Premature Neonate CPR

[Jeffrey_169]

How about the EMTs or Paramedics who might be Jehovah's Witnesses and are against blood products? Some have even been known to discuss this with the patient on the way to the trauma center?

In cases such as these, at least in my opinion, religious considerations are a must. Some patients do have have real concerns and we as patient advocates need to be aware and understanding. A person's religion is something of a special circumstance, and there are times when the "rules" change as a result.

 

[Aidey]

Maybe I misunderstood, but if not, woah there. We have NO place telling patients what medical procedures our religion does or does not allow. It is one thing if a patient asks you to pray with them, it is a whole different story to tell a patient that blood transfusions are wrong.

If a patient tells you "I am a Jehovah's Witness, don't let them give me blood", yes we have a obligation to make sure the hospital understands the patient's wishes. But our personal religion (or lack thereof) has NO place in the ambulance.

 

[VentMedic]

In cases such as these, at least in my opinion, religious considerations are a must. Some patients do have have real concerns and we as patient advocates need to be aware and understanding. A person's religion is something of a special circumstance, and there are times when the "rules" change as a result.

Aidey understood my statement.

Your own religious beliefs should not be pushed on the patient or influence the care you give as an EMT or Paramedic. That goes for receiving blood products, abortion, death, birth control, homosexuality and racial prejudices. Some also use a religion as an excuse to express things they believe to be immoral or socially incorrect when their attitude does not stem at all from a religion for them.

If a doctor is a Jehovah's Witness at a trauma center and the patient is not, the doctor still understands his responsibility about ordering a transfusion of blood when needed. If the patient is a Jehovah's Witness, it may be difficult to accept them dying because of not taking blood products if there are few to no alternatives available at a hospital. If the patient gets stuck at a smaller hospital with limited resources, it may take hours to arrange an IFT.

In some surgical procedures it is easier to conserve and recyle the blood. However, if the patient's blood is lying on the street or has been passed out the body from a GI Bleed, it may be more difficult in an emergency. If good health or be younger is on their side, there are better alternatives. However, if a newly born neonate needs an emergent transfusion to live, a court order can usually be obtained quickly. Many large NICUs do have an attorney and a judge on call 24/7 for these situations.

 

[EMSLaw]

Many large NICUs do have an attorney and a judge on call 24/7 for these situations.

I've handled medical guardianship cases, though not under the exact circumstances described. But yes, you can get a judge on the phone any hour of the day or night if needed, and can get emergent relief based on the testimony or affidavits of the doctors that the condition is immediately life threatening.

 

[SammyGirlMedic]

Besides working as a Paramedic, I work part time in a Level 3 NICU as an LPN. We take care of neonates as young as 23 weeks gestation, providing their weight/appearance seems as such.
It's often hard to "eyeball" gestational age on a neonate, and many times moms don't even know how far along they are/were...
Based on the info given in this case, most likely I would also clamp, cut, begin NRP and RUN!!!

 

[SammyGirlMedic]

If it helps, other than still needing to deliver the placenta mom was stable with no complaints but after additional unit arrived mother was complaining of abdominal and vaginal pain (Im going to have to just say Seriously?!). Mom is stable, no hemmorage or additional complaints.

Not that it's funny, but.. yeah, seriously? I haven't had any babies, but I'm quite sure it DOES hurt lol

 

[redcrossemt]

and RUN!!!

Why are you "running"?

I think resuscitation, if you chose to start it, would be much more effective in a well-lit room with lots of space that isn't bouncing down the road at a high rate of speed.

 

[VentMedic]

Besides working as a Paramedic, I work part time in a Level 3 NICU as an LPN. We take care of neonates as young as 23 weeks gestation, providing their weight/appearance seems as such.
It's often hard to "eyeball" gestational age on a neonate, and many times moms don't even know how far along they are/were...
Based on the info given in this case, most likely I would also clamp, cut, begin NRP and RUN!!!

Have you not watched the RNs do a Dubowitz/Ballard Exam?

