firedoc5 Posted December 17, 2008 Share Posted December 17, 2008 I wouldn't work it. Seen it many times, never did. Link to comment Share on other sites More sharing options...
mediccjh Posted December 17, 2008 Share Posted December 17, 2008 Worst comes to worst, give 3 rounds, and if no change, pronounce. Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 17, 2008 Author Share Posted December 17, 2008 For the record, I would not work it, unless the nurses were pushing it real hard -- if they did, I would start CPR, call MC and get orders to stop. But Kaisu put a funky wrinkle in the scenario, which intrigues me. If I changed this patient to a bedridden 4 year old Cerebral Palsey patient, who aslo has no chance at a viable life, does that change the picture for you ? If so, why work the bedridden 4 year old versus the bedridden elderly patient ? Link to comment Share on other sites More sharing options...
ERDoc Posted December 17, 2008 Share Posted December 17, 2008 Worst comes to worst, give 3 rounds, and if no change, pronounce. Yup, 3 rounds into the mattress, not the IV and call it. PS-I am not condoning doing something as unethical as putting the drugs into the mattress, just trying to get my point across. Link to comment Share on other sites More sharing options...
streethealer535 Posted December 17, 2008 Share Posted December 17, 2008 I think p3medic said it best... who are we to decide what is quality of life for anyone but ourselves?? There is no way you can not work this patient. It is not right for us to try and push our own morals and belives on others. If this Pt did not want all efforts (real efforts not medicating her bed) She could easily have signed a DNR. You may be thinking mabey she just did not get to it, or someone else talked her into not signing a DNR but as EMS it is not our place to assume anything. WORK IT and work it RIGHT! JJ Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 17, 2008 Author Share Posted December 17, 2008 What if she had no family, and the first CVA made her comatose 10 years ago. ? There are situations where the patient may not have had the opportunity to sign any advance directives ? Link to comment Share on other sites More sharing options...
Kaisu Posted December 17, 2008 Share Posted December 17, 2008 What if she had no family, and the first CVA made her comatose 10 years ago. ? There are situations where the patient may not have had the opportunity to sign any advance directives ? We are unlikely to be aware of these sorts of conditions and God help us if we start making these kinds of decisions. Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 17, 2008 Author Share Posted December 17, 2008 I wouldnt fault anyone for not working her, as long as medical control was involved or you had a protocol or policy that allowed it. Link to comment Share on other sites More sharing options...
CBEMT Posted December 17, 2008 Share Posted December 17, 2008 The closest I've gotten to this was a known Hospice patient with a DNR signed by everyone except the doctor. Down time approximately 10 minutes, no signs of death except for asystole. Hell he was still getting O2 via concentrator. Family begged me to let him go (not sure why they called.....). Called in, explained the situation, doc ok'd not working it. In this case, without even an "almost" DNR to work with, I'm required to work it..... ....and transport. Link to comment Share on other sites More sharing options...
Richard B the EMT Posted December 17, 2008 Share Posted December 17, 2008 dwayne, if you were on the call, do you have to call medical control to get permission not to work it, or do you have to start CPR, then call MC to get permission to stop working it ? FDNY EMS policies and protocols have us, unless dependent lividity, rigor, obvious death (like a decapitation), or decomposition are noted, we start CPR, follow all standing protocols and procedures, then call OLMC with the request to terminate resuscitative measures. We still do "rolling codes". Just remembered, had a late afternoon call in an assisted living center, for a DIFFBR (Difficulty Breathing) call type. Patient was found laying on his back on top of the bed, in dependent lividity, cold to the touch, breathless and pulseless. After determining this status, first for myself, and then duplicated by my partner, we looked at each other, checked our watches, and said "Time of death is..., do you concur?" Partner did. From the door, several staffers expressed gasps of shock. The staff said he had been heard gasping about a half hour earlier. They probably had heard the agonal breathing, misinterpreted it as minor, but still had called 9-1-1 after going through their internal protocols on when to call.. FYI, we were less than 100 feet from the call location when we got the assignment, and signaled "On Scene" instead of "Enroute" as we were so close to it. Referencing another string, here: we radioed for the NYPD for a DOA, and left the deceased on top of the bed in the custody and accompaniment of the LEO team that responded. Link to comment Share on other sites More sharing options...
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