Tough calls

[jbar]

Guess this is the opposite to the funny stories thread. I had one of my toughest calls today, and I've been an EMT for almost 6 years (last 1.5 on a ALS 911 rig) We got called to a "baby not breathing." We took about 4min to get there. Mom had gone to wake up the kid from a nap, found him not breathing, started CPR. Kid was 8wks old, born 8wks premature, was 5lb at time arrest. Hx Downs Syndrom, AV malformation.
I started bagging the pt, partner itubated while our EMT student did compressions. Kid was in asystole on the monitor. Partner tubed the kid, this with a 3.0 on the second attempt, confirmed with EtCo2, BS. Intial Capnography 7. We tried to get IO access, couldn't with two tries in the field. (In the ED they couldn't get IO access with two tries) started putting Epi down the tube and transported emergent. (I know, why transport a SIDS kid? Cuz mom was there, sounded like a pontentially short down time.)
So I was driving while mom sat next to me in the front seat. What the hell do you say to someone whose baby you are 99.999% sure is going to die? I told her he was getting the best possible care, but I felt like anything that I could say was totally inadaquete.
Got to the hospital, they worked the core for about another 30min. The chest xray showed an enlarged heart, it was taking up most of the left chest. The called it and mom came unglued. (Totally understandable)
The next hour was taken up putting the rig together, getting interviewed by dectectives, etc. Then we ran non stop calls for the rest of the day. In 12 hours we did 9 calls, some of the transports 10+miles (big county). We had a structure fire, motorcycalist v car, kid with 105 fever, etc. Didn't really feel like I got a good chance to proccess the pedi core until now. I know that we did everything that we could, and that no medicine could have saved that baby. Still, the image of mom handing him to us, as if finally, help had arrived and now everything will be okay will stick with me. As will my struggle to bag a 5lb baby, keep the airway open, and make sure my student did good CPR (if you have never tried to bag an infant with a BVM, go practice on a CPR dummy)


Just looking for people's thoughts, have you had SIDS calls? Or if anyone wants to vent about those calls that keep them up at night. I'm going to bed and try to get some sleep so I can get up to get back out there again tomorrow.


Jbar

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[jonb12997]

jbar, i'm very sorry for the tough call. Sounds like you guys did everything you were supposed to. Peds calls are the most memorable, (both good and bad)... I'm glad you were able to talk (type) about this to us. Find an older, more experienced EMT/Medic/Doc who has been through this type of thing that you can trust and talk with them. The best thing I found, for me anyway, for a tough call was to talk about it... Make sure to process this soon, you don't need this to fester in you for too long. Good luck.

 

[Edivocke]

I've done CPR 4 times now...with no saves. 3 times the patients were nursing home patients that were already cold upon arrival (no chance there). Stupid LPN's said it only started 3 mins ago...yeah right...bull ****!

One patient was 24...and I did perfect CPR upon arrival...and yet no save. It's hard to see someone slip away when you gave 100% effort...but then i remind myself that CPR is only 5% effective.

 

[QuikClot]

You should have access to a CISD process . . . ask your sup.

I had a similar call four days before Christmas. Mom comes home from her first day at work after five week maternity leave. Dad has been sleeping with baby. Hands Mom baby: baby isn't breathing.

We were on scene in a minute flat -- we were five blocks away. Couldn't find a peds bag -- I gave mouth to mouth respirations until my partner found it. The lighting was awful -- we were trying to assess pallor under the flickering colored lights of the Christmas tree.

We moved the baby to a table. The father cleared the kitchen table with a sweep of his arms, sending a pile of junk crashing to the floor. Couldn't get the tube on scene. I started to look for an IV, when one the the firefighters said, gently, "Maybe an IO?" I put an IO in and started with meds.

Eventually we got the tube in the car. They continued at the hospital. Throughout this the mother was indescribable. Screaming, crying, saying it was impossible, begging us to save him. That was the haunting part; code patients don't bother me, they aren't suffering. They called it at the hospital. Probably it was an accidental smothering. My partner held the mother, then I hugged my partner as she cried. My partner didn't sleep for three days afterwards.

The only people who understood were the people on the job. The firefighter compliamented my IO. The sup came out to see if we needed anything. The CISD coordination offered his help. My wife, who I wanted to talk to, didn't get it. "I thought that was kind of your job, like it happened all the time."

A farcial epilogue; the ME wrote AMR a letter to ask me why we transported (despite the fact that there was no lividity and no rigor, and thus no basis under our DIF protocals to call the code.)