Run? That is a surprising comment for someone who has NICU experience.

 

[SammyGirlMedic]

As I said, I would begin NRP and then run.. Because I don't believe it would be a good time to stay and play around on scene. I may attempt my intubation before leaving but other than that, I am getting that baby to someone with more experience and education than myself in a timely manner.

 

[VentMedic]

Originally Posted by Medic744
If it helps, other than still needing to deliver the placenta mom was stable with no complaints but after additional unit arrived mother was complaining of abdominal and vaginal pain (Im going to have to just say
Seriously?!). Mom is stable, no hemmorage or additional complaints.

Not that it's funny, but.. yeah, seriously? I haven't had any babies, but I'm quite sure it DOES hurt lol

Seriously? If the placenta still has not deliver and this was not a term birth which makes a premature birth "abnormal" there are many possibilities of things going wrong especially with the mother which caused her to go into premature labor. Seriously?

And define "stable"? Did you have a trend on her BP before and during delivery? Do you know the exact reason she delivered early and do you consider that "normal"?

 

[redcrossemt]

As I said, I would begin NRP and then run.. Because I don't believe it would be a good time to stay and play around on scene. I may attempt my intubation before leaving but other than that, I am getting that baby to someone with more experience and education than myself in a timely manner.

Please tell me what a physician is going to do for this lifeless neonate that you can not.

 

[18G]

Why are you "running"?

I think resuscitation, if you chose to start it, would be much more effective in a well-lit room with lots of space that isn't bouncing down the road at a high rate of speed.

If its an infant or small child its not uncommon for first responders or other first on-scene personnel to pick the child up and bring them direct to the ambulance as soon as they arrive. It makes transfer easier with not having to deal with all the equipment attached to the child. I like to work in my environment where I have everything and can transport with the word go. Who said anything about high rate of speed?

Run? That is a surprising comment for someone who has NICU experience.

"Run" is often a figure of speech for being expedite and not messing around. I highly doubt she meant she was gonna sprint and do hurdles with the infant on the way to the ambulance.

SammyGirlMedic... no matter what you say, your gonna be wrong with these few. Trust me.

 

[SammyGirlMedic]

Have you not watched the RNs do a Dubowitz/Ballard Exam?

Run? That is a surprising comment for someone who has NICU experience.

Yes, I have seen them do a Dubowitz. I, myself, do not do them every day. Let me rephrase it; it is hard to guess gestational age for a premie or micro-premie if that is not your every day job. I have worked in the NICU for 2 years as an LPN.. hardly well-qualified. An RN who has worked in the NICU for 20 years?? Yes, I am sure she could eyeball the age without looking at the Dubowitz chart.
And yes.. "run".. I wouldn't be playing around on scene. Surprising? How so? I don't see 24 weekers out in the field every day. I'd want to get them somewhere that DOES see them every day as quickly as possible.

 

[SammyGirlMedic]

If its an infant or small child its not uncommon for first responders or other first on-scene personnel to pick the child up and bring them direct to the ambulance as soon as they arrive. It makes transfer easier with not having to deal with all the equipment attached to the child. I like to work in my environment where I have everything and can transport with the word go. Who said anything about high rate of speed?



"Run" is often a figure of speech for being expedite and not messing around. I highly doubt she meant she was gonna sprint and do hurdles with the infant on the way to the ambulance.

SammyGirlMedic... no matter what you say, your gonna be wrong with these few. Trust me.

I'm glad you understood what I meant.
Maybe they are much more comfortable dealing with neonates out in the field than me.. that is great. I just know that in the controlled environment of the hospital with the right people is one thing, but to be out in the field is not ideal for many situations, let alone this. You learn to adapt, but how often do we get these types of calls? How often do we intubate 24 weekers? Me... I'd have to say I've never done it! Maybe they have more so! That is great experience to have.

 

[VentMedic]

Surprising? How so? I don't see 24 weekers out in the field every day. I'd want to get them somewhere that DOES see them every day as quickly as possible.

