Pediatric Cardiac Arrest

[Ridryder911]

Well thank you I do realize my first post was deffo not the route to go, But I agree with my revised plan haha, apologize if the first one was sounding like a **** move just something I herd about it and in my first instinct sounded right but DEFINITELY wrong move.

Were rough, but you will learn. I understand about "bad neighborhoods" but that is why LEO should be on the scene or at least plenty of personnel.

You will learn here there is very, very few time that l/s are really needed to transport. You are a medical professional (per say) and should be able to treat the patient so there is never no need to "act" or give a false impression.

Remember, we are a tough crowd but you will learn if you stick it out..

R/r911

 

[Sasha]

Well you did not have be so rude and disrespectful said on several occasions I am a STUDENT I am LEARNING! And after hearing over statements I changed mine, Were I live/going to be working it is a BAD city, number 5 crime rate in US so yes if I believe it is going to get violent DAMN right I am OUT it is there emergency not mine as my instructor says. But like I said if it is a safe situation do everything I can call it and confront the parents and help them. So please I appreciate all the the REAL help.

Sweetie, that was not rude or disrespectful. Student or not, you post your reply, expect to get responses to what you post, and not all are going to be filled with rainbows and butterflies. I was just pointing out how ridiculous your answer would be and how much you would have been doing instead of saying "I'm sorry, there is nothing we can do." And it's not just you, there are others who feel that obivously dead pediatrics get show codes (Though I have to wonder the legal aspect of show coding.. I'm thinking a lawyer could have a field day with it.) because they believe the parents want "Everything possibly done" and that older patients only get half an effort, they also believe because pediatrics are young and healthy they have better survival rates so they need to be rushed to the magical hospital with CPR, tubes, lines, even if they are obviously gone, when in contrast the healthier you are the quicker you die and all that has been done was jerking the family's emotions around while putting them further in debt.

Grates my nerves.

 

[Medic744]

If the baby is still warm (cause your not dead until cold and dead) I would grab and go. We have had several pedi codes in our territory and we grab the child and run with them. Unless there is an obvious reason that there is no chance of getting them back (injury incompatable with life, rigor, etc.) I am more than willing to do everything in my power to work a child. At the end of any call you need to be able to know that you did everything that you could to provide the most favorable outcome. We don't call anything in the field, its not part of our protocol. Either we work it or we don't.

 

[Hockey]

Baby warm, transport

Warmish/cold

Transport

Thats just how we do it here though

 

[reaper]

I have seen Pt's that were dead for hours and still warm. That is not a factor to look at. What if that baby was wrapped up in a heavy blanket all night? The body will be warm, but obviously dead!

 

[medic417]

If the baby is still warm (cause your not dead until cold and dead) I would grab and go. We have had several pedi codes in our territory and we grab the child and run with them. Unless there is an obvious reason that there is no chance of getting them back (injury incompatable with life, rigor, etc.) I am more than willing to do everything in my power to work a child. At the end of any call you need to be able to know that you did everything that you could to provide the most favorable outcome. We don't call anything in the field, its not part of our protocol. Either we work it or we don't.

Actually your not dead until warm and dead. Wow not calling in the field, so your service is non compliant with current pre hospital medical standards. You should voice concern for your safety and the publics safety.

 

[taporsnap44]

Isn't it also against AHA guidelines to transport a patient with CPR in progress?

 

[ResTech]

Isn't it also against AHA guidelines to transport a patient with CPR in progress?

Why would it be against AHA guidelines to transport a patient with CPR in progress???? CPR is the standard of care and the only option that is going to circulate blood! Thing about your question... I'm sure you can then answer it for yourself.

 

[ResTech]

Evaluating skin temperature is a factor to evaluate when determining down time. Granted, a child wrapped in a blanket is gonna maintain body heat and not dissipate as quickly but that is something u keep in mind. How do we know for sure when a baby actually stopped breathing? They could have stopped five minutes before they were found or 45mins.... long as they are still warm and show no obvious death signs.... I would give the benefit of the doubt solely because no exact down time can be established.

I've also had a code where a patient's bed was smack up against a window air conditioner. Obviously they were cold from the A/C but downtime was reported to be less than 10. You just have to think a little bit but definitely evaluate skin quality.

 

[redcrossemt]

Went through a PEPP class recently and heard the "run to the ambulance" mentality described as "emergency football". You get to the scene, the parents throw the "football" to you, and you run to the truck.

If you're already with the patient on-scene, you have your equipment with you as you should, and you believe the patient is viable - why not deliver the rescue breaths and at least start resuscitation on-scene? Several people have mentioned that going to the truck is faster... I'm not sure how it could be faster for me to get all of my gear and the patient out to the truck then it would be to start care bedside.

Obviously, there are reasons to go to the truck, or at least a different part of the house - lack of light, lack of space, etc.

 

[ResTech]

When u take 10 seconds to pick up the child and go direct to the Medic unit... you then dont have to mess with packaging the patient, dealing with the IV lines, pulling the ET tube, etc. And you dont' have to mess with a stretcher.... that's where some of the time savings come into play. Either way is cool and certainly not wrong... just a matter of preference.

And in some locales where the FD arrives first... they start care and soon as they hear the Medic unit mark up on scene..... they scoop the child and go right to the EMS crew.

 

[reaper]

Why would it be against AHA guidelines to transport a patient with CPR in progress???? CPR is the standard of care and the only option that is going to circulate blood! Thing about your question... I'm sure you can then answer it for yourself.

Yes, the AHA does call for the pt to be worked on scene. The evidence is clear, CPR is not effective in the back of a moving ambulance. If you get ROSC, then transport. If they code en route, then work them as normal.

A lot of agencies are starting to transport a working code, for billing reasons. Medicare and Medicaid does not pay, if no transport. Is it a good reason to put people at risk? NO! But, services do need to get paid.

 

[ResTech]

I understand the factors that come into play during transport that can make CPR less effective than in a non-transport environment. But generally speaking, they're are major issue with effective CPR being performed regardless of the environment by all level of care providers including in-hospital as well.

I'll have to look up that guideline... it seems crazy for the AHA to advocate against transporting a patient with CPR in progress. How else is the patient supposed to get to the hospital? Or are they also now advocating against transporting pulseless patients all together and calling them on-scene if no ROSC?

 

[reaper]

Basicly. Work them for 20 minutes or 3 rounds of drugs. If no ROSC, call med control and call it. In most arrests, what will the ED do, that you are not?

 

[Shishkabob]

Open heart thumping

 

[reaper]

Here is actually a decent article from JEMS, on the subject of transporting arrest pt's.

http://www.jems.com/news_and_articl...sporting_Dead_Patients_The_Final_Chapter.html

 

[medic417]

Why would it be against AHA guidelines to transport a patient with CPR in progress???? CPR is the standard of care and the only option that is going to circulate blood! Thing about your question... I'm sure you can then answer it for yourself.

Actually if no ROSC AHA says call it in the field.

 

[ResTech]

I didn't know that was something they advocated as an actual guideline and recommendation, especially for a pediatric arrest. I agree with the principle overall, however for adults but not for kids.

 

[reaper]

Why? If I may ask. There is no difference between the two, on who should be worked or not.

 

[medic417]

I didn't know that was something they advocated as an actual guideline and recommendation, especially for a pediatric arrest. I agree with the principle overall, however for adults but not for kids.

Dead is dead, adult, child, infant, neonate.