Pediatric Cardiac Arrest

[ResTech]

Dead is dead... your right. I say I disagree with working pedi codes and calling them in the field because children are as healthy as can be with perfect hearts in most cases. I just feel they should be transported to an ED where labs can be drawn and any contributing factors identified and treated that may not be immediately identifiable in the field.... is this significant and usually reveal ne thing that makes a difference... most cases not but some it may.

Plus, in the ED some physicians will try some far shot treatments and continue treatment longer for a child then for a 85 y/o who had two previous MI, HTN, and smoked for 60 years.

 

[Medic744]

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.

Sorry about the mix up, Im a littlev sleepy today. As far as standards we are above and beyond. Again we do everything we can to save someone. Its not our job to call it in the field just like on a patient whos obviously been dead a while its not our job to determine cause of death.

 

[HotelCo]

No difference than if it was an adult except the history and of course medication(s).

R/r 911

I fully agree.

 

[redcrossemt]

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.

I'm advocating for not going to the medic unit, unless there's ROSC. Same with first responder coverage areas... medics should come inside and work it.

 

[redcrossemt]

Dead is dead... your right. I say I disagree with working pedi codes and calling them in the field because children are as healthy as can be with perfect hearts in most cases. I just feel they should be transported to an ED where labs can be drawn and any contributing factors identified and treated that may not be immediately identifiable in the field.... is this significant and usually reveal ne thing that makes a difference... most cases not but some it may.

Plus, in the ED some physicians will try some far shot treatments and continue treatment longer for a child then for a 85 y/o who had two previous MI, HTN, and smoked for 60 years.

If the kid's heart is perfect, why did they arrest? In all reality, probably a respiratory arrest. Quickly institute PALS/ACLS guidelines, including aggressive airway management, and you have the best shot of resuscitation.

By the time you transport and the hospital gets blood gases or any other sort of lab, they'll just be dead-person lab values. Depending on where you are and the experience level of the doctors, the hospital may try extraordinary efforts... but it's unlikely that they will result in ROSC, except in unusual circumstances like cold water drowning.

For the most part, I've rarely seen hospitals work codes based on labs. Usually, they focus on ACLS - and a problem search (H's and T's). Unless you have unusual circumstances, or you know the hospital can fix something you can't, work it on scene.

 

[tterrag]

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

Nice post man, The articles are good

 

[maxwell]

So let me get this straight... You are going to put you and your partner at risk fir a dead person ... Give the family false hope by dramatically speeding away... Violate the childs body... Add a hospital bill onto of a funeral and ems bill.... And allow the family to drive to the hospital in an emotional state because you can't break the news? Some patient advocate.

I'd say it's you who is the questionable patient advocate. Check it. Families know when their loved one is really dead (or, they have for the 20 or so pedi codes I've run). You always, always, always, want to show the family that you've done your best, no matter how old the patient is. This isn't violation of a child's body, if it is, then it aint CPR you're doing. Driving away dramatically? No, let the family know what's up, be real. Sure, there's risk there. Real simple advice. Get over it. There have been MANY studies that say families have a better time accepting their grief when they are present for heroic measures.

My answer: Tell the family what's up. Be real. Don't give them hope. But work the code on the way to the ER. The only exception for this is if you have findings incompatible with life. General rule for pedi codes: run 'em.

 

[reaper]

I'd say it's you who is the questionable patient advocate. Check it. Families know when their loved one is really dead (or, they have for the 20 or so pedi codes I've run). You always, always, always, want to show the family that you've done your best, no matter how old the patient is. This isn't violation of a child's body, if it is, then it aint CPR you're doing. Driving away dramatically? No, let the family know what's up, be real. Sure, there's risk there. Real simple advice. Get over it. There have been MANY studies that say families have a better time accepting their grief when they are present for heroic measures.

My answer: Tell the family what's up. Be real. Don't give them hope. But work the code on the way to the ER. The only exception for this is if you have findings incompatible with life. General rule for pedi codes: run 'em.

General rule for Pedi codes: Run them as you would any other code! Leave emotions at the door.

 

[Ridryder911]

General rule for Pedi codes: Run them as you would any other code! Leave emotions at the door.

Yeah, it's called medicine with a twist of true empathy.

