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Witnessed Paeds Resus - your views

MM mmackinnon at cox.net
Thu Apr 20 22:06:45 BST 2006


Hi Tony
 
When I worked in Canada (east coast) I found family witnessed resus much
more common than I do in the south west USA. My experience with it has been 
mostly" positive. It is important to have certain things in place before
making the attempt to do it.
 
1) A designated RN with the family to explain whats happening and be
realistic about outcomes. The common BS I see of saying "there is always
hope" does much more harm than good.
 
2) The entire team really has to be onboard with the idea. It isnt fair to
providers or our patients, if we might be distracted from doing the job we
are there to do by family in the room. This has been the number one reason
ive heard (and been cited) for not allowing it. Really, its a point that
shouldn't be argued.
 
Where ive seen this used a profound understanding of how "hard we tried"
seems to be the result from witnesses. My experience is that futile codes
are often called in a more reasonable time frame with paeds than when the
parents are not there. The practice of prolonging codes because "its a child
, while it may be the knee jerk reaction of the team, is not only unethical
but harmful to the remaining family. 
 
Probably one of the biggest things that must be done prior to acquiescing to
family presence is assessing the family member. While in most cases ive been
involved in it works out very well, there have been a few who were
hysterical throughout the whole ordeal. This is not only distracting to the
team, but can escalate into a real problem situation. It is helpful to have
an RN to quickly talk to the parent and make that assessment with the
ability to deny or allow entrance based upon it.  
 
hope that helps!
 
Mike 
-------Original Message-------
 
From: Tony Joseph
Date: 04/20/06 11:33:54
To: trauma list
Subject: Re: Witnessed Paeds Resus - your views
 
Dear Andrew
There is no set standard in this.
Paeds resususcitation is not that common so you must have a plan.
If you have experienced senior staff running the resus, it is fine for the
parents to stay in the room but you need to have someone with them
explaining what is happening.
We have on occasion had either a senior nurse or one of our social workers
stay with the parents while the resus is going on and there is usually not a
problem whatever the outcome.
Just put yourself in the parent's position , where would you want to be ?
Regards
Tony Joseph
Sydney
 
 
On 21/4/06 3:21 AM, "Andrew Davidson" <0507162D at student.gla.ac.uk> wrote:
 
> Dear All
>
> Following a recent discussion with some fellow med students regarding
> witnessed resuscitation in paediatric trauma/arrest - I was interested to
hear
> the views of those more qualified than myself!
>
> Bearing in mind the following (non-typical) scenario:
>
> Father arrives at ED carrying 6 year old child - involved in vehicle
versus
> pedestrian MVA. Father transported child to hospital - no EMS involvement.
> Nursing staff take child from father and rush her to resuscitation area
and
> issue a trauma call. The child is making no respiratory effort, is mutiply
> injured and is in cardiac arrest. The frantic father demands to be present
for
> the resuscitation attempt but is asked to remain outside - much to his
> distress.
>
> I have read with interest various published materials regarding witness
adult
> resus - but was interested to hear your views (and experiences) regarding
> paeds patients.
>
> Andrew
>
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