Warning

 

Close

Confirm Action

Are you sure you wish to do this?

Confirm Cancel
Member Login
Site Notices
9/22/2017 12:11:25 AM
Posted: 9/27/2005 6:04:01 AM EDT
I'm in the ICU yesterday and I get a patient transported up urgently from the floor - hypotensive, no IV access, Full Code, about a million and four years old.
Soon, we're coding her and, being a large and fit guy who doesn't get tired quickly, I get stuck on chest compressions. And everytime I do them, I'm breaking her ribs. So, after a while I'm doing compressions on a flail chest.

The current state of the system is that people are full codes unless they choose to be a DNR. I think a more realistic approach is that everyone after the age of 70 is a DNR, unless they choose to be a full code.

I fucking hate doing this to old people. This lady was stepping through the door and I had to torture her until she finally jumped through.

Link Posted: 9/27/2005 6:08:47 AM EDT
[Last Edit: 9/27/2005 6:09:54 AM EDT by FLAL1A]
I have a good friend who is a high-level nurse (I never can remember which is which) and he quoted me some really grim stats from his own experience and research about your chances of ever being anything more than a pooping zucchini if you code and resuscitated, even if you're not 80 years old. He (~50) has told everybody and his brother to ensure that he is labeled "DNR" if he goes to the hospital. He's disgusted/terrified at the prospect.

ETA: On rereading your post, much of what you said could be a transcript of my friend's statements on the subject.
Link Posted: 9/27/2005 6:12:44 AM EDT
Link Posted: 9/27/2005 6:12:58 AM EDT
Agreed, I've been in for a few years now and I agree it does suck major donkey ballz to pound away on some old dude's chest for 40 mins, just to have the ED doc call it right as I walk in. Knowing full well that he's been in arrest for about an hour now, and if a rythm is obtained, all it will accomplish is a few more days of agonizing pain. and the misery of false hopes for the families.

But I did have an old biker a few yeas back with DO Not Resuscitate, Tattooed on his chest.

Just remember DNR, Does not mean do not treat.
Link Posted: 9/27/2005 6:13:17 AM EDT
+1

They need to have a "DNR tatoo" for people.
Link Posted: 9/27/2005 6:14:53 AM EDT

Originally Posted By SP1Grrl:

Originally Posted By Justa_TXguy:
I'm in the ICU yesterday and I get a patient transported up urgently from the floor - hypotensive, no IV access, Full Code, about a million and four years old.
Soon, we're coding her and, being a large and fit guy who doesn't get tired quickly, I get stuck on chest compressions. And everytime I do them, I'm breaking her ribs. So, after a while I'm doing compressions on a flail chest.

The current state of the system is that people are full codes unless they choose to be a DNR. I think a more realistic approach is that everyone after the age of 70 is a DNR, unless they choose to be a full code.

I fucking hate doing this to old people. This lady was stepping through the door and I had to torture her until she finally jumped through.




Wow, I can't imagine. The 'breaking ribs' part gave me the willies.



You can't even imagine. It feels like nothing I have the verbal capacity to explain, but once you feel it, you'll never forget what it feels like. (shuddering), Creepy
Link Posted: 9/27/2005 6:16:50 AM EDT
Link Posted: 9/27/2005 6:17:02 AM EDT
Shortly after a close family member became a MD, he asked everyone close to him to think about having a living will. This was way before the Schiavo ordeal.

Looking back now, in the case of my Mom, this alleviated a lot of stress on the family and allowed her to die at home with hospice care.
Link Posted: 9/27/2005 6:21:29 AM EDT

Originally Posted By SP1Grrl:
If I were performing CPR on someone, I don't know that I could continue if I started to break ribs. I hate to say that, but I get the heeby jeebies too easily. I can't even imagine how that would feel.



