do not rescusitate .............

originally posted by: bigfatfurrytexan
a reply to: saint4God

Quite a buddhist notion

Now that you mention, it does sound like one of the chapters in the Tao Te Ching, but was only illustrating going full tilt the other direction to see what was there. I hope everyone here understands the value of living.

a reply to: OtherSideOfTheCoin

It could be a UK/USA thing. Maybe American's just lose it emotionally easier and don't think as logically when faced with death of a loved one? I don't know and I wouldn't want to presume.

I did actually resuscitate a family member two years back (all somewhere in the ATS photo archives) and I would say I would always do it.

Funny though, he was so high from my two breaths, he had a huge smile on his face when the paramedics finally came and led him down the stairs.

a reply to: Buvvy
What is wrong with deciding you don't want extraordinary means to extend your life. A DNR order allows you to decide what you are willing to have done to extend your life and what you are not willing to do.

Many people do not want to leave their families strapped with ridiculous bills so that they can have their lives extended for a couple of days or weeks with a very poor quality of life.

The flip side is that many family members will keep their "loved ones" alive for their own selfish reasons. It might be a disability check or it may be guilt or just not wanting to deal with the death.

Each person should carefully decide what they are willing to go through and put others through just to stay alive. Many times very old people are in the process of natural death, having their systems shutting down and they will do anything to fight the inevitable. That happens at great financial cost that someone has to pay for.

In the US we are afraid of death and most will go to any extreme to avoid it at any cost. I have seen everything I have talked about as a nurse in critical care nursing.

Having been taught CPR is a gift.
I'm, grateful to this very day they drummed it into us.

This is a very interesting thread and from what I pick through you can see the perspective among a variety of medical types in the chain of survival as we say.

First off, a little background. I have been an RN for well over 20 years. All of it has been spent in Pediatrics. Ive worked Peds ED, Peds ICU, Peds Cardiac ICU, and the last 16 years as a Pediatric Transport Nurse Specialist which involves airborne and ground transportation of ICU level children. I have seen countless children die and often for no good reason. But, I also see the dark side of our medical science all to often.

From the perspective of my first responder colleagues: rolling up to a scene is one fo the MOST difficult aspects of medicine. You get to start from scratch, often assessing, extracting, stabilizing and transporting in god awful conditions. You often do not have the luxury of an ethical discussion regarding a plan of care unless it really obvious. Children also get a visceral reaction from all of us and that is to help at all costs. An adult face down in a lake for a hour will most likely be pronounced right there but a kid down longer will get a full on life saving attempt. IMHO children should be given the benefit of the doubt

We are a point where medical science can revive a dead lifeless child with high reliability. Give me enough drugs, and medical equipment I can revive anything. But at what cost?

When you are down more than say 3 minutes, brain cells start to die off. beyond 10 minutes, you will be lucky if you have brain stem function left. Thats the hard reality and not disputable. What happens after a resuscitation after a prolonged downtime? That child more often than not ends up getting a tracheotomy and a gastrectomy tube for feeding and is shuffled off to a skilled nursing home where they go back and forth to the hospital with pneumonia, infections, bedsores etc. until some disease process finally kills them.

Families are not exempted from this horrible process. They come day in day out to visit and care for the patient. Families are often torn apart from the stress and guilt that accompanies tragedy. The stress is brutal and the suicide rate among these families is much higher than average as well.

You see everything that made that child special died at the bottom of the pool, or lake, or when their head hit that pole etc. Whats left is almost an hollow shell of that special person. Who's heart and lungs continue to function but does not do much else. There is a reason you don't see any of those where are they now "Miracle boy pulled from cold lake stories" because there is seldom a happy ending..............

Objectively, first responders do not have enough information in 99% of the case to do anything but follow their training and fully code patients in the field. But once in the hospital, and proper assessments are made there should be a mechanism in place to prevent futile care IMHO

Per FredT's post, who defines "futile care"? The patient? The doctor/nurse? Is there a point where a miracle is impossible?

originally posted by: saint4God
Per FredT's post, who defines "futile care"? The patient? The doctor/nurse? Is there a point where a miracle is impossible?

When the brain is destroyed is an example. Head crushed or removed.

Other catastrophic injuries can be included. With bone fragments in your heart from a crushed chest the likelyhood of revival is small.

There are times. Until that point it should be up to the attending physician, who has a team there to consult with. Not a pair of EMTs making uninformed decisions in the field

originally posted by: saint4God
Per FredT's post, who defines "futile care"? The patient? The doctor/nurse? Is there a point where a miracle is impossible?

I would define futile care as continuing to keep alive a brain dead patient. We can keep your body alive for a long long time. But for whatever reason be it trauma, hypoxia, etc once the brain dies, the body is no longer what ever made that individual unique and special. Its gone. You are left with an empty vessel.

At this time the parents / guardians decide when enough is enough unless its say a full arrest situations and the team calls it.

I have seen many kids go home who should't have but Ive never seen a miracle or partial recovery once someone is brain dead beyond keeping the body going via artificial means.