It would be nice to finish with something uplifting, but I've really forgotten, in the course of telling the story, what positive I intended to finish this. I will say this; in retrospect that baby never had a chance. Nothing I did made a difference. So I can look at my mistakes, the holes in my preparation and knowledge as revealed by this call, and address them, so that I can be better next time, when I may have a patient I can help.

 

[jbar]

You should have access to a CISD process . . . ask your sup.

Thanks for sharing your experience. I feel better now after talking it over with my medic a bunch and some of the others who work wiht me. It is one of those calls that just sorta sucks and I needed to vent. It was a tough week, the day after the SIDS call we had a 23 yearold hanging, we didn't work it but while the medic was upstairs pronouncing one of the roomates came home and wanted to know what was going on, why there were a bunch of cop cars in the yard. I didn't know what to say, especially since the vic wasn't officaly dead to me until my medic said so (I hadn't seen him, didn't even know his name) I wimped out and had him go over and talk to the officer with a sorta mumbled "I'm not really sure what is going on, I just got here." Not my smoothest moment. Sigh.

 

[ShyRem]

jbar - do you work in Boulder? I used to work on Northglenn - and ran an entire summer of the most horrific kid calls ever known a few years ago. Burnt out two partners (they left EMS and never went back); the fire crew I ran most with and my remaining partner ended up taking 3 months off at the end of the string (and it was like a 12 week string with two or three bad - and I mean BAD - calls a week, and one every single Sunday), and on the last one the entire ER staff at a Denver level I (not DG) had to be sent home.

While I agree that talking helps most of the time, there are a few calls that none of us involved that summer ever talk about. Ever. And no, the ones that weren't there don't understand. My husband (a cop) doesn't quite 'get it', but knows it, and was as supportive as could be.

The hardest thing is to go back to work and run the next call like the bad one (i.e. the next 'baby not breathing' call). It gets better. I promise.

 

[jetproppilot]

Thanks for sharing your experience. I feel better now after talking it over with my medic a bunch and some of the others who work wiht me. It is one of those calls that just sorta sucks and I needed to vent. It was a tough week, the day after the SIDS call we had a 23 yearold hanging, we didn't work it but while the medic was upstairs pronouncing one of the roomates came home and wanted to know what was going on, why there were a bunch of cop cars in the yard. I didn't know what to say, especially since the vic wasn't officaly dead to me until my medic said so (I hadn't seen him, didn't even know his name) I wimped out and had him go over and talk to the officer with a sorta mumbled "I'm not really sure what is going on, I just got here." Not my smoothest moment. Sigh.

Yeah those calls suck. Sorry about your experience.

Back in my paramedic days we were dispatched to back up two other units at a fiery MVA...drunk girl in her twenties in a Trans Am head on into a Suburban...Trans Am girl paralyzed from neck down, Suburban driver entrapped, kid in the Suburban critical.

Halfway there we get a report the Suburban driver is DOA.

When we arrive, the other crew was tending to the Trans Am girl, had her loaded...so I walked over to the Suburban. Upside-down, driver hanging from the seat belt......2 nd unit already had the child intubated, getting ready to put him in the unit.

I peered in at the driver.

A few seconds later, I couldnt believe my eyes. I backed up in terror, sat down on the pavement.

It was a firefighter named Dennis....we all knew him. I knew his wife. And his kids.

His child suffered permanent brain damage. And Dennis was gone, leaving his wife and 2 kids, one of which was injured forever. All because of a drunk driver.

We were all nonfunctional after the call.

Debriefing team spent a week with us.

Took a long, long time to stop thinking about it every day.

I've got one more worse story but I'll save it for another day.

 

[fiznat]

Been working EMS in a busy urban system for about 4 years now and I'm lucky (I think) enough to say that I've never done anything truly horrible like you guys are describing.

I've done the christmas codes with the crying family, along with a few other "bad calls," but nothing has really touched me just yet. I'm waiting somewhat anxiously for that day, because I somehow feel like I havnt truly experienced what EMS is about without something really bad happening... Dont know if thats true or not.

More power to you guys who go through these things, and find the strength to stand up and keep on. I have a lot of respect for that, even if I havnt had to do it yet myself.

