Would You Work This Code?

[Dustdevil]

Are you a God? Are you Superman? Are you an RN?

I hope you are good at all of these because with a statement like that you are probably not a good medic.

If you plan to stay here, your future posts are going to need to include some intelligent reasoning, and not just personal attacks. Chill out and get some situational awareness before you dive in.

[wrmedic82]

This is just my opinions on the topic.

-Lets say he had a pulse when you arrived at his side. I would load and go.

-Lets say he DID NOT have a pulse when you arrived at his side. Give him 20 min of my best provided no obvious signs of death. Call medical control tell them what I got, and call it if the the MD is cool with it. I just feel that BCLS / ACLS is better done onscene if possible.

-Obvious signs of death with PEA or Asystole - DOS

I know everyone views this situation differently, and thats cool. I would go with your training / experience, medical direction, and gut instinct on this one. If your gut says lets go, then by all means. But the questions I would be asking is if its going to be worth saving a guy that more likely than not will live in a vegetative state for the rest of his life? Im sure there are many stories out there, and even here of people surviving and living life despite the odds. And I know some people will even say who are we to make that call. So your always going to have answers on both sides of the fence. I wasnt on the call so I didnt see what you did. But thats a generalized answer w/o variables factored in.

Edited September 8, 2009 by wrmedic82

[AlamanceMD]

These are damn hard decisions and hopefully one in which your medical control gives you clear protocols in advance.

I remember doing ride a long time early in my training and getting called to a "car vs pedestrian". The pedestrian, in his 50's or 60's arrested and I was surprised a bigger effort was not made to save him. There are many jurisdictions that do not perform CPR on traumatic arrest in the field.

And that is the issue here - traumatic arrest. This is not a medical arrest as in the example of the intermediate's father (point #2 - copied below). The successful resuscitation following traumatic arrest is low, as in point #1 - copied below. After a prolonged effort, the guy who arrested with gray matter coming out of his head still died. While people training may have learned from this, the education part is obviously not the reason to run a code. Think of the amount of time spent on this effort and the numerous other people who may have received less medical attention due to this.

I would certainly start CPR on this patient, as the on scene fire fighters had done. I'd support an emergent chest decompression, but I would support calling the death on the scene if none of this was successful. 10 min to load, go, and unload after already 10-15 min on the scene leads to nothing but a pronouncement of death in the ED. Sometimes that may seem like a better way to go.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Prior post from Intermediate quoted:

1.-The Medical Reason- On my most recent ER rotation we had a patient come in that everyone knew had pretty much zero chance of making it. He was a 52yo bicicylist had been hit from the rear by an SUV going approx 45 mph. Despite wearing a helmet, the back of his skull was shattered with gray matter coming out and large amounts of blood. They did everything they could think of to save him, including getting a head ct. When they arrived on scene he was pulseless with agonal respirations and they could have called it right there. But they started cpr and actually got an organized sinus rhythm back. He eventually died 3 hours after arriving at the ER. Now, I'm not sure who decided to work it or why. But if nothing else maybe something was learned from this by someone. Other than me, because I learned a lot that night.

2.-The Personal Reason- May 2005, my father(an alcoholic) was taken to the ER by my mother because "he wasn't acting right." He was evaluated, found to be ETOH, and was about to be discharged when he went pulseless and apneic. A ct showed extensive bilateral subdural hematomas. They could have called it there. Instead, they revived him. I'm not sure on the details as I wasn't there and my mother says it's a blur at that point. He was then taken to the ICU in a coma on life support. It was 4 days before they could get his clotting factors high enough to go to the OR for them to drain it for burr holes. He spent another 4 weeks in a coma, suffering another bleed a week into it. He ended up with permanent compression to his brain and we were told he may not wake up, which he did. We were told at this point he'd be lucky to walk, speak, feed himself, etc, again. He did all those things. He's actually driving again, doing his own yard work, tinkering with his gadgets, etc. His neurologist says the compression is still there but that he has full cognitive and reflexive abilities, with the only memory loss being a 5 yr gap when he was at his worst with the alcohol but they think it's more of a psychological thing as he can still recall events from his childhood. It took over a year of rehab but I have my dad back even though by all medical standards he should be dead. I can't imagine my life right now if someone had not made the decision to at least try. Even if it was only so that the ball would be in someone else's court.

[SWA_EMT]

I would work the code.

That said.......I would also be talking to my base hospital PHYSICIAN. Once he/she has decided that efforts should be continued or discontinued, I would immediately and fully comply.

Key point here is: Share the $*!+ sandwich. Don't forget that you ALWAYS have someone of a higher medical level above you...they're just a phone call away.

**Keep in mind that this is only my opinion. I work in an area that I run these exact types of calls every now & then. I will always give my 500% before I give up. BUT.....at the same time, I realize that no matter how much I give....people will still die. That's why I'm here.....so that those who DON'T die.....have a chance to keep living.**

Edited September 11, 2009 by SWA_EMT

[Dustdevil]

Don't forget that you ALWAYS have someone of a higher medical level above you...

Maybe you big city boys do. Speak for yourself.