Premature Neonate CPR

[VentMedic]

That's great. You were very quick to jump down my throat I must say... I didn't claim to be an expert did I? I just answered the question about what I would do. You could've used the opportunity to give me your expert opinion in a way that would make me really think and not immediately try to make me think I was dead wrong.
They say nurses eat their young.. but so do many others!
And no one scared me away.. I'll be around! Thanks for your time!

Those who come back with a good debate get more respect than those who get their panties in a knot when someone calls them out on a subject. You'll find this true in the NICU. To get respect, you have to stand your ground without letting them see you sweat or get ruffled. We are of course very protective of the babies and that includes the young nurses who get our respect.

 

[SammyGirlMedic]

Those who come back with a good debate get more respect than those who get their panties in a knot when someone calls them out on a subject. You'll find this true in the NICU. To get respect, you have to stand your ground without letting them see you sweat or get ruffled. We are of course very protective of the babies and that includes the young nurses who get our respect.

Oh I knew the minute I walked in the NICU they were a very head-strong bunch. And, close-knit.
I was slightly intimidated at first but I wanted very badly to stay..and I have. I feel as though I have earned their respect.. But the nice thing was, they seemed to want mine as well. They have all definitely earned it.

 

[VentMedic]

But the nice thing was, they seemed to want mine as well.

We just love the attention.

 

[SammyGirlMedic]

We just love the attention.

I can see that! I have less than 6 hours left in my shift. I should try and get some sleep.
Everyone have a good, safe night!

 

[Medic744]

Im glad to see that this is turning into a well discussed topic. Its true that you dont know what you will do until you are in the situation. This was not my call but the crew that I was coming on for. They did everything within their training and saved a life that day. The paramedic who worked it is the type of paramedic I want to be, in all aspects of his life. As far as transporting "dead" I am going to go with the arrogant part of me and say nobody ever dies or is dead on my stretcher. I may end up sweaty and sore but I am doing my best. We dont have protocol to call in the field other than the presence of an OOH DNR or obvious signs incompatible with life. That goes for all age ranges. As far as the Seriously remark I made, that was being sarcastic, because childbirth hurts! I speak from experience and dont know too many women who say it didnt.

 

[VentMedic]

As far as transporting "dead" I am going to go with the arrogant part of me and say nobody ever dies or is dead on my stretcher.

This is something you are going to have to get over if you want to assume responsibilty as a Paramedic. Patients die...fact of life...and you may not be able to change that. You have to come to grips with that and do what is best for the patient, their family and the public that you might endanger while running hot with every trauma code and cardiac arrest that has been asystolic too long. You will have to learn there will be a time when working a code at scene is more effective than barely working one at all in the back of a moving truck. If you get ROSC at scene, great. But if you don't, let it go and call the patient dead. This is about the patient and not your ego or bragging rights to "no one dies" crap.

 

[Veneficus]

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.

To just expand on this for a minute, religious groups that take/perform medical aid (as providers or lay persons) overseas, does it absolvve them of the ethical and professional standards tht they would be accountable to in the US or other modern nation? Why or why not?

(open fire)

 

[Medic744]

This is something you are going to have to get over if you want to assume responsibilty as a Paramedic. Patients die...fact of life...and you may not be able to change that. You have to come to grips with that and do what is best for the patient, their family and the public that you might endanger while running hot with every trauma code and cardiac arrest that has been asystolic too long. You will have to learn there will be a time when working a code at scene is more effective than barely working one at all in the back of a moving truck. If you get ROSC at scene, great. But if you don't, let it go and call the patient dead. This is about the patient and not your ego or bragging rights to "no one dies" crap.

There is a difference between driving hot and driving without regard for safety. Our crews are the highest trained medics in the area and I trust them with my life every time they get behind the wheel. They know the rules and abide by them and still manage to get me where I need to be without hurting anyone or getting complained on. And I do agree that if you are so far out that it is better to work on scene then go right ahead but I have to luxury of being close to one of the top medical centers in the US and having some of the worlds greatest medical teams on hand no matter what the situation. I also dont need to "come to grips" with death. I get that but I also get that I have the chance to do MY best to change the outcome. I have lost people and saved them too. But with the ones I have lost I know I did everything I could and I try very hard not to second guess myself. Every service has many different factors that have to go into making every transport decision and we are going to have to agree that mine are different from yours. We are also going to have to agree that I think maybe a little bit of ego and arrogance is a good thing and I see it as a sign of a strong person and you see it as a weakness. I would rather have someone have a small ego and be self assured than somebody who second guesses themselves and doubts everything. Thats just me.

 

[Aidey]

As far as transporting "dead" I am going to go with the arrogant part of me and say nobody ever dies or is dead on my stretcher.

This is something you are going to have to get over if you want to assume responsibilty as a Paramedic. Patients die...fact of life...and you may not be able to change that. You have to come to grips with that and do what is best for the patient, their family and the public that you might endanger while running hot with every trauma code and cardiac arrest that has been asystolic too long. You will have to learn there will be a time when working a code at scene is more effective than barely working one at all in the back of a moving truck. If you get ROSC at scene, great. But if you don't, let it go and call the patient dead. This is about the patient and not your ego or bragging rights to "no one dies" crap.

I want to comment on Medic744's comment.

Legally, in my ambulance no one does die on the stretcher. They die somewhere else. If a patient is declared dead on the stretcher we get to park were we are at and sit there for who knows how many hours until the coroner gets there.

It has nothing to do with arrogance in our (me and my co-workers) case, it is about not getting in massive amounts of trouble. Our med control, supervisors, and the coroner all get pretty upset when we do that. It has happened a couple of times over the years, once since I was working here and it was a HUGE mess.

