Sunday, July 22, 2012

Witnessed Futility

"Respond to ________ for the Code Blue."

This was to one of the medical/surgical floors of the hospitals we cover. One of our Paramedic units was dispatched there, and being in charge I figured it would be a good idea if I showed up as well. After all, I do what I have to so that my folks are protected.

When we all got there, the code team was indeed working a cardiac arrest. I say that because more often than not when we get scrambled to an in-hospital code the patient is conscious and breathing and it was an overreaction on the part of someone, usually the on-duty unit coordinator. However, this was not to be one of those times.

A 67 year-old female. African-American. Found pulseless and apeneic by staff on the floor, presumably her nurse. CPR was in progress. One of the docs was looking for an IO drill. And one of the medics from the truck jumped into the code with both feet. Personally, I wasn't thinking that was such a good idea. Read on, and you will understand why.

The code team consisted of all kinds of people: docs, nurses (many of both), respiratory, radiology, pharmacists, and us. Our job often consists of standing to the side and watching. In the event, however, that the patient needs to brought to the Emergency department, then we get pulled in to Fortunately, that doesn't happen often; either the patients we deal with in these situations are stabilized successfully, or they are not. Each time the team thought they had a successful resuscitation, pulses would be lost again and they would have to start over.

At the same time, the patient's family was present when all of the activity was going on. Four adult children and an older woman; her sister, I believe. They were going back and forth between the room where the patient was and the family room on the floor. They were all extremely concerned and quite anxious about what was going on, and for most of the time the patient was being worked I am not certain they were being informed as to what was going on. As the time spent accumulated, they became more anxious, confused, and agitated. It had the potential for becoming a bad situation.

One of the docs who was on the code team - an older female who I presume to be a senior doc, in fact - saw what was happening and went to the family. I suspect she spoke to the patient's oldest child because a few minutes later she brought her an another of the daughters into the room where the patient was being worked. It had been about an hour into it by this time and the team was getting nowhere. The doc was patiently explaining to the patient's children what was happening and telling them what their options were. As she was doing this the older of the two daughters, in a plaintive wail like nothing I've ever heard before, said "stop! Please - STOP!" Then she broke down and cried, as did her sister.

The atmosphere around this family, and all of the people on the floor, changed in an instant. Staff on the floor made sure doors on the patient rooms got closed. We packed up to leave.

It was one of the most heart-wrenching situations I have ever witnessed.


TOTWTYTR said...

I've "evolved" over the years in my approach to family at the scene. It used to be that I'd try to keep them in another room while we worked. I felt that there was high potential for family to become too agitated and require us to divert people from the patient to them.

Over time, I've come to realize that one size doesn't fit all. In some cases, we can utilize one family member to liaison with the rest. In others, the family doesn't want to be present. In still others the family will stand by and participate in the decision making.

Flexibility is the key.

As to your medic jumping in, I think it's poor judgement on his part unless the doctor running the case asks for assistance.

Walter Trachim said...

No argument from me on the last part. His partner and I had a word with him afterwards to let him know that he should have kept his distance. Fortunately the doc in charge didn't get upset; I woild have heard about it otherwise.

Walter Trachim said...
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