure he looks dead but..... he's not dead. People would take you more seriously if you would add something to this thread.

[cynical_as_hell]

I whole heartly disagree the lack of clarification of clear information is not tangible grounds to discuss or entertain a valid cessation of life support in the field with this pity info and why dust makes legal and the lazy arse comment.

Is it not clear that the OPs post from the onset is less that straight up ? he/she it has brought this dubious scenario to the masses to support he/she/its ..... IN MY OPINION.

BUT I have learned something .... I should stop bothering to get involved with stupid scenarios lacking enough criteria to decide to wipe my arse because it could be a fart or a double coiled dump.

If this is how you truly feel then by all means, leave this discussion and take your poor attitude with you so that the rest of us who ARE interested in this discussion can be involved in a much better enviroment. I have been following the replies since I did the original and post and you are the only one causing conflict. All the others have stated their opinions and given reasons why for what they chose and have left it alone. Maybe you could learn something from this.

It must be alot easier to make decisions and say how everyone else is wrong when you weren't there and you are just quarter backing.... Perhaps you should learn to take the information that is given and quite reading into things and interjecting your own perspectives.

[Niftymedi911]

Another thing my clinical educator / Medical Director said to us is simple: Even though you can see em, we don't transport dead people. Funny saying but its catchy and sticks.

[tniuqs]

The lack of clarification of clear information is not tangible grounds to discuss or entertain a valid cessation of life support in the field with this pity information provided.

Quoting Kaisu: I should probably tell you that I came to save your ass, not to kiss it

.

I hope Kaisu does mind the plagerizm but the real point is some are not listening to the advice of very experienced EMS providers, of whom 80 % of those polled are telling that your "opinion" is unfounded and you are in fact are arm chair quarterbacking yourself and after the fact as well .. I highly suspect in your hall to generate controversy (and will bite you in the ass) just my suspicion but your looking for affirmation that your opinion is somehow more politically correct.

If this is how you truly feel then by all means, leave this discussion and take your poor attitude with you so that the rest of us who ARE interested in this discussion can be involved in a much better enviroment. I have been following the replies since I did the original and post and you are the only one causing conflict. All the others have stated their opinions and given reasons why for what they chose and have left it alone. Maybe you could learn something from this.

It must be alot easier to make decisions and say how everyone else is wrong when you weren't there and you are just quarter backing.... Perhaps you should learn to take the information that is given and quite reading into things and interjecting your own perspectives.

I love this response .. everyone ? is again 80 % that your are wrong clearly in your opinion, you have not learned that you can be tangented on the social aspects ONLY .. look to your original post it is full of "social" inference lacks solid medical evidence or clinical observations and many questions still remain unanswered.

If this was actually your call you would be shredded in court challenge and I have a poor attitude? Ok then go with that if it makes you "feel" better, and as a sidebar this call was NOT about you at all.

If one looks to the seniors in EMT city .. the good ones state the disscussion then wait for questions, provide answers and then discuss, this methodology one receives positive unbiased information and clear in-sight.

In my opinion I feel that we should not have worked this code. Given the circumstances and how he was presenting on scene, there was nothing we could do to change the outcome. When we arrived on scene and I looked at the patient his eyes were already fixed and staring off to the side. Now I understand that we had bystanders who all expected us to do something, but I guess I'm still stuck on the question of at what point do we just say "I'm sorry but there's nothing we can do." I also understand that in a way it's arrogant of us to sit there and say that we can't do anything, but if there's obvious signs of death, who are we trying to fool.

Want an honest opinion ... your more concerned with what people think, that do your job.

So to go the extra mile with my poor attitude:

Harvard Ad Hoc Committee on Brain Death

In 1968, this committee of the Harvard Medical School published a report describing the following characteristics of a permanently nonfunctioning brain, a condition it referred to as "irreversible coma," now known as brain death:

Unreceptivity and unresponsitivity--patient shows total unawareness to external stimuli and unresponsiveness to painful stimuli;

No movements or breathing--all spontaneous muscular movement, spontaneous respiration and response to stimuli are absent;

No reflexes--fixed, dilated pupils; lack of eye movement even when hit or turned, or ice water is placed in the ear; lack of response to noxious stimuli; unelicitable tendon reflexes.

In addition to these criteria, a flat electroencephalogram (EEG) was recommended. The committee also noted that drug intoxication and hypothermia which can both cause reversible loss of brain functions should be excluded as causes. The report was used in determining patient care issues and organ transplants. The condition of irreversible coma, i.e., brain death, needs to be distinguished from the persistent vegetative state, in which clinical presentations are similar but in which patients manifest cycles of sleep and wakefulness.

In a court of Law this criteria would be considered ... can one with this scenario answer all criteria without reservation in the presented post ...

cheers

Even though you can see em, we don't transport dead people.

Maybe just me but could you explain that ...

Edited May 17, 2009 by tniuqs

[nypamedic43]

I have read all 6 pages of this thread...some of the replies I have really just shook my head at.. especially Diazapam's "he's dead". I don't post alot on these forums because my experience has been negative 90% of the time. There have been a couple of people (Ruff and one other) that have kept me coming back to these forums because there is ALOT of very good information here and even more learning opportunites.

The question of whether any one of us would work this code is really a matter of our individual systems protocols but it also has to with the individuals conscience. I would work it because there are signs of life...albeit agonal breathing is not necessarily the best sign to follow. I was taught that a PEA is workable...if there is electrical activity you may get pulses back. The fact that there is a crowd of people around would prompt me to do SOMETHING for this guy instead of just standing back and watch him take his last breath while I'm on the phone with medical control.

However I have to agree with some of the people that have posted replies...there simply isnt enough info to make any kind of call. Since this guy t-boned an suv at 70 mph on a motorcycle with no helmet on I am guessing that it would be fair to assume that he has other major injuries as well. A torn aorta at impact, abdominal injuries, a broken neck....besides the obvious head injury.

I wouldnt fault the medic who made the decision to work this patient and I wouldnt be asking questions about his judgement behind his/her back. I would have gone to him/her after the call and talked about it. Most medics are more than willing to discuss thier reasoning behind the decisions made on a call if asked in a way that is nonjudgemental and truly in the interest of learning.

There was also alot of confusion in the first couple pages of this thread because one of the posters interjected thier own personal experience of a completely different type of patient on a completely different type of call. And subsequent replies were tainted by that.

It is easy for any of us at any time to armchair quarterback. But the bottom line is...if this was my patient, I would have worked him. While trauma arrests have low survivablity, there are people around today because someone wouldnt give up on them. The number is low but they are out there. We dont ever know what the outcome will be and it isnt for us to play God and decide that this patient isnt viable. Do what you can for him/her even if you know that the outcome will not be good.

just my 2 cents....oh and tniuqs?? keep up the "poor attitude" you make us think before we speak