Pediatric arrest

  1. Babies that arrest have already lost the fight. You started 20 feet in the hole with no shovel. No palpable pulse in a pedi is arrest and 99 out of 100 times is to deep into it to pull back to this side of the line.

  2. I agree with this. I’m a pediatric ER nurse and an infant rolling in like that in general isn’t going to make it. Peds codes are awful and difficult and honestly not everyone can handle them. I feel for y’all in the field- in the ER, those of us in peds choose peds for a reason, and we can handle it. Outside of our peds pod, the adult ER staff doesn’t even want to look at a child much less run a code. Y’all don’t have that choice.

  3. As a PICU nurse, this type of arrest would have been difficult at best, and unlikely have a good outcome based on history (i.e. meaningful recovery), even with all the skill, resources, and manpower available in a PICU or ER. Let alone in the field, in the back of a truck, with people who don't run these scenarios with frequency, and without a plethora of peds equipment at your disposal. You have what sounds like a septic, starved, neglected infant with likely a severe electrolyte derangement, and from an H's & T's standpoint, that's a deck stacked against you even before a code, let alone when you don't know how long these factors have been going on, and you don't know how long they have been down.

  4. Thank you for adding all this to the discussion. I wish I would have had this resource 20 years ago, would have saved me a lot of time, anguish, and self-doubt. In medic school you are taught "This is the problem, do X and Y and Z and that will fix it." Even ACLS megacodes would always have you run through the whole thing and then would always end up in a stable rhythm ending with call the hospital and transport. It should really be, you did everything absolutely perfectly and flawless and guess what, the pt. still died--tough shit. It would be far more realistic...

  5. Sounds like you did a fantastic job! You got the baby to the hospital where it had the best chance. We can’t do much during a code but you absolutely did everything you could and then some. You practically did a 1000 man job by yourself and I’m proud of you. Unfortunately the baby didn’t make it longer term but if you hadn’t been there the baby probably wouldn’t even have made it past the resus entrance. You did a damn fine job and I cannot stress enough about how awesome you did.

  6. This. Resuscitating a baby on your own is HARD and traumatic, let alone trying to manage others to do basic things like plug in the leads! It sounds like you did a really incredible job. I hope you get all the rest, healing, and TLC you need

  7. An unimaginable situation and an unfortunate outcome. You and your partner tried everything you could have within the confines of this cluster of a call. Sounds like mom is the bad guy here, not you. Don’t carry that weight on your shoulders. Talk, reach out, vent, contact your agency’s crisis team if you feel you need it. This job continues to show us how cruel the world can be.

  8. First, you sound passionate and like you know your stuff for “just an EMT.” Go to medic school. We need more medics who are intelligent AS WELL AS passionate.

  9. The baby died with competent loving medical professionals doing everything they could to save his life and cried for him. Sadly, this may have been the most anyone has felt or done for this baby. If not for you, baby would have died alone. You fought that death. I’m sorry you went through this.

  10. It is normal to feel this way. These days I turned 14 years on the streets, but I struggled to read your post, because it reminds me of many things.

  11. Man it really sounds like you really did a good job given the horrendous circumstances of this call. Hang in there; and get help. Talk to people who can help you, especially your agency’s CISM team. You did everything you could’ve done and you gave that kid the best chance it could’ve had.

  12. I'm really sorry. Those calls a tough (understatement of the year) and sounds like yours was really hard. It sounds like you did a great job, you did everything within your power to give that kid the best possible outcome. "It is possible to make no mistakes, and still lose" are words I carry with me at work. Please go talk to someone, does your work have CISM team? I know personally having kids makes these call bit harder than they did when I was young and single. If you can't shake the call, and you keep thinking about you should really go talk to someone. It's amazing how much just saying words to someone who wants to listen helps. Much Love from California.

  13. Listen from what I read and your experience, you did an amazing job as ultimately a one man team!! Dont be hard on yourself as it will continue to beat you up and pull you into a black hole. Ive been in your shoes and its hard to dig out.

  14. Great suggestion! I am an FTO and regularly pull newbies in and play with expired equipment, run through scenarios, and difficult runs to show and teach them not everything is black or white. I think everyone should refresh on training and continue their own education.

  15. trying to feel a pulse on a hypotensive sick infant is next to impossible, pale floppy babies with either slow or too fast heart rates get compressions anyway, so forget about whether there was a pulse or not.

  16. Yes, absolutely NO SHAME to my partner! He has a son who's around the same age as the baby, it was his first peds code as a medic, and it wasn't textbook. We all freeze up, we all have firsts, we all make mistakes. We practice medicine, not perfect it. With that being said, I think it's extremely important that after having a call where mistakes were made, freezing up happens, etc.... we look back on the run and talk about what could have gone better and how to do better next time. I don't want to be the only one doing this. I want the whole team (of 3) involved so everyone is better prepared for the next one because it will come. And when no one expects it to.

