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amzyRN amzyRN (Member)

Futile ressusitation

Emergency   (6,040 Views 32 Comments)
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I have noticed during my short time as an ED nurse that many of the cardiac arrest cases that come in through my ED (while I was on shift) seemed to be a waste. I've never seen anyone achieve ROSC that had a chance of actually recovering meaningful function (more seasoned staff saying they may die in ICU or live out their lives in a "vent farm"). Maybe some of the patients may recover, but they certainly never woke up after CPR.

There was a trauma case that came in a very severe car accident and the person was already in cardiac arrest when they rolled in and we spent at least 30 to 40 minutes trying to save this guy. He must have got like 8 units of blood and died anyway.

I feel like sometimes my efforts and the efforts of the team are wasted and that we should have stopped sooner.

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I know what you mean, but the one time you have someone you thought was futile walk back into your department under his/her own power to thank the physician and staff, it changes you forever.

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I know what you mean, but the one time you have someone you thought was futile walk back into your department under his/her own power to thank the physician and staff, it changes you forever.

I just feel disheartened sometimes that despite our best efforts, the patient dies or won't recover to a meaningful extent. I will always continue to do my best, it still bugs me sometimes when efforts fail.

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I know what you mean, but the one time you have someone you thought was futile walk back into your department under his/her own power to thank the physician and staff, it changes you forever.

Exactly this!

So much comes into play when it comes to getting someone back. But it does happen and they can go on to a meaningful life. Heck best case I saw? 67 yr old Veteran (should have been our first sign) CPR had been started within 2 mins of him going down, just right person around at the right time. EMS brings him in (was maybe 3 mins from hospital) we code him for about 6 mins and he comes back. I KID YOU NOT. He comes too fully, like if he didn't just get revived. Stubborn man. Wants to get transferred to the VA. Said they can check him out there. He was discharged the next morning and the BLS van took him to the VA hospital.

Another one came back after TOD was called, sat up and looked around and said "what's going on" however that was some freak incident and he died the next day and he was coded for 49 mins. and was already on deaths doorstep.

But depending on the back story and what happened, you will get them once in a great while and it will remind you why we try.

Not to get morbid but also all the no wins are still great learning experiences as well for people to practice their CPR and codes and all that.

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Hundreds of codes in the 20 years I have been in EMS or nursing, know of 2 that have walked out.

Was it a waste for those 2?

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One of the situations I've noticed I really feel frustrated has to do with the line "s/he wants everything done", or the team feels pressured because pt wanted or family wants "everything" done. This is an inappropriate reverse of the idea of code status as it has been has been perverted over the years. Making one's wishes known was originally about the ability to make known what a person did/would NOT want done, but has been twisted such that if a patient did/does NOT have restrictions on what s/he would want (in other words, they are a "full code"), people start saying things like, "you have to do everything", and providers have begun to feel pressured to go through all motions doing things that are not reasonable for the situation at hand.

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Had an older man come in PNB after being found down for an indeterminate amount of time. We resuscitated for around 20 minutes before it was called. No cardiac activity on US. Everybody, including myself, left the room to attend to other patients. I went back in about 30-45 minutes later to start morgue care and noticed the tips of his ears were pink and getting pinker. Next thing I know he took a breath. Not an agonal breath but a real honest to goodness breath. I threw the curtain open and yelled "Dr. N he's aliiiiiiiiiive. The doc leaped OVER the desk (no small feat since it had a 4 foot tall shelf above it) and we resumed care. EKG-nsr and he began to buck the vent. He was extubated about 12 hours later in the ICU and demanding to go smoke. Apparently he woke up his usual cantankerous self and went home the next day. It happens but more often than not it doesn't end well so I do get where you're coming from. It's those outliers that remind me daily that I'm not steering the ship so even when things look dim I still have to at least try o give my patients a fighting chance.

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I went back in about 30-45 minutes later to start morgue care and noticed the tips of his ears were pink and getting pinker. Next thing I know he took a breath. Not an agonal breath but a real honest to goodness breath. I threw the curtain open and yelled "Dr. N he's aliiiiiiiiiive.

OMG, I might have peed my scrubs! lol. That is pretty amazing.

Ours was a young patient who apparently experienced sudden cardiac death, found by roommates down in the bathroom after they heard a thud. We worked this patient FOREVER, and achieved ROSC when we thought it was way past time to call it (but our doc just refused to call it, to his credit — spider sense?). That young patient walked in with their parents some months later to thank us, and everyone got choked up. It was amazing. Very few deficits for such a long downtime, just some minor memory issues (I guess we perfused the heck out of that brain with our CPR). I will never forget the patient's mom hugging our crusty ol' doc and thanking him for saving her child. My eyes well up even now!

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As someone who is "not a nurse", but has many family members who are (thus, I follow this page), from personal experience? FIL, had his 1st MAJOR heart attack at age 32. followed by numerous "minor" attacks there after. TOLD by various Drs that he would never live to see 50. AT approx age 55, collapsed at home. No discernible pulse. MIL provided CPR while my SIL (age 15) called 911. Today, he is now aged 73, cantankerous and ornery a man as you ever will meet! Lesson? Don't give up! There is always a chance!

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PS I love this man with all my heart! He may be "cantankerous and ornery" with me, lowly Dogan that I am, all he wants, but he loves his grandboys! And that is all I care about! I thank the small gods every day that he survived to teach them all he knows about hunting, fishing and snaffling coo beasties!

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It will be extremely futile, if we as nurses, can't correctly spell the word: "Ressususcitititate" :nailbiting:

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There was a trauma case that came in a very severe car accident and the person was already in cardiac arrest when they rolled in and we spent at least 30 to 40 minutes trying to save this guy. He must have got like 8 units of blood and died anyway.

I feel like sometimes my efforts and the efforts of the team are wasted and that we should have stopped sooner.

8 whole units! my god it must have been awful for you. We gave 60 to a criminal who slit his throat and wrist after barricading himself in his house after he just murdered his wife and child.

And you know what, not one person in that room cared on what we thought was worth it. We have a job to do and thats to try.

Your efforts ARE mostly wasted on these sickest of sick people. Statistics proves it too. So does that mean we just don't try?

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