 

[streetdoc]

Hey Jetprop,
i can somewhat relate to your story and feel for you. We had a call for "unresponsive" one day. call was made by a door-to-door saleman that said a child was alone in a house and he thought he saw someone inside on the floor. We break in with police and the child (about 4 y) says her mommie is sleeping. Clearly, lady has been down for quite some time-rigor/pooling. played with the little girl and waited for social services. Anyway, bagged her up and took her to the morgue...she looked young, and i was a bit unnerved. It wasn't till an hour or so later that they got her name-it was a co-worker...
i don't know if i unconsciously didn't look at her face or if it was some kind of protection, but definitely not a call i will forget. those HAVE to be the toughest. UHHHH, this is why medics are drinkers.
take care,
streetdoc

 

[a_ditchdoc]

I have been a medic for approximatly 14 years now. Over the years, I experienced a few highs and more than a few low points. Occasionally I would have a save, most often short lived as they would later succumb in the ICU. Although my career was sprinkled with difficult calls, there was a brief period that I considered giving up EMS, and medicine completely. My week had been crummy. I had witnessed two arrests earlier in the week. Both died of course. Although both were without much hope to begin with as I recall. But, the final straw came when I had a man in his thirties in severe respiratory distress. He had complained of a "cold" for several days and difficulty sleeping. His "Cold" was the onset of heart failure and pulmonary edema. Enroute to the hospital, between gasps, he begged me to save him between promises to God. Despite my efforts, he arrested, and despite even more effort, he died.

I was a bit distressed, but having practiced EMS for a while, I know a bad day is just a bad day, tomorrow will be better. But, later in the day, I had a call for a house fire in which two young children were trapped inside. I tried to go into the house at one point but the heat, not even the flames, was so intense, that it was impossible. When the firfighters retrieved them from under their bed, they were both beyond help and I made no efforts to resuscitate. I tried to console the mother as she screamed, but as most of you know, there is little you can do to console someone in a situation like this. I placed the bodies in body bags and transported them to the morgue. When I arrived, I walked into the autopsy room to get the attendant. He was just starting to close the body of an autopsy that still had her chest opened and scalp pulled over her face. As he pulled the scalp back over the head, I recognized a beautiful but misguided old friend that I later learned had overdosed earlier in the day.

I didn't say much. Nor did I take any time off as I should have. In part because it gives me more time to think. Nor am I one that likes all of the attention. But inside, my thoughts were "Screw this...I can't do it anymore." For the next week I considered my resignation. I was just waiting for one more call to push me over the edge so that I could feel justified in giving up a career that I loved. As fate would have it, I don't think I tranported anyone with much more than a severe cold for the next three months, an oddity where I worked. I am thankful that I continued in medicine.

Over the years, I have resuscitated friends and coworkers, picked them up off the pavement, questioned why they shot themselves, performed compressions on dead babies, and told countless people "I'm sorry, there is nothing we can do." Once, I saw a car crash victim on which all efforts were ceased. I showed his many avulsions, flail chest, and fractures to my EMT students. Yet, somehow, underneath all of his injuries, he looked familiar. Noone knew his identity at the moment, but later, as I looked at his bag of possessions, I saw it had my last name on it. I initially thought someone was playing a prank on me. But unfortunatley, I had given the students a lesson in trauma on my dead uncle. It was long drive to my fathers house.

My point is not to try to outdo anyone with my "stories". People that do this profession for any length of time will, unfortunately, have their own. Perhaps this is why I am always put off by people that ask "What is the worst thing you ever saw?" as they anticipate a story about a bloody accident scene. I often want to ask "What keeps you awake at night? What makes you wake up in a cold sweat! Of course, I almost never do. Most of the time I tell them the ol' "I saw a broken leg once! I was really bent at a weird angle... the guy screamed and everything!" There is nothing that gives me more satisfaction that seeing that vague look of disappointment on their face as they try to act interested. Occasionally I will draw it out to make it a little more painful for them.

Someone once asked me to recall to myself the horrible things I had seen and the times when I couldn't save someone. I started making an internal list. After a few moments she interrupted and asked me to recall the people I did help, the people I did save. At the moment I could only remember a few things. Her point: We all seem to recall our worst moments while downplaying our better ones. Remember your good days, and good deeds, and let them balance the bad ones that you have.

These types of calls will never be easy. And occasionally, staying awake at night, tortured by what you see and by the deficits you think you have, is a sign of humanity and a means of self improvement.



(As for the CISD: People have their own styles and means of coping, but this never did much for me. Give it a try for yourself, but don't feel obligated to attend in the future if it isn't your thing...)

 

[jbar]

jbar - do you work in Boulder? I used to work on Northglenn - and ran an entire summer of the most horrific kid calls ever known a few years ago.

