Resuscitate of SIDS

[Just Plain Ruff]

VS that was the best post I've seen out of all the posts here.

[Ridryder 911]

VS that was the best post I've seen out of all the posts here.

I agree...sometimes it has to be directly hard hitting for some to understand. Thanks VS. I guess, I amazed that so many do not know basic guidelines of CPR..

R/R 911

[jmac]

while i agree with all that has been said, it might be an idea to think that some are giving their opinion on a level that does not take into account that some people would initiate resus on an obviously deceased person, though this is an interesting discussion i myself understood it all wrong and and commented on things that i would take for granted, recognition of signs ect.

i must apologise if i seemed arguementative, my fault entirely, i was looking at it as a level playing field and not from different skill or interpretive levels and my understanding of the money end of it is nil...so i will take a step back and i think i have learned something about the difference between countries,

keep safe.

[BlackSheep]

Thank you VS![/font:f7d75729fc]

[Ace844]

Hi All,

Somewhere along the line it seems either through inattention and or ignorance some of the posters to this thread began to confuse the 2 issues this thread has now degenerated into.

A.) The EMS documentation as it relates to 'the pronouncement of Death by pre-hospital providers' using various means, i.e.: the monitor, obvious signs, injuries incompatible with life etc...

B.) Whether one pre-hospital clinician or another would work an OBVIOUSLY DEAD PEDI PT

For those providers whom are confused about the differences I'd suggest educating yourselves in this thread (Please re-read "Rid's, VS, Ace's, Bandaid's, et.al., etc.." and the many others who have contributed conclusively to this topic) via searches here or online, or even education via your Med Con. One's inability to determine and be aware of obvious death SX's and SX's and or posting statements that you'd work it no matter what because of YOUR EMOTIONS on the subject rather than good medical care, practioce or evidence on further cements the reality that our EDUCATIONAL PROCESS in this field is BEYOND LACKING!!!! Next, as mentioned by others you should also re-evaluate your clinical abilities, education, and abilities and seriously consider the possibility that you may actually be negligent in your practice!!!

:occasion5: :occasion5: "VS & Rid." I agree completely with your preceeding statements...:occasion5::occasion5::glasses5:

To further clarify here are some definitions of what obviously dead means or is evidenced by;

Trauma inconsistent with survival

a. Decapitation: severing of the vital structures of the head from the remainder of the

patient’s body

b. Transection of the torso: body is completely cut across below the shoulders and

above the hips

c. Evident complete destruction of brain or heart

d. Incineration of the body

e. Cardiac arrest (i.e. pulselessness) documented at first EMS evaluation when such

condition is the result of significant blunt or penetrating trauma and the arrest is

obviously and unequivocally due to such trauma, EXCEPT in the specific case of

arrest due to penetrating chest trauma and short transport time to definitive care (in

which circumstance, resuscitate and transport)

3. Body condition clearly indicating biological death.

a. Complete decomposition or putrefaction: the skin surface (not only in isolated

areas) is bloated or ruptured, with sloughing of soft tissue, and the odor of decaying

flesh.

b. Dependent lividity and/or rigor: when the patient’s body is appropriately examined,

there is a clear demarcation of pooled blood within the body, and/or major joints

(jaw, shoulders, elbows, hips, or knees) are immovable.

Next, as for the documentation portion, YMMV, and as much as the population of this board/forum is, thus one should be familiar with WHAT THEIR COMPELLED TO DO BY THEIR MINIMUM PRACTICE STANDARDS!! An example is this::

Procedure for lividity and/or rigor: All of the criteria below must be established and

documented in addition to lividity and/or rigor in order to withhold resuscitation:

i. Respirations are absent for at least 30 seconds; and

ii. Carotid pulse is absent for at least 30 seconds; and

iii. Lung sounds auscultated by stethoscope bilaterally are absent for at

least 30 seconds; and

iv. Both pupils, if assessable, are non-reactive to light.

2. EMTs certified at the Paramedic level only may cease resuscitative efforts in an adult

patient 18 years of age or older, regardless of who initiated the resuscitative efforts,

without finding “obvious death” criteria only by the following procedure, and only if the

EMS system’s Affiliate Hospital Medical Director has approved of use of this procedure,

as follows:

a. There is no evidence of or suspicion of hypothermia; AND

b. Indicated standard Advanced Life Support measures have been successfully

undertaken (including for example effective airway support, intravenous access,

medications, transcutaneous pacing, and rhythm monitoring); AND

c. The patient is in asystole or pulseless electrical activity (PEA), and REMAINS SO

persistently, unresponsive to resuscitative efforts, for at least twenty (20) minutes while

resuscitative efforts continue; AND

d. No reversible cause of arrest is evident; AND

e. The patient is not visibly pregnant; AND

f. An on-line medical control physician gives an order to terminate resuscitative efforts.

