Thursday, January 1

You Make the Call...Code Blue...What Happened

First, read the item and comments here to get up to speed.

Most posters agreed that following the protocols in this situation is why we have protocols, to protect EMS providers and offer guidelines when there are questions. But protect us from what? Lawsuits. People who don't understand we are not a one call pharmacy/taxi company. But when people really need us and we can make a positive difference, the protocols can get in the way.

Unfortunately most protocols are diagnosis based, ie stroke, or hypoglycemia, but not listed by presentation. Of course each area of the country is different, but the basics are always the same per AHA. It is up to the practitioner in the field to collect all the data and place a person into the neat little pages of the protocol. When they don't fit what we have, we find ourselves awash in options.
Is the person intoxicated, but not altered? Is the trauma above the clavicles pre-existing? We could go for years on patients that didn't fit.

So what did I do on this particular run?

Let me begin by making this run even worse. The partner asking what to do is my preceptor at the time. I was brand new at this particular department and nervous out of my skull. I knew the protocols backwards and forwards and realized I had to think fast and act slow.

I instructed my partner that no, CPR is not indicated for a pulse and the patient is breathing. I then asked him to monitor both the pulse and respirations for 60 seconds to confirm accurate readings. I then turned to the family and told them we would have to defib and intubate their family member unless someone found that DNR. They went everywhere looking. The person bringing the DNR accidentally left with the hospice folder but turned around and is coming. Time seemed to move so quickly. My preceptor was beginning to sweat knowing what we would have to do if they didn't find something. A family member comes into the room carrying a copy of a DNR. Then I got an idea.

I instruct my partner to start oxygen and hook up the monitor while I make a call to the Online Medical Control Physician to pass the buck upstairs. I explain where I am and what is happening and the physician wants to know what the cardiac rhythm is. I move into the other room and see a small smile.


The physician advises that with the "presenting" rhythm he will allow us to honor the copy but must remain on scene until the original arrives. Just then she came sprinting upstairs and into the room, DNR in hand. It was legit. As we began to leave the family thanked us for what we did.

Did we break protocol, no. Per the written guidelines we were by the numbers, just slow.

This situation taught me that anyone who has a DNR should post it on the wall over their bed and now when I walk in it's the first place I look.

If you said follow protocol and honor the patient's wishes, you made the right call.

1 comment:

Anonymous said...

HM, I just wanted to share a little family story with you about DNRs.

My grandfather had a DNR - may God bless his soul, he has since pasted on.

When my grandfather was still alive, but not doing very well he use to carry his DNR with him everywhere. He was a very independent man, and he wanted his wishes carried out.

Just before his time came, my Uncle had taken him out for nice steak supper and a beer. My grandfather had a heart attack in the restaurant right after finishing his steak and beer.

Of course the paramedics, fire department, and police arrived. I am sure the paramedics arrived to the restaurant fully expecting to work a code, and transport but they didn't - the DNR was fully present in my grandfather's coat pocket, all my Uncle did was pull it out.

Yes, I am sure it was a little traumatic for the general public.

I don't know this for sure, because I wasn't there, but in my mind this is what happened. The medics came, did their initial assessment, saw the DNR, and because it was a public setting they put my grandfather on the stretcher and moved him to the ambulance - where notification was done.

Those DNRs sometimes are very scary to family members.