Yeah, I work in Boulder, for a few more weeks at least. (I'm quiting becuase I'm going to do some traveling before med school starts in the fall.) It's a fun system, lots of variety but I have to say, there are some really wierd people up here.

 

[jbar]

(As for the CISD: People have their own styles and means of coping, but this never did much for me. Give it a try for yourself, but don't feel obligated to attend in the future if it isn't your thing...)

I think that it is interesting that there is no evidence that a formal CISD process reduces PTSD. (that being said, I know plenty of people who have felt better after such a process, but it seems that just the act of talking about the incident with somone is as effective as having this guided process where you talk through the call with a moderator.)
I've been through one CISD when I was a patroller at college, we had a call were another college student hit a tree while skiing and was flown with a severe closed head injury. The patrol did a good job, the patient was backboarded and in the chopper within 20min of the call coming in. (I wasn't on the call, went to the CISD becuase I was an officer) It really helped the young patrollers who were there to hear from the ED doc that they did everything right and that there was nothing else that they could have done. Not sure walking through the call itself helped, but sometimes talking with someone who can back you up that you did what you could makes a difference.

 

[southerndoc]

I think that it is interesting that there is no evidence that a formal CISD process reduces PTSD.

It's actually more serious than that. There is evidence that CISD actually causes harm instead of making people better!

 

[jbar]

It's actually more serious than that. There is evidence that CISD actually causes harm instead of making people better!

You know where I could find that study? I would be interested to read it.

 

[canjosh]

You know where I could find that study? I would be interested to read it.

I think Dr. Bledsoe did one. Sorry I don't have it at the moment, but maybe you could find it.

 

[QuikClot]

It's actually more serious than that. There is evidence that CISD actually causes harm instead of making people better!

It varies a lot, I think. The evidence of harm, I've heard, comes from the within-72-hours, everyone-whether-they-want-to-or-not model CISD. I think everyone has realized that's a mistake. When people want it, and do it on their own timetable, I think it can be helpful.

Bottom line, we don't understand PTSD. Most of the clinical experience comes from war vets and sexual abuse victims, and the kind that medics, cops, and firefighters get ("burnout") is almost off the radar.

This is my thinking (excuse me while I riff without scientific evidence, using my intuition heavily): most people who have been on the street for five years or more (with some exceptions) have mild to severe PTSD. They are sensitive to loud noises (hate the radios, hate the siren), have temper problems, sleep poorly, and avoid the places they work (how many medics commute long distances to work? This made no sense to me until I read that PTSD characteristically avoid things that remind them of their trauma.)

This is a challenge to tradition PTSD thinking, because it suggests that PTSD is a cumulative process of "stress loading" rather than an acute mental injury from trauma. And I think that's true: when I had the bad baby call, I had a fight with my wife and then more or less let it go. My partner, tough as nails, but with 26 years on the job, didn't sleep for three days. Experience makes bad calls worse, like pressing on a bruise.

I'd like to do some research on this . . . I have some thoughts on how to test these ideas, as well as ways to reduce "stress loading" in EMS. 'Scuse my rambling.

 

[Lexems118]

Yea I know the feeling..If I may add a call I ran that still is sort of with me.

I am an EMT for a sort of big city in Virginia where two colleges are, one is military and the other is a university. I swear, the university has so many parties, its ridiculous. Anyways, We got toned out for an approx. 17-19 yoa female with "alcohol sickness." Well that sorta got me in a bad mood right there because of the girl's age, and she had been to the a major drinking area near my house unfortunally. We get on scene to find a jeep and in the backseat is the girl who we had been toned out to get. It looked as though they had been getting ready to go to the hospital but backed down and called us instead. We get to asking around to see what exactly happened, did anyone know her, what did she drink and how much..you know..the usual qusetions..well no one knew her, no one knew how old she was because they never asked..she had no ID on her either, and all we were told was she had rum and something else but unsure how much of it she had drank. We get her into the back of the unit and go through all of the protocol that we had to do as a rescue level unit. She apparently had aspirated and it went back into her airway, thus compromising it making it hard for her to breathe, so we suctioned and went through that whole thing and monitored her condition all the way to the hospital. One of her , I guess friends, was with her in the truck sitting upfront but she had no idea who she was or anything about her. When we got to the hospital, I had to hold her hand over the stretcher to make sure it didnt get crunched between the cot and the ambulance, which happened to have been in contact with her...up-bringings..and I didnt know what it was until I looked at her mouth and thought about it for a split second...i about threwup.(the finding the puke happened in the truck for clarification)
The thing that gets me is why the heck does someone feel the need to not only screw themselves up to the point where she wasnt even responsive anymore, and why do they feel the need to push the limit....its amazing that they dont even know what theyre doing to their bodies..and even if they do..just the thought of them still doing it kinda ticked me off..i dunno in a way, i sorta just wanted to pump some of the drugs into her to combat the effects but i know I couldnt as a BLS provider....ah well...people these days

 

[jetproppilot]

most people who have been on the street for five years or more (with some exceptions) have mild to severe PTSD. They are sensitive to loud noises

Interesting you mention that.