  17. I see a big long story, as you stream of conscious it in chronological order. Now, go through what you've written down and concise it into bullet points of the issues that went wrong.. But then, I'd want you to go through the scenario again, and write down what went right. Prompt arrival and CPR by PD? Good radio updates? Prompt recognition by EMS? Clarifying communication and resolution when you noticed it was PEA? Quality equipment? Correct sizes? Safe transport? Smooth handoff to ER staff?

  18. I have chills reading this and tears in my eyes. I’m not a nurse, but a child life specialist (psychosocial and emotional support for hospitalized children and their families). Prior to having my own little girl, I worked in the ER and part of my job was supporting families during resuscitation and providing bereavement support. I will never forget my first bereavement. It haunted me for months and months.

  19. Uggh, that one's going to leave a mark. I think it's fair to say you did the best job you could have under the circumstances and for that, you have my respect. You knew what needed to be done and did as much as you could to make it happen and kept it together. I got lucky with the pediatric code I was a part of. To this day it's one of the best run codes I've been involved with. Even though we didn't get ROSC we were able to take comfort in the fact that we hit our marks and there wasn't much to second guess ourselves over, even then it played over and over again in my head for quite a while.

  20. I feel like I'd be able to handle it better if I could confidently say we hit all our marks even though the baby died. But unfortunately I can't say that. So we didn't hit our marks AND the baby died. I knew the baby really had no chance. But what if the next one does and this chaos happens again and it's because of us that the next one doesn't survive? I know I can't think like that but I am. I strive to do better each run. I think everyone should make each run a learning experience but I'm not confident that everyone in this situation will.

  21. I love the comments here, and I really can’t say it any better than others. I’m just here to say I’ll be thinking of you today. And for fucks sake, become a paramedic - or more. This was an awful scenario for even seasoned people. You demonstrated tenacity, knowledge and instinct, and managed a team that was frozen. You have the grit and character to be leading more in life.

  22. To me it sounds like you were doing everything right. You were trying to do the job of multiple people simultaneously, and of course that's stressful. But even with all the additional stress and the stress on top of that of it being a pediatric code you still recognized what needed to be done and worked to accomplish it. I agree with a previous poster that said you're not the bad guy here. Mom is who put the baby in the situation in the first place and you did your damndest to reverse that. If the baby was already in PEA it would have been a hard uphill battle to overcome that and ultimately who knows what the quality life would be if the baby survived (hemodynamicly speaking) If the code had run completely textbook, and everyone had done exactly what needed to be done at the right time it's very possible the outcome would've still been the same. But I don't blame you at all for wondering the "what if?" I hope you can see by the responses here that you didn't cause or contribute to what sounds like a terrible situation and that you can let go of any guilt you hold for feeling in any way responsible.

  23. having worked a peds arrest myself, without positive outcome, please please vent to the appropriate avenues… you did an outstanding job with what you had, including other bodies… use this to improve future cases… this mother is to blame, not you… mine still haunts me…

  24. You fought an uphill battle and carried your team along the way. You did the absolute best with what you had and no one can ask more of you than that. Sorry you went through that.

  25. I can relate, I had a pedi trauma code back in July. This kiddo's grandma accidentally backed over him with her car. They got ROSC in the hospital but then it disappeared and it didn't come back.

  26. I know I'm late to the party here But your actions during this call were beyond amazing. If I ever coded, I'd pray to God that you were the EMT that showed up. Not only were you able to assess the baby, you also assessed the entire situation including those working the call with you. You took command of the incident and took a lifeless body and gave it a chance.

  27. You used your training and resources to do everything you could. I would personally take advantage of some counselling offered from work so you can mitigate this guilt - again, you did everything you could and you held the scene together. You should be proud. I know how this feels in my own way from my own experiences though, and it helps a lot to unpack in trauma counselling. I wish you rest and kindness to yourself ❤️

  28. It certainly sounds like you're the only person who's given that kid a chance outside of the hospital, and like others have already said, they already started out far worse than most codes do.

  29. I think it is definitely worth following up on with my team, even if we never end up saving a child. Atleast we can feel better knowing we did literally everything we could.

  30. You and your team may have been the only people that ever gave that child a fair chance at life. Every person on that call had something different going trough their mind and for you to recognizes that it was a possible PEA and start CPR and Airway management was the right call and no one can take that away. Take solace in the fact that you did everything you could and in my opinion (and the others here in the sub) you did a phenomenal job. Not everyone can be saved, but as many here have said it was a losing battle that you gave 110% in, and gave the child a fighting chance.