No the surprising part is that you would blow off the mother's complaint of abdominal pain with a premature birth and the placenta still not delivered.

I'd want to get them somewhere that DOES see them every day as quickly as possible.

How many premature baby codes do you think an ED physican has worked?

I worked in one hospital where I was the only one who had taken care of anyone under the age of 50 in a long time. Even in the hospital I am at now with the Level 3 NICU, the Neo team responds to the ED and works the baby, not the ED physician or RNs.

 

[redcrossemt]

If its an infant or small child its not uncommon for first responders or other first on-scene personnel to pick the child up and bring them direct to the ambulance as soon as they arrive.

We call this "baby football". It happens all the time because parents are frantic, and then the providers become frantic due to the nature of the scene and lack of experience with neonates, peds, whatever. It's one of the worst things you can do at the scene of a pediatric emergency. It's even a focal point of the PEPP class from the American Academy of Pediatrics.

It makes transfer easier with not having to deal with all the equipment attached to the child. I like to work in my environment where I have everything and can transport with the word go. Who said anything about high rate of speed?

Run implies a high rate of speed.

So why don't we move adult CPR-in-progresses to the truck first, before intubating, putting on the pads, EKG, EtCO2, SpO2, BP cuff, etc? We do this in the field because research has proven time and time again that the effectiveness of resuscitation is directly linked to the time between arrest and initiation of resuscitation.

Don't you think the same is true for neonates, infants, toddlers, and kids in general? If my kid arrests, I sure as hell want you to provide high quality care when you find him unless/until he has a ROSC.

"Run" is often a figure of speech for being expedite and not messing around. I highly doubt she meant she was gonna sprint and do hurdles with the infant on the way to the ambulance.

She said run, which I assumed meant going lights and sirens. Tell me that you are going to drive it nice and slow, non-emergently, and I will say you are not going at a high rate of speed. Otherwise, please note that drivers' emotions have been proven to get the best of them time and time again.

SammyGirlMedic... no matter what you say, your gonna be wrong with these few. Trust me.

Wrong with these few? Perhaps because "these few" know what they are talking about, and choose logic, research, and common sense over emotion.

 

[VentMedic]

"Run" is often a figure of speech for being expedite and not messing around. I highly doubt she meant she was gonna sprint and do hurdles with the infant on the way to the ambulance.

"Run" with 3 exclamation marks kinda shows something a little more than "just gonna run on down to the hospital now".

RUN!!!

 

[SammyGirlMedic]

No the surprising part is that you would blow off the mother's complaint of abdominal pain with a premature birth and the placenta still not delivered.



How many premature baby codes do you think an ED physican has worked?

??? I didn't say I would blow off the mother's complaint??
I would make sure the mother is cared for as well.. when I said "run" I was just implying I am not going to delay care and play around on scene.

Where I work as a Medic, I am aware of which hospital has a neonatologist on staff and I would take the child to that hospital. The neonatologists will respond to the ER for a case such as this. He/She knows a hell of a lot more than I do!

 

[SammyGirlMedic]

"Run" with 3 exclamation marks kinda shows something a little more than "just gonna run on down to the hospital now".

LOL!!! Or maybe it's just how I type! It's a life-threatening situation, so I thought it deserved 3 exclamation points.

 

[VentMedic]

??? I didn't say I would blow off the mother's complaint??
I would make sure the mother is cared for as well.. when I said "run" I was just implying I am not going to delay care and play around on scene.

We're past the "RUN!!!" part.

Remember your "seriously" remark in your reply to Medic744 who also didn't take her seriously?

Originally Posted by Medic744
If it helps, other than still needing to deliver the placenta mom was stable with no complaints but after additional unit arrived mother was complaining of abdominal and vaginal pain (Im going to have to just say Seriously?!). Mom is stable, no hemmorage or additional complaints.

Not that it's funny, but.. yeah, seriously? I haven't had any babies, but I'm quite sure it DOES hurt lol