But the CPR does get alot easier to do after that's happened.
Link Posted: 9/27/2005 6:23:37 AM EDT
Link Posted: 9/27/2005 6:24:19 AM EDT
Hospice workers are good at explaining this to people. When my dad was in there a few weeks ago we were very explicit -DNR. They did give him oxygen toward the end but that was to insure he was not suffering. The people that are sent to hospice and demand to be resuscitated simple die multiple deaths. Once is enough.
Link Posted: 9/27/2005 6:28:25 AM EDT

Originally Posted By SmilingBandit:

Originally Posted By SP1Grrl:
If I were performing CPR on someone, I don't know that I could continue if I started to break ribs. I hate to say that, but I get the heeby jeebies too easily. I can't even imagine how that would feel. hr


But the CPR does get alot easier to do after that's happened. hinking.gif



hock.gif................Yeah your'e right..............But damn that was cold.
Link Posted: 9/27/2005 6:29:27 AM EDT

Originally Posted By SP1Grrl:

Originally Posted By Maxim_Mag:

Originally Posted By SP1Grrl:

Originally Posted By Justa_TXguy:
I'm in the ICU yesterday and I get a patient transported up urgently from the floor - hypotensive, no IV access, Full Code, about a million and four years old.
Soon, we're coding her and, being a large and fit guy who doesn't get tired quickly, I get stuck on chest compressions. And everytime I do them, I'm breaking her ribs. So, after a while I'm doing compressions on a flail chest.

The current state of the system is that people are full codes unless they choose to be a DNR. I think a more realistic approach is that everyone after the age of 70 is a DNR, unless they choose to be a full code.

I fucking hate doing this to old people. This lady was stepping through the door and I had to torture her until she finally jumped through.




Wow, I can't imagine. The 'breaking ribs' part gave me the willies.



You can't even imagine. It feels like nothing I have the verbal capacity to explain, but once you feel it, you'll never forget what it feels like. (shuddering), Creepy



If I were performing CPR on someone, I don't know that I could continue if I started to break ribs. I hate to say that, but I get the heeby jeebies too easily. I can't even imagine how that would feel.



I was a lifeguard in college. I once rescued an elderly lady caught in a rip current. Her ribs snapped like dry kindling when I administered CPR. Didn't bother me much, my partner had to do the "kiss and blow."
Link Posted: 9/27/2005 6:30:25 AM EDT
We picked up one cancer patient at home not too long ago. We show up and she's pulseless and apneaic. The husband states that she was a nurse before getting ill, we ask if they have DNR orders. After answering no he wondered why we were coding his wife.

If anyone should have known, it would have been her.
Link Posted: 9/27/2005 6:32:19 AM EDT

Originally Posted By SmilingBandit:

Originally Posted By SP1Grrl:
If I were performing CPR on someone, I don't know that I could continue if I started to break ribs. I hate to say that, but I get the heeby jeebies too easily. I can't even imagine how that would feel.



But the CPR does get alot easier to do after that's happened.




Sarcasm, right? I hope that was sarcasm.



Vulcan94
Link Posted: 9/27/2005 6:34:15 AM EDT
If you aren't breaking ribs, you aren't doing it right. That's just how it goes. I seriously doubt she suffered from your chest compressions. Don't sweat it. I definitely hear you about the DNR DNI thing. The tattoo idea stated above is one that several of my co-workers and I have agreed is a good idea. When it's time, it's time.
I did chest compressions on a guy with two tiny little stubs where his legs should have been. They moved when I pushed. A month or so later I was doing ACLS re-cert and I was doing compressions on resuci-annie and I just broke down laughing. It was a huge flashback. She had the two little stubs for legs, and it was just like that guy. Now every time I do CPR stuff on a doll I can't help but laugh. Not as funny as the guy with a prioprism we coded. His "member" kept flapping all over the place. Hard to run a serious code under those conditions.
Link Posted: 9/27/2005 6:35:04 AM EDT

Originally Posted By Vulcan94:

Originally Posted By SmilingBandit:

Originally Posted By SP1Grrl:
If I were performing CPR on someone, I don't know that I could continue if I started to break ribs. I hate to say that, but I get the heeby jeebies too easily. I can't even imagine how that would feel.



But the CPR does get alot easier to do after that's happened.




Sarcasm, right? I hope that was sarcasm.



Vulcan94



Why? It's true.
Link Posted: 9/27/2005 6:38:12 AM EDT

Originally Posted By 2IDdoc:

Originally Posted By Vulcan94:

Originally Posted By SmilingBandit:

Originally Posted By SP1Grrl:
If I were performing CPR on someone, I don't know that I could continue if I started to break ribs. I hate to say that, but I get the heeby jeebies too easily. I can't even imagine how that would feel. hr


But the CPR does get alot easier to do after that's happened. hinking.gif




Sarcasm, right? I hope that was sarcasm.



