Family witnessed resuscitatioI would like to present ns

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At 2:50 PM +0000 7/10/05, revegg at att.net wrote:
>Rules are needed. Not blind adherence,

I agree with both points. Now, I'm not a clinician per se, but do a 
lot of biomedical engineering, and, in the course of learning how my 
systems would be/are used, have attended quite a few procedures, 
elective and not. I have been in the room, observing, staying out of 
the way, but available for scut when needed, during major traumas.

I've had some odd involvements in what started to be routine office 
procedures that went sour. I had been in the room at the request of 
the family patient, with an attending that knew me. In about three 
cases, assorted things went wrong, including having a nurse pulled 
away for a code. Without much warning, I found myself called into 
service, doing things that I was in no way licensed to do, but 
understanding what was to be done.

Only in one of those cases did EMS have to be called. When they 
arrived, the physician was handling IV meds, and I was maintaining 
pressure on the reopened surgical wound and reassuring the patient. 
The prehospital people never really asked my status and appreciated 
an extra pair of hands.  I suppose they assumed anybody masked, 
gloved, and blood-spattered probably had a good reason to be there.

While I recognize that formally qualified medical family members will 
be rare, and even rarer to find a family member without formal status 
but directly involved with care, it is worth remembering that a 
family member isn't automatically going to be shocked by what they 
see. I offer this as one more variable in the decision that has to be 
of the team.

There may not be space in the treatment area for one more person, and 
I can see clearly that the team doesn't have time to find out if a 
family member is capable of staying out of the way.

>a few to be considered:
>
>CPR/Procedures. - Someone explaining the procedure(s), is assigned 
>to the family member, (not member(s)), hopefully the decider for 
>healthcare or significant other. The assigned person is trained in 
>the approach, the understanding of the procedures and has a SKILL in 
>dealing with the potential problems. I usually find the words to say 
>and how to approach. Never had a problem in at least 25 events. (Not 
>to say it won't happen). YOU DO NEED AN ASSIGNED PERSON, do not have 
>the family member/ SO in the vicintiy without SOMEONE to 
>support/explain and is comfortable with doing so.  What is evident 
>is the professionalism the procedure is carried out by the 
>partcipants. AND the explanations from the physicians/staff during 
>the effort leads to better family behavior/acceptance (And possibly 
>a DNR if there is not one).

Again probably a rarity, but remember that the family member just 
might want specifics and know what they mean.

>
>TRAUMA; too disruptive initially to have them present, need the 
>room,etc, but to be allowed in as soon as possible or if death 
>inevitable. Again a support person in attendance, just for the 
>family/SO needs.
>  -------------- Original message ----------------------
>From: "ecthompson" <ecthompson at msn.com>
>>  I can only speak for America, other countries and cultures may react
>>  differently.  All resuscitations are not alike.  As far as trauma goes there
>>  are way too many variables to have family at the bedside.  What type of
>>  family are they?  Within the last 2 weeks I have had family members warring
>>  with each other, families that haven't seen each other or spoke for more
>>  than 10 years (but they still haven't gotten a divorce), loving elderly
>>  couple, a same sex marriage (female) in which the spouse just lost it at the
>>  bedside (hours after the resuscitation).  The emotional outburst is what you
>>  can not control.  The misdirected anger.  The family member who states that
>>  they can handle being in the room then they pass out as soon as you put in a
>>  central line.  Should the family be in the room for procedures that occur
>  > during the resuscitation?  Chest tubes?  Central lines? 
>Intubations?  Chest
>>  compressions?  ER Thoracotomy?  What do you do when a doctor says stop the
>>  chest compressions and a family member says no?
>>
>>  Too many variables.  In a trauma resuscitation, we, the medical team, are
>>  trying to get control of the situation.  We would like more control not
>>  less.
>>
>>  E
>>
>>  Errington C. Thompson, MD, FACS, FCCM
>>  Trauma/Critical Care
>>  Author - A Letter to America
>>  www.erringtonthompsonmd.com
>> 
>>  I can only show you the door...
>>                                                 Morpheus (The Matrix)
>>
>>  -----Original Message-----
>>  From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
>>  On Behalf Of Catherine Ley
>>  Sent: Saturday, July 09, 2005 7:04 PM
>>  To: trauma-list at trauma.org
>>  Subject: Family witnessed resuscitatioI would like to present ns
>>
>>  Dear All:
>>  I have been absent from this list for a while and now that I need something
>>  Here I come slithering back.
>>  I have been asked (on extremely short notice) to give a presentation on
>>  family witnessed resuscitation.
>>  My plan is to provide the pros and cons, hence my request.
>>  I downloaded some listserve dialogue from Trauma.org.  The dialogue was
>>  quite animated but it is from 1999.  I am certain that all the people that
>>  contributed to it are all still around, esp Dr. K.M.
>>  If any of you could find the time, could you post your 2005 thoughts on this
>>  subject?  i have done a lit search but am having trouble finding the
>>  prehospital provider perspective, if any of you are lurking about, I would
>>  be interested.
>>  Thanks in advance.
>>  To all my colleagues in London, my thoughts and prayers are with you and
>>  your patients.
>>
>>  Catherine Ley, RN, MS
>>  Trauma Nurse Coordinator
>>  Redding, California
>>  USA
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>
>
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