There was a particular WalMart that used to have one of those "beeps" that preceded an overhead announcement...used to make me cringe because it sounded exactly like the Plectron's beep that announced our calls.

 

[jbar]

Interesting you mention that.

There was a particular WalMart that used to have one of those "beeps" that preceded an overhead announcement...used to make me cringe because it sounded exactly like the Plectron's beep that announced our calls.

It is especially tough for us since we respond with about 35 different fire departments, and each have their own set of tones so there are a lot of sounds out there (fax machines, some peoples cells, etc.) that get my heart rate up cuz I think I have a call.

 

[Lexems118]

yea really, even at home in silence I sometimes hear the tones going off or even just walking around and such.

 

[southerndoc]

You know where I could find that study? I would be interested to read it.

Sure, check out the PDF article available on Bryan Bledsoe's website: http://www.bryanbledsoe.com/pdf/cism_debunk.pdf (requires Adobe Acrobat Reader).

It contains a list of all CISM research.

Bryan occasionally peruses the message boards. Perhaps he will post some stuff on CISM. He has a very strong opinion of it, and I think he's right: CISM doesn't work.

 

[leviathan]

I can give my $0.02 on CISM since I was contacted by my EMS organization's team. I don't think it helped much, although perhaps its benefits were superceded by the assistance provided by all of my freinds and family and even coming on the message board here. By the time the CISM member called me, I was already basically recovered, had spoken about it countless times to other people, and didn't see much use. I think there were actually a couple things she mentioned which may have brought things into a new perspective, but overall I'm a pretty emotionally adjusted person, I have all the same coping strategies and mindsets they were trying to tell me about (eg. you did the best you could), and so the only thing I needed was to just get it off my chest.

Since the incident on Thursday I've gone from it being on my mind every waking moment (and even in my dreams the first night) to 3 days later it is now just a fleeting thought every hour or so.

 

[jetproppilot]

I can give my $0.02 on CISM since I was contacted by my EMS organization's team. I don't think it helped much, although perhaps its benefits were superceded by the assistance provided by all of my freinds and family and even coming on the message board here. By the time the CISM member called me, I was already basically recovered, had spoken about it countless times to other people, and didn't see much use. I think there were actually a couple things she mentioned which may have brought things into a new perspective, but overall I'm a pretty emotionally adjusted person, I have all the same coping strategies and mindsets they were trying to tell me about (eg. you did the best you could), and so the only thing I needed was to just get it off my chest.

Since the incident on Thursday I've gone from it being on my mind every waking moment (and even in my dreams the first night) to 3 days later it is now just a fleeting thought every hour or so.

Again, as I said to another reader, sorry about what youre going through. I and every other reader can say we relate.

Very interesting stuff on the lack of efficacy concerning crisis intervention. I didnt know that.

And reflecting back on my 2 experiences with it, I cant say whether it helped (me individually) or not. But then again I'm 41, and that was 20 years ago....actually a little more than 20 years ago.

I think what helped just as much was talking with people in the same business who I knew personally, who had been through the same ordeals...i.e. friends that could relate, that I could speak openly with.

 

[jetproppilot]

