Scenario: Ethics of violating protocol

[AnthonyM83]

I don't even know what the procedure is, but I'm guessing this person is going to die without it. The doctor does know the procedure and can tell me how difficult/easy it is. If I screw it up, how is the patient going to end up worse?

SO, I'm okay with it morally and ethically. My only concern would be losing my certification then preventing me from helping others in the future.

[akroeze]

Sitting here now I don't think I would do it but I recognize that anything could happen.

[ERDoc]

Having been trained how to do one before I had to do it on a person didn't make the first time any easier. I can understand everyone's reluctance. On the flip side, can you make her any more dead?

[Ridryder 911]

[You don't need an alligator clip for the procedure. Nobody actually does this, despite its apperance in the procedure manuals. The monitor will show you all kinds of ugly ectopy when you hit the heart. All you need is a syringe (60cc would be good, but you can make do with smaller) and a BFN (big friggin' needle). The 14g 2.5" Angiocath that you use for chest decompression will do.'zilla

Very true, however if I going to stick my neck out, I want to have everything that the "text" says I will need. Although, this procedure used to be taught even in the routine ACLS as one of the skill station, it has lost favor for prehospital care. Strange, because it is a standard treatment for PEA, and should be evaluated... especially in trauma.

I suppose as we started "dumbing" & diluting down our skills and education level, it away with other knowledgeable skills as well..

R/r 911

[JPINFV]

-5 for asking for more exam findings. PEA with sinus tachycardia, if you're curious.

I was interested in knowing the rhythm because if it was treatable by other methods, then I would try those first. True, I should have assumed PEA given the scenario.

I would attempt the procedure because the worst that could happen would be the patient dies. If you do nothing, the patient dies, if you attempt but screw up, the patient dies. If you successfully evacuate the fluid, the patient might die, but you might end the conditions leading to the electromechanical dissociation.

[nsmedic393]

In reading the replies to this thread, and i think i'm noticing a little bit of a trend (feel free to correct me if i'm wrong). It seems to me that the ALS providers are opting not to perform the procedure and the BLS providers are saying they would do the procedure.

So a question for the BLS providers....At your current BLS level, presented with a situation like this and no ALS avaliable to intercept would you consider doing this procedure at the direction of an on-line doctor?

[AnthonyM83]

In reading the replies to this thread, and i think i'm noticing a little bit of a trend (feel free to correct me if i'm wrong). It seems to me that the ALS providers are opting not to perform the procedure and the BLS providers are saying they would do the procedure.

So a question for the BLS providers....At your current BLS level, presented with a situation like this and no ALS avaliable to intercept would you consider doing this procedure at the direction of an on-line doctor?

I think the reason might be that ALS providers are more educated on protocols, liability, and the whole topic of doing things outside your scope. Like I said in a previous post, I'm coming at it from a more uneducated angle since we almost never have to deal with this type of issue or discussed it in class.

SO, my answer following my previous logic would have to be, yes. Keeping in mind I don't even know what this procedure is, if the doctor said I was capable of doing it (making me think finess/experience isn't necessary), then I would. In the moment, once it was explained to me, I might feel uncomfortable with it and throw this answer I just gave out, though.

[flight-lp]

Very true, however if I going to stick my neck out, I want to have everything that the "text" says I will need. Although, this procedure used to be taught even in the routine ACLS as one of the skill station, it has lost favor for prehospital care. Strange, because it is a standard treatment for PEA, and should be evaluated... especially in trauma.

I suppose as we started "dumbing" & diluting down our skills and education level, it away with other knowledgeable skills as well..

R/r 911

Words well spoken! I for one would not hesitate to perform it, possibly even before she arrested based on sound conclusive evidence that she was decompensating from her effusion. I am truly surprised at the number of ALS responses that wouldn't due to lack of knowledge about the procedure vs. not having a specific protocol for it. Has this procedure been lost by the wayside? I realize that AHA no longer emphasizes it, but is it not covered in Paramedic school or in continuing education?

[JPINFV]

In reading the replies to this thread, and i think i'm noticing a little bit of a trend (feel free to correct me if i'm wrong). It seems to me that the ALS providers are opting not to perform the procedure and the BLS providers are saying they would do the procedure.

So a question for the BLS providers....At your current BLS level, presented with a situation like this and no ALS avaliable to intercept would you consider doing this procedure at the direction of an on-line doctor?

20 minutes out, no ALS, patient in arrest? Most probably. You can't get much worst then dead. An apneic and pulseless patient that the AED is refusing to shock isn't going to get better. Assuming picture perfect CPR with combitube (arguments aside on the BLS use of rescue devices, let's give the patient the best chance possible), what do you think that patient's status is going to be 20 minutes later at the hospital?

[mediccjh]

Hell no.

I love my job, thank you.