? for those at delivery hospitals - page 2

by Imafloat

1,889 Views | 16 Comments

I work at a Children's hospital so I don't know a lot about deliveries. I figured someone here would have an answer. When a baby is born with an Apgar of 0, who is a suspected fetal demise, how long do you code the baby? We... Read More


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    It's not cool to have a "discussion" about calling a code for a new baby when the parents are right there listening to every word. Discuss comfort care after the fact, discuss limits on resuscitation with an ethics committee, but don't make the parents listen to health care workers disagree when their child's life is at stake.

    Refusing to continue a code could easily cost you your job, and have you reported to the BON. If there are no signs of life at 15 minutes you can be pretty sure the child is dead and likely to remain so. Hard to put your career on the line when there's only a 1-2% chance the child will regain a heartbeat and have to suffer....

    Every once in a while a bad situation happens to good people. The nurses and possibly the neonatologist are agonizing over what happened, and what they should have done. I would have done the same things, and been upset at the outcome too. Raindreamer did a good job, but life just isn't fair. I hope the baby passes peacefully.
    DDRN4me, Kiwimid, danissa, and 5 others like this.
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    Quote from canoehead
    It's not cool to have a "discussion" about calling a code for a new baby when the parents are right there listening to every word. Discuss comfort care after the fact, discuss limits on resuscitation with an ethics committee, but don't make the parents listen to health care workers disagree when their child's life is at stake.

    Refusing to continue a code could easily cost you your job, and have you reported to the BON. If there are no signs of life at 15 minutes you can be pretty sure the child is dead and likely to remain so. Hard to put your career on the line when there's only a 1-2% chance the child will regain a heartbeat and have to suffer....

    Every once in a while a bad situation happens to good people. The nurses and possibly the neonatologist are agonizing over what happened, and what they should have done. I would have done the same things, and been upset at the outcome too. Raindreamer did a good job, but life just isn't fair. I hope the baby passes peacefully.
    Thanks so much for this post, it means a lot. I needed to hear that.
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    In that situation, the Neonatalogist is the team leader, the RN/RT cannot, in mid-resus, announce "we're going longer than NRP allows" and quit playing.

    And, as Canoe pointed out, discussions about ethics and philosophy should never occur in the DR.

    Sometimes you just have to "deal" w/the situation in front of you; all the Monday morning Quarterbacking in the world won't change things.

    Praying for peaceful outcomes for the OP and Rain. For all the good things about NICU, this is one of the difficult things.
    Last edit by prmenrs on Jan 13, '08
    Elvish, danissa, BittyBabyGrower, and 1 other like this.
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    Everyone is right...you as part of the team cannot say, nope not doing that because it has been 10 minutes. I was in a situation similar and what we were told is that this is a GUIDELINE, not something that is written in stone or says that you have to absolutely have to stop after 10 minutes. That baby was coded in DR for 20 minutes and came back to the unit essentially dead and lived for another 30 minutes, I can tell you that plenty of us were appalled, but if it what the attending is calling then you play the game, as the RN, unfortuntely we do not call the shots. And yes, I will say that is a flame because you weren't in that situation, seems you haven't been, and I hope you never are, but I can tell you that sometime in your career you will run up against something like this and no one feels good about what happened.
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    Quote from BittyBabyGrower
    this is a GUIDELINE, not something that is written in stone or says that you have to absolutely have to stop after 10 minutes.
    Excellent point. The NRP guidelines say something along the line of after 10 minutes it "may be appropriate" to discontinue the code. I don't see that as being black and white.
    danissa likes this.
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    we have a poor wee guy, no heartbeat until 22 minutes!! but the resus kept going, and he's now got a shunt in his head and an extremely bleak outlook, as you can imagine. My friend at work and I were talking about this tonite, sometimes, when the code continues way past the time when you know the team should have stopped, you get that spine shiver and think..omg, what have we done? Suceeded in bringing back a baby that was dead, who almost certainly will suffer for their lifetime. No good feelings over saving a life, but causing a lifetime of suffering,and leaving a family to deal with all that will come.

    As the Neo-Nurse, you cant call the code, only the Senior Doc can, and they all have different outlooks, some will try anything, some not. Sad situation.
    Last edit by danissa on Jan 16, '08
    DeLanaHarvickWannabe likes this.
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    Quote from cshell1964
    According to NRP if you are coding in the delivery room, the code should be called after 10 minutes if there is no improvement or response to resusitation efforts.

    Unfortunately what should happen and what does happen is always different!! I HATE when we get a kid who was coded for 30 plus minutes. They never come out normal...ever. I think that the NNPs and Nurses play a huge role in saying....look we need to stop. The problem is, no one wants to do that. I had a 26weeker who was 345 grams come to the unit. She basically coded while we put lines in and the Neo asked if we agreed to not do compressions...thank god!

    I think the Neos have a hard time "failing" the baby even if they had nothing to do with the situation.
    danissa likes this.


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