Vulcan94



Why? It's true. hinking.gif



Absolutely true. But I disagree with the statement made ealier, If your not breaking ribs, you're not doing it right. This would not hold true on a 20 something in arrest after an OD of some sort.
Link Posted: 9/27/2005 7:10:36 AM EDT
[Last Edit: 9/27/2005 7:10:51 AM EDT by TheRedGoat]
Link Posted: 9/27/2005 7:34:17 AM EDT
I actually haven't done chest compressions on a person for a few years. Between becoming an ALS provider and being replaced by robots, I find myself not getting the workout.

Link Posted: 9/27/2005 7:43:49 AM EDT
Link Posted: 9/27/2005 7:44:23 AM EDT

But I disagree with the statement made ealier, If your not breaking ribs, you're not doing it right. This would not hold true on a 20 something in arrest after an OD of some sort.


Yeah, you're right. It's just a saying used in EMS. Honestly I think the saying "if you're not breaking ribs you're not doing it right" was intended to calm the nerves of a responder that experienced this phenomenon and was worried that it was their fault. There are a number of other sayings that are not too hard to find exceptions for as well. Like a saying that was common in a DC ER ambulance team I worked with, "Babies bounce, and all bleeding stops eventually.". Ridiculous? Of course! But the intent is to ease the guilt or stress of a responder that is experiencing a lot of guilt over a situation. It's a kind of gallows humor and not meant to be taken literally. My statement about the ribs was not intended to imply that the established CPR guidlines for chest compressions should be discarded in the event that ribs are not in fact being broken. It's good you clarified this point.
Link Posted: 9/27/2005 8:58:13 AM EDT
i have worked in large hospitals for 15 years..
i have always wondered whyyyyyyyyyy.

i even thought about a DNR tattoo on my chest. but then i came to my senses and realized that the people working on me would just say.." hey cool tattoo....CLEARrrrrrrrrrrrrrrrrrrr"

as far as chest compressions go..

if your not feeling snap, crackle and pop...chances are the compressions are being done forcefully enough. its sad that the weak and the frail are the ones that it will be done to.

Link Posted: 9/27/2005 9:01:49 AM EDT

Originally Posted By SP1Grrl:
I can see how that would be possible, but what about if the patient makes it? All their ribs are broken...Can't a rib puncture a lung or something and do more damage?



Bones (or more often cartilige) heal, dead is dead.

From what I understand the parts that mostly break during cpr are right around the sternum, which behave differently than a more lateral fracture.
Link Posted: 9/27/2005 9:05:05 AM EDT
The worst part of this scenario are the relatives. Its never fails some long lost relative will show up and insist that measures be taken. Due to guilt or whatever, the main caretaker of the person is ignored and not allowed to make decisions.

But I fucking hate these people that ignored the living and then show up at the last minute waiting for handouts and trying to make decsions for a forgotten relative.

Link Posted: 9/27/2005 9:15:21 AM EDT
Oh God, why did I click on this thread.


Originally posted by SmilingBandit
We picked up one cancer patient at home not too long ago. We show up and she's pulseless and apneaic. The husband states that she was a nurse before getting ill, we ask if they have DNR orders. After answering no he wondered why we were coding his wife.



What does it mean to "code" someone.
Link Posted: 9/27/2005 9:18:46 AM EDT

Originally Posted By bvmjethead:
Oh God, why did I click on this thread.


Originally posted by SmilingBandit
We picked up one cancer patient at home not too long ago. We show up and she's pulseless and apneaic. The husband states that she was a nurse before getting ill, we ask if they have DNR orders. After answering no he wondered why we were coding his wife.



What does it mean to "code" someone.



To preform the whole CPR workup.

Depending on the level of care it can just be CPR and artificial ventilations all the way to IVs, advanced airway management, pushing medications, and shocking the patient.