R/r 911

 

[daedalus]

My teacher has brought up similar situations but I would grab and run. Go code 3 for about a mile then cut it to code 1 contact base and call it. Simply because you said 3 hours since last seen "alive". But I would do that one not really to give the parents hope but to show them you did soothing and with parents and pedi death parents can get combative and my scene can be come extremely unsafe. Just my though again only a student with a few rides under my belt so if I am wrong let me know please I am here to learn.

I know others here have told you, but I hope that I never hear of something like this happening. The thought of your scenario of fleeing the scene code 3 with a child and than cutting down to no code a mile away all for a show makes me literally cringe.

It is immature, irresponsible, a waste of resources, dangerous to the public, unethical, immoral, and totally below the standards of our profession. It is quite frankly disturbing. We do not play, pretend, or act! Thats for hollywood, not a medical profession! Do you see doctors and nurses pretend to rush a dead child to the ICU or OR and than when they get around a corner out of sight of family, stop and call the death?

You do nothing except endanger the public and your crew, give the parents false hope, incur ambulance and hospital bills as pointed out, and show some pretty careless judgement.

 

[sdaileyemt]

OK I under stand what I said was wrong looking at the whole picture like I said I am a student if you wanna keep ripping my *** for it YOU are the immature one NOT me. Grow up

 

[firemedic1563]

OK, so i agree in theory with field termination of effort. However, please remember that we all are in very different places with very different rules and resources. In MD, without rigor AND lividity, and in absence of "Injuries Incompatible with Life", it can be difficult at best to terminate efforts. It requires the MD agreeing, and even with the best advocate clearly painting the picture of futility, many if not most of our ED MD's want to make the call after THEY look at the patient. And I do say look because I have seen them hop in the back of unit outside ED after an hour or more of CPR and call it there.

As for ped's (and others in special circumstances), I have a somewhat unique outlook on them. Having worked as a member of a dedicated Pediatric Critical Care Team, that transports only ped's, I have worked at least a few dozen ped arrests in a few years, and have seen extended CPR times that resulted in positive outcomes. Yes it is rare. But even after EMS transport to local ED, ED time, our response time of 25 minutes to that facility, load time, and return time, the patient's recovered after the heart rested on ECMO for some time. Again, rare, but we are in an area where any of our hospitals are within a 15 minute flight of two of the nations top pediatric center's.

That said, that was a pediatric patient with a undiagnosed heart defect that went into arrest because of the stress on the heart. Good cpr was performed from time of arrest.

My point is that consideration needs to be given to the circumstances, distances to specialty centers, resources, etc. However, with signs of death, why start CPR? In that case, remember that the parents are also patients, victims of stress. Empathy can go a long way. On all my pediatric transports, wether 911, or critical care team, I make sure somebody is acting as a liason to the family.

 

[paccookie]

You are a paramedic unit composed of a medic and a basic. You are toned out for a 7 week old cardiac arrest. Arrive on scene and find the mother and farther very upset, leading you to the baby. The mother states that the baby was sleeping in his crib when she checked on him 3 hours ago. Before the call she went to check on him and he was unresponsive, not breathing and no pulse. You are 7 minutes from the hospital, and an engine is on scene for manpower.

This scenario is to see how other providers would handle this. I have not yet been on a pediatric cardiac arrest but have been discussing this with various people as to how to handle. Do you grab the baby and run out the door, doing CPR and such enroute to the hospital. Or do you work the code in the ambulance or in the house.

Depends on a lot of things. Are there obvious signs of death - rigor, lividity, glassy eyes, etc? Is baby cold to the touch? Or is baby warm? It could be that the child took his or her last breath seconds or minutes prior to being found and could be viable. Not likely, but it is possible. I would assess the patient before making a definitive decision. Unless there were obvious signs of death, I would work it. No one knows how long that child was down. As to how to work the code, follow PALS.

 

[daughertyemta]

I would load the baby up and get them in my enviroment. Start all the necessary tx. Given that the baby showed no signs of rigor or anything of that nature. Even if I knew I wasn't going to get that baby back..with no signs of rigor...its a show code...Do everything I can...leaving the parents with some peace of mind knowing we did all we could instead of walking in their house and saying yep..your baby is dead. Some might say a waste of time and effort but I call it compassion. Parents are in shock and they think you can fix it. Put yourself in their shoes if you had a little one like that. And more then likely its SIDS something your not going to fix anyways.

 

[Ridryder911]

Even if I knew I wasn't going to get that baby back..with no signs of rigor...its a show code...Do everything I can...leaving the parents with some peace of mind knowing we did all we could instead of walking in their house and saying yep..your baby is dead. Some might say a waste of time and effort but I call it compassion. Parents are in shock and they think you can fix it. Put yourself in their shoes if you had a little one like that. And more then likely its SIDS something your not going to fix anyways.

