Kaisu Posted May 12, 2012 Posted May 12, 2012 Had an 88 year old witnessed arrest at a nursing home, family in the room, full code. Daughter screaming to save him save him. Protocols insist we worked him. We had been toned out for altered level of consciousness, downtime when I walked into the room of less than 2 minutes. Rolled him onto the floor, began compressions, rhythm check as soon as the pads were on. He was in asystole. All rational reason says do not work him but the loss of a father was too much for the family and they wanted "everything done". Lo and behold, after 2 rounds of drugs I have a perfusing wide complex bradycardia and a systolic of 120. Patient was tubed with 100% O2 and 34 ETCO2. Roll into the ED and the doc is pissed. He asks the daughter "do you want him to live forever?". The daughter asks me if it is possible that her father will recover from this. I state that "something made his heart stop and unless that can be fixed, survival to life with any kind of quality is unlikely. The patient died 3 hours later and they left him dead. So - asystole on the scene, the much balihoed ROSC and the end result was what? Huge transport and ED bills, the father's body subjected to all the indignities of a code, including broken ribs, I/O, intubation, etc etc. The only comfort I take from all that effort is that the family knew that everything that could be done had been done. Is it enough? Not for me to say. From my point of view no. From the family's? Only they can know. I don't believe we will ever educate the public to the extent that our point of view becomes shared. 2
Kiwiology Posted May 12, 2012 Posted May 12, 2012 If you ask me he should have stayed dead right there on the floor Honestly, he's already in the rest home so he's on the downhill so where is the point in resuscitating him to go on living at the home? Locally for you it may be different but here neither the patient nor family can insist on treatment which the crew does not think is justified and that's the way it should be
Kaisu Posted May 12, 2012 Posted May 12, 2012 There is the law.. and the law states that without a VALID DNR and obvious signs of death the code is worked. We work within the parameters of the law.
DFIB Posted May 13, 2012 Posted May 13, 2012 Thats unfortunate Unfortunate for who? The medic or the patient?
mobey Posted May 13, 2012 Posted May 13, 2012 If you ask me he should have stayed dead right there on the floor Honestly, he's already in the rest home so he's on the downhill so where is the point in resuscitating him to go on living at the home? Locally for you it may be different but here neither the patient nor family can insist on treatment which the crew does not think is justified and that's the way it should be WTF?? A warm code, and you would not work it?? This is where actually working the call, and armchair quarterbacking just do not align. There is no freaking way you are dispatched to a warm code, with no signs of obvious irreversible death, and do nothing. I do not believe youhave a law that allows that for any level of provider. Perhaps after 2 min of CPR and one shock, he recovers back to his 100% and is able to snuggle his first grandaughter that is born one week later..... we don't know, that is why we do what is in the best interest of the patient EVERY TIME!
Asysin2leads Posted May 13, 2012 Posted May 13, 2012 A warm code, and you would not work it?? Its in Arizona. There was a possibility it might have been JT Ready.
mobey Posted May 13, 2012 Posted May 13, 2012 Should have said fresh. Point remains the same. Red-neck again JT??
Kiwiology Posted May 13, 2012 Posted May 13, 2012 The survival rate for cardiac arrest is already pretty shit, and for asystole as initial rhythm is even shittier, the guy is already is in the nursing home for a good reason, he's not there by choice, where is the dignity in subjecting him and the family to the trauma of working him so he can go on to die at the hospital or go back to the nursing home? I tell you after my first rest home cardiac arrest I got my ass a DNR
mobey Posted May 13, 2012 Posted May 13, 2012 The survival rate for cardiac arrest is already pretty shit, and for asystole as initial rhythm is even shittier, the guy is already is in the nursing home for a good reason, he's not there by choice, where is the dignity in subjecting him and the family to the trauma of working him so he can go on to die at the hospital or go back to the nursing home? I tell you after my first rest home cardiac arrest I got my ass a DNR Perhaps then, you need to work 50 of them so you can see the 1 or 2 that make it and thank you. Yes most dead people stay dead, but that is a horrible excuse to not treat them.
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