Code is (my own guess) from code blue, the common term for a pulseless patient in a hospital. (Or Code 99 as we transport CPR in progress).
Link Posted: 9/27/2005 9:20:50 AM EDT

Originally Posted By Justa_TXguy:
I'm in the ICU yesterday and I get a patient transported up urgently from the floor - hypotensive, no IV access, Full Code, about a million and four years old.
Soon, we're coding her and, being a large and fit guy who doesn't get tired quickly, I get stuck on chest compressions. And everytime I do them, I'm breaking her ribs. So, after a while I'm doing compressions on a flail chest.

The current state of the system is that people are full codes unless they choose to be a DNR. I think a more realistic approach is that everyone after the age of 70 is a DNR, unless they choose to be a full code.
I fucking hate doing this to old people. This lady was stepping through the door and I had to torture her until she finally jumped through.




I have thought about this subject many times.
I agree with what you said.

It should be DNR unless you opt out.
Link Posted: 9/27/2005 9:22:06 AM EDT

Originally Posted By bvmjethead:
Oh God, why did I click on this thread.


Originally posted by SmilingBandit
We picked up one cancer patient at home not too long ago. We show up and she's pulseless and apneaic. The husband states that she was a nurse before getting ill, we ask if they have DNR orders. After answering no he wondered why we were coding his wife.



What does it mean to "code" someone.



Code blue. Cessation of cardiac and/or pulmonary function. You're dead.
We perform basic CPR, which is chest compressions and oxygenation. We also perform ACLS, which would involve intubation (sticking a breathing tube down your throat) and ventilation. We start a big IV and fill you full of fluids and IV drugs. We may defibrillate you ("shock", as in clear!)
For a frail, sickly, and elderly patient, it is essentially torture. For an otherwise healthy person, it can revive you with a possibility of having a meaningful life.

Link Posted: 9/27/2005 9:31:25 AM EDT
[Last Edit: 9/27/2005 9:32:27 AM EDT by HardShell]

Originally Posted By Maxim_Mag:

Originally Posted By SP1Grrl:
Wow, I can't imagine. The 'breaking ribs' part gave me the willies.



You can't even imagine. It feels like nothing I have the verbal capacity to explain, but once you feel it, you'll never forget what it feels like. (shuddering), Creepy



It's sort of muffled, wet crunch - like the worst knuckle-popping you've ever felt but not as loud, but even that description doesn't do it justice... and it happens much more often during CPR than most folks realize.

(I worked my way through undergrad working nights in the ER/Trauma Unit of a large urban hospital, often was the largest [or only] guy on hand, and always got stuck doing compressions... )
Link Posted: 9/27/2005 9:51:06 AM EDT
Link Posted: 9/27/2005 9:53:58 AM EDT

Originally Posted By TheRedGoat:
...but I was hoping he would not make it. Broken chest would make his next few years painful at best.

Rest in peace, Old Fella, was my thoughts...

TRG



They're looking at changing how we can call codes in the field soon (here at least). That should eliminate some unnecessary chest thumping.
Link Posted: 9/27/2005 9:55:05 AM EDT
At 83 my dad was taken to the hospital after a convulsion. He had DNR stickers all over his file, and a medical will that stated the same on file with the hospital and with his attorney. He stabilized for awhile, had all the monitors hooked up to him, then had another convulsion of some type. He flatlined and they brought him back, even with a large DNR sticker at the top of his chart, When he awoke, he was partially paralyzed...slurred speech, etc. It's the one scenario he always talked about trying to avoid. He just kept saying "WHAT'S THE USE?" over and over. We finally insisted that they move him into the hospice ward, where they don't have such monitors. He died later that night in his sleep. Sometimes DNR orders are not enough. He was such a proud man and never wanted to be 'damaged' like that. I had a long talk with the doctor, who really had nothing to say in the hospital's defense.
Link Posted: 9/27/2005 9:58:38 AM EDT
[Last Edit: 9/27/2005 10:01:07 AM EDT by Tango7]

Originally Posted By ARDOC:
The worst part of this scenario are the relatives. Its never fails some long lost relative will show up and insist that measures be taken. Due to guilt or whatever, the main caretaker of the person is ignored and not allowed to make decisions.

But I fucking hate these people that ignored the living and then show up at the last minute waiting for handouts and trying to make decsions for a forgotten relative.




