pedi code

PageRespiratory! · Jul 13, 2008

Been there to many times, hindsight is 20/20. Don't should've/would've/could've yourself. Not your fault, call it what you will (natural selection) it does'nt make it suck any less. Does your institution offer a debriefing after an incident like this? It helps........some. Sometimes I feel like it's our job to be heartless.

rlgiv · Jul 13, 2008

Had a very nice debriefing. The doc said we all did a great job and did all we could do. Chaplains where very supportive. I don't feel bad for our effort.

Hands and Heart · Jul 13, 2008

I'm sorry to hear about your unfortunate experience. No amount of training and experience can prepare you for the loss of a patient.

needsmore$ · Jul 13, 2008

i'm sorry. but you did what you could do. you recognized the seriousness of the child's condition, you intervened appropriately- it just was too little, too late. and the 'too late' wasn't your fault.

what is that quote?

rule #1- people die

rule #2- doctors and nurses can't change rule #1

recognize that you did all that you could, and during your discharge teachings to other parents-- maybe stress to them the red flags that they need to recognize so that they bring their kids in sooner than later. maybe in this way, the little one's death will help prevent another child from a similiar situation

we started doing this on the asthma group. there was this one lady who always tried to 'take care of it at home'- so by the time she arrived- she was ready for the tube- required long hospitalizations. we finally talked her into coming sooner than later and how much nicer it was when she would come for a flare-- only need a few nebs and iv steroids and be discharged from the ed then stuck on ventilators! she's doing so much better.

good luck to you. you did the best you could. sometimes, it's just not in the cards. people die. young, old, rich, poor. they die. because it's their time.

Pediatric Critical Care Columnist · Jul 14, 2008

Unfortunately with kids, once they start looking that sick the battle to keep them alive is an uphill fight. They will compensate and compensate and look pretty good, playing and interacting, color okay and mentation normal... right up till the instant their compensatory mechanisms are overwhelmed. Then they look like your guy looked. Oliguria and hypotension in kids are VERY late signs. When they're present, it takes the most skillful and persistent of pediatric critical care to turn things around. If it makes you feel any better, many times when we manage to "save" a kid like this, they are either profoundly damaged or they die later on in the PICU. You and your team did everything you could but the odds were stacked against you long before you ever saw this kid. As someone else said, take the lessons learned and use them to teach others how to recognize the kind of deterioration that leads to this outcome so that they can seek help sooner. You know that there will be others, so choose the method you get the most comfort from to help you when it happens. Talking always makes me feel better and this is where I come.

MassED, BSN, RN · Jul 15, 2008

Two years and I have had four pedi codes. Tonite was the first one in which I was the primary nurse and we lost him. Mom said he had been running a fever for three days with a runny nose. Also found out from dad later that he had not urinated in at least 48 hours and he was almost two months behind on his shots. Day three he started having a hard time breathing and was turning blue. Mom brought him into the ER threw triage. When I got him he had a HR of about 200 and was breathing about 48-54 per minute. He was mottled and dusky. He just decompensated before we could get a tube down him. We got it but if we could have gotten to him just a little sooner he probably would have made it.

oh so sad. how old? that's just rough... divorced parents? Hard to believe no wet diaper wasn't noted by parent/s and basic care wasn't a priority (it sounds) for this child - just neglectful and could have been so easily avoided....

rlgiv · Jul 16, 2008

oh so sad. how old? that's just rough... divorced parents? Hard to believe no wet diaper wasn't noted by parent/s and basic care wasn't a priority (it sounds) for this child - just neglectful and could have been so easily avoided....

5 months old. Parents wern't divorced. I really got the impression from the parents that it was normally well cared for. Dad said he thought he was getting better because the morning he died he began to get his appetite back. I really feel like they just didn't realize how sick their baby was.

MassED, BSN, RN · Jul 16, 2008

5 months old. Parents wern't divorced. I really got the impression from the parents that it was normally well cared for. Dad said he thought he was getting better because the morning he died he began to get his appetite back. I really feel like they just didn't realize how sick their baby was.

how sad.... :bluecry1: Awful because they will feel guilty for the rest of their lives, I would imagine.... as to what they might have done differently. Perhaps the child had other medical issues that weren't uncovered... will there be an autopsy, do you know?

rlgiv · Jul 17, 2008

how sad.... Awful because they will feel guilty for the rest of their lives, I would imagine.... as to what they might have done differently. Perhaps the child had other medical issues that weren't uncovered... will there be an autopsy, do you know?

Our doctor in the ER said it doesn't need to be a mec case. The family is requesting one but I think in that circumstance the family may have to pay for it on their own.

Your right the mother especially is blaming herself. She said several times "If I had just brought him in sooner" She did not want to be in the rom during the code. After it was over she was in denial about what had happened and was upset that we had stopped trying to resusicate her baby. She came to the realization that he was dead and stayed with him for another hour or so and then went home.

Our chaplain usually does most of the dealing with the family after a death. He told me that they didn't want an autopsy and we later called the family back to confirm and they said that they did want it. I probably won't hear about the results if it does take place but the baby had a lactate level of over 4. That was an istat blood level. I didn't see the other blood results but the chest X-ray was clear.

MassED, BSN, RN · Jul 17, 2008

Our doctor in the ER said it doesn't need to be a mec case. The family is requesting one but I think in that circumstance the family may have to pay for it on their own.
Your right the mother especially is blaming herself. She said several times "If I had just brought him in sooner" She did not want to be in the rom during the code. After it was over she was in denial about what had happened and was upset that we had stopped trying to resusicate her baby. She came to the realization that he was dead and stayed with him for another hour or so and then went home.
Our chaplain usually does most of the dealing with the family after a death. He told me that they didn't want an autopsy and we later called the family back to confirm and they said that they did want it. I probably won't hear about the results if it does take place but the baby had a lactate level of over 4. That was an istat blood level. I didn't see the other blood results but the chest X-ray was clear.

was that lactate level because of the hypoxia before or after the code? I'm unfamiliar with lactate levels.... what about SIDS? Could this entire thing have been a SIDS baby that the parents happened to catch and bring in as the child was crumping anyway?????

Trauma Columnist · Jul 17, 2008

Pedi - codes are rough, no one will disagree. Kids are our future so there is so much at stake. Very sad situation for everyone.