  31. It sounds like you did a good job despite being given a crappy situation. It is okay for these calls to bother you and to have doubts, questions, and so forth. Please be aware of how this call affects you, your team, and everyone else involved. Take the time to make sure you're getting access to resources to help you, and your team, deal with this.

  32. You did everything possible working in Hell. Protect each other. NOTHING would have changed this out come. PEA in an adult rarely has a good outcome. There was no way to address what sent this child into PEA. Give it time then gather and review what happened from ALL perspectives. Look carefully at what went right and what went wrong. Make a plan to change what went wrong. Remind yourself and others that this child’s life had value and accomplished great things because these are the things we learned. This is what we changed. This is what we now do differently because of this child’s life. You and those involved honor the child as no one else will. You will remember him and learn from his life carrying it forward. I foresee other children surviving because of the lessons you and the crew have learned. What more can anyone ask but to be remembered and have an impact on others?

  33. I don't intend to be a hero by any means. However if one of my children were in cardiac arrest I'd want the best qualified people working on her/him.

  34. From what I'm reading here, it sounds like you did an amazing job, even though the circumstances were messed up from the beginning. You kept a really good overview during the whole action, reassessed the situation constantly and made good decisions under very difficult circumstances. To me it sounds that only YOUR and your team's actions made it possible to achieve ROSC at the ER. You did a great job. You are not responsible for the circumstances that didn't give the patient a chance from the beginning. Talk to your colleagues if needed and take time.

  35. First here is a hug, it is the only thing that really matters. Second you gave that baby a fighting chance, you had some issues with everything but you now know what to work on with the departments for the future. As far as I can tell, you cant grant miracles and this baby needed one. So congrats on giving them a chance. Please seek help if you need it and know that you did everything you could with the resources you had available

  36. Paramedic student here. I am so angry for you. My heart breaks for all of you. That baby didn’t have a chance. You were stuck on a call short handed and everything that happened was just far enough outside your control because you only have two hands. I keep asking myself why the fire medic kept stopping compressions!!!!!! I’m crying along with you. I’ve never had a bad peds call yet and I know it’s going to stay with me. You did all the right things, you were that baby’s advocate and you did the best you could do. God bless you for keeping your head up, I am thinking of you.

  37. The moments death lifts a soul from under our hands, our hands that are actively fighting it, stick with us. Some of the best advice I ever have gotten was to allow it to fuck you up, to feel, to acknowledge that that life mattered and it doesn’t go away. I carry them with me in the fight now. You gave death the middle finger and that tiny soul is never going to hurt again. But don’t shut this in. Keep talking. Keep remembering.

  38. That's actually how I started in EMS. When I was 18 I was driving home from work and drove by an overturned truck. It was really dark outside and really icy, and I was too scared to stop so I called 911 and drove away. It ate me up so much inside that I decided I owed the guy something so here I am.

  39. Pediatrician here. Sounds like you did everything you could, and then some. Child abuse cases are the worst. You can’t unsee that stuff. Do as much self-care as you need.

  40. Ouch. This is so awful - I’m so sorry for you - BUT it sounds like you had your shit together and then some. Kudos to you for everything you did.

  41. Nothing else to say other than what everyone else here has said - you honestly did everything you're trained to do...it wasn't perfect but everyone there learnt something to pass on to their next one.

  42. You were given a shit show and you did your job, kept your cool and dragged 2 incompetent providers along. The situation that you were put in is not your fault and the outcome is not your fault. I’m not a big internet comment guy but my heart sank reading your story. I can’t imagine the helplessness you felt on this call. You should take a day or two for yourself. Wherever you work is lucky to have someone like you on the truck.

  43. Luckily I haven’t had a pedi arrest yet but my god does it sound like you did everything you could. If you have to take multiple roles during an arrest (which you did) its only right you start to doubt the quality of it. I applaud you OP for trying your best. A lot of the times we don’t get arrests back but we try our damn hearts out. Every call we can learn something from it. Don’t beat yourself up and talk to somebody if you need to. Good job OP 💪🏼

  44. We can only use IGELs in adults on a basic level here. Using an igel on a peds patient is restricted for ALS only, just at my service, not statewide.

  45. Rusty EMT-B and current nursing student here. You did the right things. Please know that you gave that baby the best chance he had - just because the outcome wasn't favorable doesn't mean you didn't do your job (and a good one at that especially with your lack of support). As someone who works in non-emergent peds (physical disabilities and seizures), I strongly suggest finding some debriefing support for your own mental health as it can be particularly difficult processing pediatric cases of neglect and abuse.

  46. "Mother" you mean the mother failed her baby. Society didn't and doesn't know how a woman cares for a child. Unfortunately until we do.

  47. This call sounds like my worst nightmare. I’m sorry you had to take it. Purely based on reading this I’m planning on doing a pediatric code drill with my crew next shift.