+1

ETA - or show up at the hospital wailing and caterwauling like banshees when 20 minutes earlier they had called EMS because "uncle Willie was drunk again and (they) couldn't wake him up... " then they asked "can we just take him outta here" and get offended when you're trying to get hx & info from them while they're on the phone with their friends...

Of course, the snoring is really agonal respirations...
Link Posted: 9/27/2005 10:00:58 AM EDT
Not me, I have an "at all costs" attitude. As well, I'll never be an organ donor. Too easy for someone to decide your gone, and take your organs for profit. Fuck that.
Link Posted: 9/27/2005 10:03:17 AM EDT

Originally Posted By skpp108:
Not me, I have an "at all costs" attitude. As well, I'll never be an organ donor. Too easy for someone to decide your gone, and take your organs for profit. Fuck that.



You have your plan, I'll have mine.

Just watch out for those Vegas hookers, they'll take your kidneys too.
Link Posted: 9/27/2005 10:05:38 AM EDT

Originally Posted By DoubleFeed:

Originally Posted By SP1Grrl:

Originally Posted By Maxim_Mag:

Originally Posted By SP1Grrl:

Originally Posted By Justa_TXguy:
I'm in the ICU yesterday and I get a patient transported up urgently from the floor - hypotensive, no IV access, Full Code, about a million and four years old.
Soon, we're coding her and, being a large and fit guy who doesn't get tired quickly, I get stuck on chest compressions. And everytime I do them, I'm breaking her ribs. So, after a while I'm doing compressions on a flail chest.

The current state of the system is that people are full codes unless they choose to be a DNR. I think a more realistic approach is that everyone after the age of 70 is a DNR, unless they choose to be a full code.

I fucking hate doing this to old people. This lady was stepping through the door and I had to torture her until she finally jumped through.




Wow, I can't imagine. The 'breaking ribs' part gave me the willies.



You can't even imagine. It feels like nothing I have the verbal capacity to explain, but once you feel it, you'll never forget what it feels like. (shuddering), Creepy



If I were performing CPR on someone, I don't know that I could continue if I started to break ribs. I hate to say that, but I get the heeby jeebies too easily. I can't even imagine how that would feel.

I've had more than one CPR instructor tell me to expect to break ribs if I went at it efficiently.

BOOM. We got told, "go deep enough till you hear ribs crack, then your going deep enough. They are already dead, what are you gonna do, hurt them?" And that was that. To this day I've NEVER done compressions on someone and not broke ribs. I've been lucky enough to only have to do them on the elderly.
Link Posted: 9/27/2005 10:06:29 AM EDT

Originally Posted By Vulcan94:

Originally Posted By SmilingBandit:

Originally Posted By SP1Grrl:
If I were performing CPR on someone, I don't know that I could continue if I started to break ribs. I hate to say that, but I get the heeby jeebies too easily. I can't even imagine how that would feel.



But the CPR does get alot easier to do after that's happened.




Sarcasm, right? I hope that was sarcasm.



Vulcan94

Nope, it's true, and anyone that has done chest compressions for more than 40 seconds will appreciate anything that makes it easier.
Link Posted: 9/27/2005 10:07:04 AM EDT
The first code I worked I did compressions on this old man who had been brought into the ER by EMS, and he'd been down ~45 min, although CPR had been started almost immediately. By the time it was my turn his chest was kind of a mush. Yeah, that was interesting.
Link Posted: 9/27/2005 10:11:54 AM EDT

Originally Posted By skpp108:
Not me, I have an "at all costs" attitude. As well, I'll never be an organ donor. Too easy for someone to decide your gone, and take your organs for profit. Fuck that.



How old are you?
Link Posted: 9/27/2005 10:12:06 AM EDT
I don't care how ruined my body is, I'll be darned if I'm going to just roll over and die for the universe's convenience. Fuck the universe, all it's done is screw me over. I'll survive whatever lemons it gives me and wing a few of my own right back at it. If that means some ER nurse helping me fight to stay alive just to spite fate, so be it.

I'm not concerned about lingering on in agony. When it's my time to go, I'll go. Until then, I'm fighting death and kicking him in the balls every chance I get. I've done it two or three times already, I don't see why I should change.

