I agree with many expressed opinions about the futility of certain
situations and the need for the team leader to take control and act or order
action to cease.
I strongly disagree with one of the reasons often listed for ceasing resus -
"assault on the dead" or any negative implications on the "dignity" of the
patient.
First, no-matter what we say in this forum, and how obvious it seems in
retrospect, we are dealing with a patient, not a dead person. The patient is
not dead until that decision is made. Until the decision is made, the
patient is alive. My definition of life as "that which has not been declared
dead" is useful in preventing premature decision, even if it is not
scientific.
Second, why is a well-intended, professional attempt to do one's best (even
if it is statistically contra-indicated in retrospect) ever considered
beneath "dignity"? Why is any sign (excess vomit, distribution of lividity,
low body temperature) or any procedure (CPR, intubation, pericardial
aspiration) ever considered to lower anyone's dignity? Surely, if our
patient is beyond being helped by these, he/she is beyond being "insulted"
by it all.
If the patient is alive, I believe we must accept all procedures judged
appropriate by the team leader, while I strongly advocate training and
guidance on when to stop, which is often the only appropriate choice, for
reasons such as safety of the team, efficiency of the service, finances, the
family, WHATEVER... But leave "dignity" alone, unless you think someone has
less than best intentions at heart.
>From: [log in to unmask] (Rowley Cottingham)
>
>Further to previous comments, not only is performing CPR in this situation
>completely
>irrelevant it is also a gross assault on the dead.
>
>Why on earth do ambulance personnel persist in this ludicrous belief that
>once they have
>arrived at a patient only they can make a decision? The first thing any of
>you should have
>done is to contact your control for advice. If the control room supervisor
>was in any doubt
>then the on-call doctor for your service should have been contacted without
>delay and an
>opinion sought at that level.
>
>Just because your only connection with the rest of the world is by
>invisible radio waves does
>not mean the rest of the world has suddenly ceased to exist.
>
>Best wishes,
>
>
>Rowley Cottingham
>
>[log in to unmask]
>
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