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AnthonyM83

Unconcious Male At Bus Stop

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I try to save them all. The ones that are supposed to die do but the ones who are going to live will definitely get their chance under my care at a basic level it is not much of a chance, but they get it anyway.

Edited by DFIB

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I agree that its futile to work a code over the 20-30min mark. Full stop.

However, its a shit excuse to say that folks at nursing homes have zero quality of life, as not every individual who resides at one has the brain activity of a cucumber. In fact, by kiwi reasoning maybe we should just stop responding to any medical situation at the nursing homes, I mean their just an albatross on our necks anyway.

As for calcium and Bicarb in a code, I think they have their place, in particular with the hyperkalemic cardiac arrests.

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However, its a shit excuse to say that folks at nursing homes have zero quality of life, as not every individual who resides at one has the brain activity of a cucumber. In fact, by kiwi reasoning maybe we should just stop responding to any medical situation at the nursing homes, I mean their just an albatross on our necks anyway.

Rob please, you're making me look bad :D

I should disclaim I am referring to the rest home patient who is on the severe end of the scale or somebody with such a reduced health related quality of life that its really not in their interest to be resuscitated.

Sure, there are those at the rest home who just need a bit of hand with whatever and are doing OK, my Nana is one of them, then there are the ones who are just waiting to die from severe systemic disease

Look I'm probably way too overbiased and will freely admit that

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.. and who is qualified to make that call? Certainly not an EMS hero. Who better than the patient themself, hence advance directives, DNRs etc? In the absence of expressed wishes of the patient, then why not those that love the patient?

I know that as an old person, the things I derive joy and satisfaction appear pretty boring and non-fulfilling to the twenty somethings I run with. I am pretty sure my perspective is not that of an 80 or 90 year old. My mother at 84 lives to see another sunrise - she loves them. Just because she is physically and mentally incapacitated, who am I to say she should go? She wants to stay- regardless of the indignities of incontinence and the pains of a failing body. Now if she codes, I would let her go, because she has told me she is ready anytime. Her cousin, 86 and in worse shape, says "do everything" otherwise how would God be able to demonstrate a miracle if that is what He has in mind?"

Doesn't make any sense to me, but it is her life.

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Hmmm looking at Steven Hawking how debilitated his body is I wonder what he lives for? I mean he is a pretty damn good writer and he seems pretty full of his faculties.

someone like him with his body a wreck would surely not be worth saving right?

how bout the person who's mind is gone but can run a mile in 6 minutes? All he does is run but his mind is shot.

What about the idiot savant who's mind is so sharp but his body is out of it?

Who are we to say that they are not worth saving.

I know someone who thought they knew better in who was not worth living and who was. I think his first name was Adolf. Let's not go down this road folks.

All the above people listed would not be deemed savable according to the above person.

There are people out there who we deem not valuable but to someone close to them they are very valuable. Put yourself in their shoes, just because you are on the EMS end of the equation, does not make you the one to make that decision. What if those we are discussing are your loved ones? The discussion takes on a different meaning right?

We can put ourselves at arms length as a EMS provider and say "this guy is bedridden, has no quality of life" so he doesn't qualify for lifesaving interventions or doesn't qualify for being coded but are you really sure that he has no quality of life?

All we see are small swatches of time in these peoples lives, yet we have the ARROGANCE to make a end of life judgement based on a single hour or two that we spend with that patient. We need to check ourselves.

We do not know the backstories of these patients. Remember, in 30, 40, or 50 years, you are going to be in that position as the patient and you are going to have some ems provider making the same assumptions about your quality of life, and maybe by then, their assumption might lead them to be able to make the decision to end your life not save it. They might be able to decide by just looking at your current circumstances and other assessments that they can just go ahead and decide (per procedure) that your life is time to end. Think about that for a bit. I mean, that's what we have been skirting on for a bit with this discussion haven't we, that some people should not be resuscitated based on quality of life perceived by US as providers, hasn't it?

Edited by Captain Kickass

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I know someone who thought they knew better in who was not worth living and who was. I think his first name was Adolf. Let's not go down this road folks.

Sadly the White House seems to share this idea as well.

Edited by DFIB

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I'm not sure I'd go that far Dfib.

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I'm referring to clinical scenarios where resuscitation is not best interests of the patient e.g. those who are dying from cancer or with severe end stage chronic medical conditions (e.g. end stage heart failure or end stage COPD) who are bed/house bound or have a such a severely reduced quality of life they are "waiting to die" and may or may not be on palliative care

What about the guy who sits in his recliner all day attached to an oxygen machine and continuous pump driven hospice meds, needs a carer to feed, toilet and shower him and who has not left the house in three years? Where the fuck is the point in coding him?

Look maybe I'm just too out in left field but I find cardiac arrest resuscitation to be incredibly undignified and brutally invasive and in some scenarios it is far more dignified and humane to not work them; sometimes doing what is in the best interest of the patient is to do nothing especially if they have been down any length of time.

The last cardiac arrest I went to was brutal it was horrendous, six people showed up (including myself) and this poor little old lady stayed just as dead as when she got found on the loo.

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I'm referring to clinical scenarios where resuscitation is not best interests of the patient e.g. those who are dying from cancer or with severe end stage chronic medical conditions (e.g. end stage heart failure or end stage COPD) who are bed/house bound or have a such a severely reduced quality of life they are "waiting to die" and may or may not be on palliative care

What about the guy who sits in his recliner all day attached to an oxygen machine and continuous pump driven hospice meds, needs a carer to feed, toilet and shower him and who has not left the house in three years? Where the fuck is the point in coding him?

Look maybe I'm just too out in left field but I find cardiac arrest resuscitation to be incredibly undignified and brutally invasive and in some scenarios it is far more dignified and humane to not work them; sometimes doing what is in the best interest of the patient is to do nothing especially if they have been down any length of time.

The last cardiac arrest I went to was brutal it was horrendous, six people showed up (including myself) and this poor little old lady stayed just as dead as when she got found on the loo.

dont dispute anything you say Kiwi, however it is not up to us to 'play paragod' if the person has not organised an NFR then how can we say that they should not be resusitated at a scene.

how do you know that they do not want all that is possible done to them? whilst I also feel it is cruel to see people in situations like that, WE are not the ones to make the decision that they should be in a better place upon their impending death.

If they do not have an end life plan, then I assume that they do not want to have and end of life (who does) and i am OBLIGATED to assist them to survive (even thought I realise it probably will be a waste of time)...but unfortuntely that is NOT MY CHOICE........

that is why when my father passed away a few weeks ago, he had a end life plan (vebal one in the hospital) they still asked if the family wanted him to have any resusitation attempts when he went unconscious.........we didnt want him to suffer and agreed witht he verbal plan........and as a paramedic whose father was the patient it was a very easy decision for me.

Edited by craig

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I'm not sure I'd go that far Dfib.

Right, not Adolf like. I stand corrected.

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