Of course, that may change when I'm actually the frail body with massive organ failure lying on the table being subjected to further abuse in order to gain borrowed time, but for now I'll stick with a perverse desire to live for all eternity.
Link Posted: 9/27/2005 10:20:34 AM EDT
so DNR tattoos don't work, what about a tattoo thats says "you will be sued if I live through all this"?
Link Posted: 9/27/2005 10:23:56 AM EDT

Originally Posted By Mmanwitgun:
so DNR tattoos don't work, what about a tattoo thats says "you will be sued if I live through all this"?



I can think of many ways that could backfire



To the docs/EMS folk: Do DNR tattoos really not work? Are they seriously sometimes ignored?
Link Posted: 9/27/2005 11:37:31 AM EDT

Originally Posted By DK-Prof:

Originally Posted By Mmanwitgun:
so DNR tattoos don't work, what about a tattoo thats says "you will be sued if I live through all this"?



I can think of many ways that could backfire



To the docs/EMS folk: Do DNR tattoos really not work? Are they seriously sometimes ignored?



I've never actually seen someone get a DNR tat. But in all actuality in Nebraska at least one would not be legally binding as a DNR needs to be signed by an MD and expires in a year.
Link Posted: 9/27/2005 11:43:04 AM EDT

Originally Posted By SmilingBandit:

Originally Posted By DK-Prof:

Originally Posted By Mmanwitgun:
so DNR tattoos don't work, what about a tattoo thats says "you will be sued if I live through all this"?



I can think of many ways that could backfire



To the docs/EMS folk: Do DNR tattoos really not work? Are they seriously sometimes ignored?



I've never actually seen someone get a DNR tat. But in all actuality in Nebraska at least one would not be legally binding as a DNR needs to be signed by an MD and expires in a year.



so what your saying is my tattoo artist also has to be a licensed doctor?
Link Posted: 9/27/2005 11:49:20 AM EDT

Originally Posted By Mmanwitgun:

Originally Posted By SmilingBandit:

Originally Posted By DK-Prof:

Originally Posted By Mmanwitgun:
so DNR tattoos don't work, what about a tattoo thats says "you will be sued if I live through all this"?



I can think of many ways that could backfire



To the docs/EMS folk: Do DNR tattoos really not work? Are they seriously sometimes ignored?



I've never actually seen someone get a DNR tat. But in all actuality in Nebraska at least one would not be legally binding as a DNR needs to be signed by an MD and expires in a year.



so what your saying is my tattoo artist also has to be a licensed doctor?



DNRs have always been a problematic subject for field emergency medics. On one hand you have limited information (He has a DNR somewhere), conflicting stories, incomplete paperwork and group of professionals that are bound not to their own liscense, as doctors are, but to a set of protocols which deligate a doctor's liscense to folks in the field.

In a hospital the doctor can talk to the family and decide to call the code. In the field we have a very finite sete of circumstances that allow us to withhold CPR. It's all kinda crappy, and we get stuck in the middle. Ain't helping people fun?
Link Posted: 9/27/2005 12:00:44 PM EDT
I have a buddy who is about my age around 22 but he has some wheight on him. He and I work as EMTs and he also worked as a hospital tech. He went and got DNR in big block letters tattoed to his chest but it wasn't just the enitials it was the words written out.

Now he may be big but I think he is too young to have made that choice.
But hey he knows him better than I do.
Link Posted: 9/27/2005 2:41:17 PM EDT
Mmmm, flail chest.


Nothing quite like paradoxical movement to brighten up one's day.
Link Posted: 9/27/2005 3:02:32 PM EDT
How about a tattoo of "DNR" in big letters and under it (in smaller print)

"If Jesse Jackson is in my hospital room at any time you will wish you died before me."
Link Posted: 9/27/2005 3:06:31 PM EDT
After watching both my parents die in a hospice it certainly appears to me there is not much chance of any quality of life whatsoever after resuscitation. They make the family leave the room when they ventilate....and for a good reason. That has to be the most agonizing torture to a dying person that one could imagine. My mother looked at us as if to say, "Why are you doing this to me?" Of course they can not speak.

Also, subjecting your loved ones to hear those last few hours or days of that god-awful death rattle is more than a loved one should have to endure. Two weeks ago today I watched my dad go into that phase......nightmarish.
Top Top