Guess this is the opposite to the funny stories thread. I had one of my toughest calls today, and I've been an EMT for almost 6 years (last 1.5 on a ALS 911 rig) We got called to a "baby not breathing." We took about 4min to get there. Mom had gone to wake up the kid from a nap, found him not breathing, started CPR. Kid was 8wks old, born 8wks premature, was 5lb at time arrest. Hx Downs Syndrom, AV malformation.
I started bagging the pt, partner itubated while our EMT student did compressions. Kid was in asystole on the monitor. Partner tubed the kid, this with a 3.0 on the second attempt, confirmed with EtCo2, BS. Intial Capnography 7. We tried to get IO access, couldn't with two tries in the field. (In the ED they couldn't get IO access with two tries) started putting Epi down the tube and transported emergent. (I know, why transport a SIDS kid? Cuz mom was there, sounded like a pontentially short down time.)
So I was driving while mom sat next to me in the front seat. What the hell do you say to someone whose baby you are 99.999% sure is going to die? I told her he was getting the best possible care, but I felt like anything that I could say was totally inadaquete.
Got to the hospital, they worked the core for about another 30min. The chest xray showed an enlarged heart, it was taking up most of the left chest. The called it and mom came unglued. (Totally understandable)
The next hour was taken up putting the rig together, getting interviewed by dectectives, etc. Then we ran non stop calls for the rest of the day. In 12 hours we did 9 calls, some of the transports 10+miles (big county). We had a structure fire, motorcycalist v car, kid with 105 fever, etc. Didn't really feel like I got a good chance to proccess the pedi core until now. I know that we did everything that we could, and that no medicine could have saved that baby. Still, the image of mom handing him to us, as if finally, help had arrived and now everything will be okay will stick with me. As will my struggle to bag a 5lb baby, keep the airway open, and make sure my student did good CPR (if you have never tried to bag an infant with a BVM, go practice on a CPR dummy)


Just looking for people's thoughts, have you had SIDS calls? Or if anyone wants to vent about those calls that keep them up at night. I'm going to bed and try to get some sleep so I can get up to get back out there again tomorrow.


Jbar

OK, here it is.

Absolute worst call ever...revisited. Yeah, it was 22 years ago. I was a nineteen year old professional firefighter. Had some cool dudes on my shift. Captain Tony F, firefighter Gail A., firefighter Keith F, etc.

I was assigned to the Engine that memorable day. Thank God.

Plectron sounds. Pedestrian accident. Rescue 214 gets on the road with Capt F and firefighter A.

10-97. Its a boy. A young boy. Hit by a car. Face unrecognizable. Cardiac arrest. Guys start CPR, waiting on the ALS unit.

Firefighter A, helping with the BLS, glances over at the nearby ditch. Theres a boot there. A boy's boot. "Geez," he thought to himself. That looks like my son's boot.

He relieves himself of what he's doing, walks over to the boot. Inspects it. Really LOOKS at it.

Yep.

Its his son's boot.

And thats his son, over there. In cardiac arrest. The call he just responded on was his own son. And he didnt recognize him until he saw the boot, and put two-and-two together.

Gail A., 22 years later, I still feel your pain, bro.

Lord, hear our prayers.

 

[viostorm]

I definitely agree with SouthernDoc that CISM does more harm then good.

I think CISM creates "Critical Incidents" in your life as opposed to solving them. Anecdotally, I have much more vivid memories/emotions of the calls that had a CISM briefing following them as opposed to equally as bad calls that I did not have CISM debriefing.

As far as how to deal with it, just wake up and do what you do every day. Be aware for signs of clinical depression and be aware if the incident is effecting your life. If it is causing problem, then deal with it and don't wait until it becomes a real problem. I think it is good to maintain positive activities like exercise and social interaction during periods following tough calls, especially if it isn't what you want to do.

Time heals all.

I recommend against CISM, in my experience wallowing in it cements it in your memory. Getting up and living your life helps put it behind you.

I sort of equate dealing with tough calls to anesthesia. Whether this is a good analogy or not, I like to think of what we do for cardioversion. We give versed which has very little anesthetic (pain reducing) effects but has significant amnestic effects (patient doesnt remember). Because we give the amnestic, the pain of the procedure doesn't cause any long term fears or complications or anxiety about the cardioversion. They just wake up and they are happy not knowing they were in intense pain 5 minutes earlier. People are often conscious when they are getting shoulder's put back in with propofol, but they harbor no ill will or fears because they don't remember the pain they were in.

My opinion, and only my opinion, they more you cement this call into your memory the longer it will be with you and more it will effect your job and personal interactions.

Dude, and don't beat yourself up over a kid with a screwed up heart.

 

[viostorm]

On an sort of related topic I heard there was talk of using MDMA (ecstasy) or LSD for potential treatment of post traumatic stress disorder and I was checking around the internet after reading your post.

I found this, it is really interesting. I have no idea if it authentic, but it is still neat to see. It is 9 drawings done by an artist during LSD usage over the course of the exposure.

http://www.cowboybooks.com.au/html/acidtrip1.html

I think it is an instructive insight into the mental functioning of the people we pick up sometimes!!!

 

[Gatewayhoward]

Although I'm a newer medic and have never had a ped's arrest, that just made me remember one call where I was trying to console a wife who's husband was in trauma arrest and act like there was some chance left even though of course trauma arrests have a lower survival than medical ones. It's tough