III. Special Considerations and Procedures:

1. In all cases where a decedent is left in the field, procedures must include notification of

appropriate medical or medico-legal authorities.

2. EMS documentation must reflect the criteria used to determine obvious death or allow

cessation of resuscitative efforts.

out here,

ACE844

[Just Plain Ruff]

I agree, working an obviously dead patient leads to major questions on your ability to function as a medic.

Obvious signs means just that, obvious

As for emotions getting into this. You have to be professional and not let your emotions get in the way. If we all let our emotions get in the way we'd be very bad but caring caregivers. For example: you have a 3 year old patient, screaming and saying please don't hurt me, and you are goin to start an iv on him. He needs it due to vomiting and dehydration. Are you gonna let your emotions rule and not start the iv cause the child is crying and screaming not to do it or are you gonna start the iv. Emotions play a role in EMS but to let your emotions rule you and work an obviously dead body, it doesn't matter adult or ped, is a dangerous road to go down.

CRY after the fact, get help if needed but to work an obvious is just plain STUPID AND DUMB

If you started to work an obviously dead patient and transported them into the ED you would get the award for Dumbest Medic in the world for that day.

You would also be reported to your ems director for remediation.

[Eric]

ok Obvious signs of death then no i would do nothing but if the signs are not there then hell yea im going to work them

and i would like to just come out and say this who in here has lost there baby other then me to sids??? i dont wish on any one but i like to know

[medik8]

Eric,

While your loss was unfortunate, that does not excuse you to initiate resuscitative measures on an obviously dead patient (no matter what age). In reality all you are doing is desecrating a body, plain and simple folks. If anything it gives you a real understanding of what the parents are going though and you can aid them in their initial phase of mourning.

So you decide to initiate resus and transport (this is for all levels)...

- Jaw is rigored so you can't do laryngealscopy, no tube, so you bag...

- No IV is possible, no drugs down the tube (cause you can't get one), so IO it is (if you are able to do it)...

- Kid is asystole so you are running the arrest like that, do your first round of epi 0.01mg/kg 1:10,000 and start to roll...

- You are obviously going lights and sirens because this is a kid...

- The parents don't go in the ambulance, and drive their own car, you tell them not to follow you, but they ignore you and are on your tail all the way because "there baby has a chance"...

- You are increasing your risk of being in/causing an accident by a very significant amount, as are the parents who are following you...

- You get to the ER, with the parents 1 min behind you...

- ER Doc says "Ok, page for an RT, lets get the...Wait a sec this baby is cold...I can't move the jaw...(flips baby over)....there is dependent homeostasis...what was the downtime time again....WTF ARE YOU GUYS DOING!!!!"

- Doc, nurses, etc.... are looking at you like an idiot, parents are wondering what is going on....

- And in the US they get a fair sized bill for your "life saving" efforts, that would have always been futile...

Moral = Do not start resuscitative efforts on any patient of any age that have signs of obvious death.

This also falls back on education and length of precepting. Talking to your patients on routine calls, and especially family in times of their tragedy is not something that is "learned" in 150 hours of class room time and 48 hours of preceptorship. It takes time to develop your "style" and earn a patients and grieving loved one's trust in times of tragedy. Giving false hope does NOT make you a better professional.

=D> As incredibly sad as this is.....I have to agree with you, VS... Great job of pointing out just how much false hope can and will be given by trying to "do a good thing". We are so much better off just helping with that grieving period. It's hard enough to try to work on a baby that is going down the tubes. I have no desire to put a baby that is already deceased through everything that we do...just for a show. It's wrong. The acceptance of death is going to be difficult no matter when it starts...now or later. It's not going to make it any better because we prolonged it and gave false hope.

I do not mean any disrespect toward anyone here that has a different opinion or who has lost a child. I am very sorry for any pain that this may bring someone in that position... However, it's just the right thing to do.

Excellent post, VS.....you did a great job of explaining this...

xoxo

8

[bandaidpatrol]

I've lost four grandchildren to "SIDS".

[Just Plain Ruff]

my best friends 2 year old was taken by sids. His son was my son in my eyes. So I feel your pain.