On top of that, you tell the family you are transporting them to the hospital, which makes them think the hospital can do something. Then declaring them dead en route leaves the family stuck at the hospital asking what is going on. Not cool.

 

[redcrossemt]

I'm always very close (typically <6 minutes) to many community hospitals, and always within 20 minutes of at least one of seven ACS-verified level I and II trauma centers, who also have many very good specialty teams.

That doesn't mean that I rush people to the hospital all the time.

The fact of the matter is that ACLS, PALS, and NRP are no different for the ER than they are for us. We do the same thing they do! So why delay the care if we can do it? Especially with the poor resuscitation that's going to occur during the transportation and transition to the ER. It is almost entirely IMPOSSIBLE to do good CPR in the back of an ambulance without a mechanical device for compressions. The best resuscitative outcomes are from resuscitation at the time and place of arrest. We know that interruptions in compressions are really bad for these patients; yet some of us are advocating to move the patient, wheel the cot, move the patient again, etc. You can NOT do CPR while moving a patient, and CPR while in motion on a cot is not very effective, or safe.

On top of that, you tell the family you are transporting them to the hospital, which makes them think the hospital can do something. Then declaring them dead en route leaves the family stuck at the hospital asking what is going on. Not cool.

Uhm, maybe I'm reading this wrong, but why don't we just advocate to change the protocols and declare death on-scene - thus preventing both of the problems you explained above (getting in trouble for declaring enroute, and family issues)??

 

[Aidey]

We can declare on scene, that was a hypothetical problem if a operation doesn't allow declaring on scene but allows declaration in the ambulance. We either declare on scene, or they are declared at the hospital. Hence, no one is ever technically dead in my ambulance.

I was just trying to point out that saying that isn't necessarily arrogance, but possibly a legal distinction.

 

[rhan101277]

Several seasoned medics I talk to say, paramedics can do as much as the ER can, besides cold steel. I know there isn't xrays or ct scans in the back of the truck, but medics aren't making definitive diagnosis.

I am just saying when it comes to what we can do to change the outcome initially, the ER does just the same as medics.

 

[redcrossemt]

We can declare on scene, that was a hypothetical problem if a operation doesn't allow declaring on scene but allows declaration in the ambulance. We either declare on scene, or they are declared at the hospital. Hence, no one is ever technically dead in my ambulance.

I was just trying to point out that saying that isn't necessarily arrogance, but possibly a legal distinction.

I see now.

I would never declare in my ambulance either, too much paperwork.

 

[Medic744]

It is almost entirely IMPOSSIBLE to do good CPR in the back of an ambulance without a mechanical device for compressions.
QUOTE]

We are lucky enough to have the Autopulse.

 

[redcrossemt]

It is almost entirely IMPOSSIBLE to do good CPR in the back of an ambulance without a mechanical device for compressions.
QUOTE]

We are lucky enough to have the Autopulse.

Too bad you can't use it on neonates...

 

[ah2388]

Too bad you can't use it on neonates...

yea i wasnt sure of this...

Peds coming up so this discussion was definitely quite interesting...not looking forward to my first ped code

 

[Rogue Medic]

18G,

Science, statistics, numbers, or whatever... need to be strongly considered, however, who are we to say, "they are gone", or "no chance in surviving"?

We are the trained professionals they called. We are supposed to provide appropriate care, not provide CPR theater. Appropriate care includes care of the family.

Misleading the family at this time is cruel. Treating a dead patient, just to avoid telling the family that the patient is dead, is not doing anything for the family. How is this not just doing what you want to do, to make yourself feel better?

This obviously is exempt from the obvious situations of death.

So there are times when you do pronounce patients dead. Do you base that on emotions?

But we need to give patients every fighting chance we can.

We need to provide the best care we can. The Rah! Rah! stuff is for fights or football games, but not patient care.

Miracles do happen and patients defy the odds.

Provide documentation of some miracle.

You clearly do not understand odds. If the odds are that 9 out of 10 cardiac arrest patients will not leave the hospital with good neurological function, then it is expected that 10% of cardiac arrest patients will leave the hospital with good neurological function.

They are not defying the odds. They are just demonstrating the way that statistics work. A lack of understanding of statistics is not a valid excuse for bad patient care.

We do work on cardiac arrest patients. If I were to believe what you write, I would assume that we never attempt resuscitation.

The 2005 ACLS Neonatal Resuscitation Guidelines include Guidelines for Withholding and Discontinuing Resuscitation.

Each clinician needs to make decisions that they are comfortable with and at the end of the night, they can sleep well with.

Clinician? That does not sound very emotional.

 

[Rogue Medic]

Jeffrey 169,

I understand your point, and please don't think me sarcastic when I say this, but according to science as it pertains to the laws of physics, it is impossible for a bumble bee to fly. It is, according to science, not physically possible, yet everyone, even a 3 year old knows it happens, all the time.

Just something to think about, and again please don't think I am being a smart a**; its true.

I don't think that you are sarcastic.

You are wrong.

You claim that this is true, but you provide no evidence to support your dramatic claim.

It is likely that you do not understand science, even a little bit, but you use this old wives tale to pretend that you know more than scientists.

There are words for people like you, but none of them are polite.


Earlier you wrote -

Decapitations, the onset of rigormortous (I think I spelled it right) etc are all causes to call it quits,

No. You did not spell it correctly. Do you not trust dictionaries?

Rigor mortis is the correct spelling.

Since you appear to be using a computer, you might consider looking up a word, if you have doubts about the spelling.

You can't spell.

You can't tell the truth.

What can do you do?