Saturday, December 27

You Make the Call...Code Blue

Read the following story, then post a comment. After a few days, I will post what happened.

I am on an ALS transport ambulance rung out for a code blue recuscitation. On arrival at the address we are met with a large amount of grieving family, not causing a problem in any way, but clearly this event was expected.
I enter the living room which has been converted into a hospice/visiting room and find the patient supine in the bed, appearing aepnic.
No one is crying, wailing, screaming for me to do something, they all appear calm, but sadened. Being the thoughtful person that I am I first ask for any advanced directives or Do Not Recuscitate orders. The family states that there is a DNR on the way over, ETA 20 minutes.
It is then that my partner informs me he detects a faint pulse at the carotid, maybe at a rate of 30, but weak. You then notice an agonal breath by the patient. Your partner asks you if he should start CPR and call for a Paramedic Supervisor.
We are about 20 minutes from a hospital.
Protocols in this situation require all efforts be taken.

What should I do? You Make the Call.


Anonymous said...

I had this call about a month ago. No choice, do the workup, get the leads on the PT. and see what you have, start CPR, run the drug protocol, etc. When the DNR arrives, and IF it is legal, you can cease your efforts. You apologize to the family and explain that it is the law and you have no choice. They should have had the DNR with the pt.. The Doctor SHOULD have told them this.
Lt. Tom

Pat said...

I agree with Lt Tom...DNRs MUST be with the patient for them to be valid. Won't do you any good to go on the word of the family members, then have them decide they want resuscitative measures to be taken, 30 minutes after you arrive.
I've often found that the family doctor often tells the family to call 911 when a terminal patient dies, expecting the ambulance to merely transport the deceased. Sorry, but if the call is for a VSA (vital signs absent), our crews will follow protocol to the letter, unless of course there is a DNR available.

Anonymous said...

I haven't seen them all yet, but I've had a bunch of these calls, including : "Oh Yes, we have a DNR in the house here somewhere, BUT I'M SURE HE WOULD WANT YOU TO DO EVERYTHING YOU CAN TO SAVE HIM" (Ok, Ma'am, so why did he have a DNR then? This on a pt. who had frim rigor, dependent lividity, the whole 9 yards. Probably deceased 12 hours or more.) You see a lot and you have to follow the protocols to cover your ass and give the patient what they deserve.
Lt. Tom

Anonymous said...

This is what protocols are for, to answer these puzzles in a way that protects the medic from being found at fault by having a predefined response. I wouldn't *want* to work it, but I would, absent the DNR. That's what the protocol says.

The Happy Medic said...

Get your comments in, "What happened" coming on Jan 1st.

Anonymous said...

Before you hit us with something from out of the blue, let me state what should be an obvious caveat: Every State has differnt laws, and every region (at least in my state) has different protocols. You options may be different. The last one of these calls I did was almost identical to yours except that the family thoguth we would just pronounce and be done. With no DNR, a warm patient, and no witnesses, we had to work it. What we did do was get the medic on the phone to Medical control to try to get a Doctor to allow us to discontinue based on the conditions. This took longer than everyone hoped, but eventually we were able to stop.
So what you are allowed or expected to do in your state may vary from what the rest of us, in our States, for good or bad, are allowed to do.
By the time you tell us how this went, I won't be a Lt. anymore, so please enlighten us. I'll be up before the sun on 1/1 to see what happened.
Lt. Tom

The Happy Medic said...

Lt Tom,
Every municipality does have their own guidelines, but the basics are always the same. Mainly this topic is to get us all thinking about the weird situations we're in.

MotorCop said...

We all know I'm no medic. Having said that, I'm gonna go ahead and compare it to the court and/or custody orders I deal with. If there's no lawful order with a judge's signature (not your lame ass attorney's letterhead), you don't get what you want. That is to say, no DNR, HM's gotta do his job.