Here we go again ! Geeez, I did not know so many Paramedics wanted to be actors?
Amazing, I never read or taught to pretend anything!

Remember the emergency is NOT about you, it's about the patient and the patient is dead. It's NOT compassion it's being unethical, mean and cruel! Your placing false hopes and ideas and basically being gutless because you can't do your job.

Be empathetic, the patient is now the family. The family needs to have chaplain, family, etc.. called and later on grief counseling if appropriate. What they do NOT need is a $1000 EMS bill and a $5,000 ED bill because a EMT or Paramedic was not able to do what they should had done. Inform them there is nothing can further done. Guess what? Someone will and it is not a good idea for them to think you did not know your job or you treated the body without respect (yeah, running a code is pretty traumatic on the body).


If the child is workable, then work them for the right reason. If they are dead, then there is NO difference between being a child or an 80 year old granny.....

R/r 911

 

[daughertyemta]

So let me get this straight... You are going to put you and your partner at risk fir a dead person ... Give the family false hope by dramatically speeding away... Violate the childs body... Add a hospital bill onto of a funeral and ems bill.... And allow the family to drive to the hospital in an emotional state because you can't break the news? Some patient advocate.

Can we say compassion??? Or patient advocate??? You need to learn those terms again...Im guessing maybe you've been a medic for wayyyy to long and are burnt out!? I wouldn't want you as my medic if thats the way my family would get treated! If that was my baby, I would want you to do EVERYTHING you could!! Even if that meant poking my baby with needles, tubes, and meds! Seriously you need to think about how that family feels and not how much work you have to do! We run lights and sirens for all kinds of stupid crap but an arresting pedi is not worth all your effort?? :glare:

 

[daughertyemta]

Here we go again ! Geeez, I did not know so many Paramedics wanted to be actors?
Amazing, I never read or taught to pretend anything!

Remember the emergency is NOT about you, it's about the patient and the patient is dead. It's NOT compassion it's being unethical, mean and cruel! Your placing false hopes and ideas and basically being gutless because you can't do your job.

Be empathetic, the patient is now the family. The family needs to have chaplain, family, etc.. called and later on grief counseling if appropriate. What they do NOT need is a $1000 EMS bill and a $5,000 ED bill because a EMT or Paramedic was not able to do what they should had done. Inform them there is nothing can further done. Guess what? Someone will and it is not a good idea for them to think you did not know your job or you treated the body without respect (yeah, running a code is pretty traumatic on the body).


If the child is workable, then work them for the right reason. If they are dead, then there is NO difference between being a child or an 80 year old granny.....

R/r 911

Well you can work your codes how you do and Ill work mine how I do. I do believe I put in there that I would work them if they were workable! Meaning no signs of rigor or etc....

 

[Medic744]

In the past month I have worked a 50ish cardiac arrest of unknown cause and down time and an 18 month old with a down time of approx 2min. First one didn't make it and the baby cried all the way to the hospital for me. Both were worked originally by bystanders and good bless my first responders and police dept. Both were worked with the same level of care appropriate to their situations. When we arrived on scene for the pedi we snatched the baby out of the PDs arms and immediately started working him and as soon as dad was in the front seat and we secured a driver we were out of there. Just because the down time was known and ROSC was achieved by bystanders didn't mean that child was out of the woods and even if we had to work a full code on the child I wouldnt have done anything less than everything I was trained to do. Unless it is obvious that ANYBODY is gone and has been for a while then they are getting worked to the full extent of my ability. You can say to leave your emotions at the door and in the moment that is possible but at the end of the call those emotions will catch up to you. On a side note as a mother if something were (God forbid) to happen to my child and the crew that arrived in essence gave up before even working it and not trying or doing a show code then yes you had better have a LEO on scene.

 

[medic417]

Holy unprofessional batman crap. If a patient has obvious signs of death you would get mad at them for not doing a show code. I think someone really needs to reconsider if they belong in the medical profession.

 

[daughertyemta]

Holy unprofessional batman crap. If a patient has obvious signs of death you would get mad at them for not doing a show code. I think someone really needs to reconsider if they belong in the medical profession.

I think you need to re-read the statements...it has been put out there UNLESS there were obivous signs of death! Put ur reading glasses on or retire!