  48. That's difficult, and it sounds like you did all you could to give the infant a fighting chance. The deck was stacked against you from the start.

  49. I find it very helpful to debrief calls like this. I like to get a medic who wasn't on scene (that I respect and trust,) have them read my chart and then talk over the call with my partner and that outside provider.

  50. I’ve had a pedi code due to neglect as well. 1month old M. Worked it on the floor of a drug house, unknown downtime, so we basically knew from the beginning we’d lost the fight. I agree with what everyone else is saying — even if everything had gone perfectly with your team it’s highly unlikely that the outcome would have been different. But still, reading this was just agonizing. I think for me it really highlights how unprepared most of us are when we start. My pedi code I mentioned actually took place right after I started in EMS: it was my first code, it also happened on the second half of my first 24hour shift I ever tried to pull (we usually do 12s because we’re high volume) and I was with a partner I’d never worked with before and it was our first call together after my partner from the last shift went home. I didn’t freeze but almost as bad, we had a full set of 2 fire crews plus the ambulance crew (including me) and I asked to not do compressions and just bag. I mean, it was honestly as close to a show code as I’ve ever worked since. Later that day I picked a fight with a different fire captain and did some other stupid, self-destructive shit but the initial blowoff, depression etc. only lasted maybe a week and then it was back to business as normal for me at work. But your situation sounds 10x more traumatic. I just feel so wretched for you, the key difference in our calls is that my medic was experienced and handled everything right and I got to just look to him and try to go along with everyone else. This honestly sounds like you’re the only one who had a handle on the call. You’re right that your job is to be an advocate for the patient. And I think you did that job really well. You can’t control what other people do but you can feel proud of the fact that you fought really hard for this one, and as long as you know what you’re doing I don’t think there’s anything inherently wrong with stepping into a medic’s role if they’re not filling it, for the simple fact that someone has to lead, and if nobody leads then patient care suffers. The chain of command is only as useful and the results it yields.

  51. I’m in EMT school rn and all I could think reading your post was “I wanna be this guy”. You know your stuff, you dug deep and stepped up to the plate when things got chaotic, you never lost your cool even when you didn’t have the support you needed and should have been able to count on, you still empathize with why your partner froze and don’t fault him for it, you clearly care about your work and your patients, and you reach out when you need it. I’m really sorry things turned out the way they did, just want you to know you’re the kind of EMT I’d want to be.

  52. Our environment is constantly changing on us. You did you best with what you had and adapted to those changes as best you could.

  53. You did everything you could do, and sounds like you did an amazing job. You didn’t fail the patient. The people who didn’t know how to manage the kiddos arrest didn’t fail the patient.

  54. You didn’t fail the baby. You tried your best, and the fact that you felt remorse for it clearly shows your empathy. Mom was at fault. Horrible that you could even keep your children in those squalid conditions. At the least, she should have put them up for adoption if she couldn’t afford it. She has no reason to explain why she treated her babies like that.

  55. I think you did the best anyone could do with a shit situation really. Things go wrong and you can only control your own actions. This poor child had the odds stacked against them and you went above and beyond. Make sure you reach out for help as this job sucks. reach out to your partner and check in with them. Also provide a good statement to police so that mum can rot in jail

  56. Hey man, I’m super sorry this happened…but I want to tell you, being a basic with two other medics on a pediatric arrest, and basically being the lead guy on a call, you did good. You did what you could, and you tried. That’s all you can do in these situations. I’m very sorry about this.

  57. Everything is learning experience. It sucks this one ended up the way it did. Pediatric arrests are even more mentally demanding. We have the H's and T's when thinking about the causes of arrest, but with Ped's, I have an acronym I use - S.T.O.P. Sugar, Temp/Tox, Oxygenation, Pee.

  58. You did what you could with what seems like an ineffective crew around you. You can only do so much. You tried your best and at least gave that kid a chance. That poor baby was up against a wall and you tried your damnedest. Hold your head high. I know you are hurting right now and that's ok. It's ok to hurt. But don't "what if" this call. It never helps and you'll never know anyways. Use this as a learning experience and move forward. If your agency has any sort of CISM, or mental health resources, use them. This call is why they are there. A professional can help you process everything that's going on. And if you need an ear to listen, you can message me. ✌🏻❤️

  59. I’ve read through a lot of the replies here and I want to echo what they’ve already said - you did a fantastic job with the resources you had, and the outcome was not your fault. You gave the kid a chance. This goes to your crew as well - pediatric calls like this are difficult for everybody, and they at least tried. Reading about the mom towards the end had me livid - if there’s anyone to blame, it’s her.

  60. I have goosebumps. You did amazing. That was a horrible thing that happened, and you stayed focused and kept everything in line, despite everyone else fumbling around. U knew what was important and prioritized it. Shit, I’m proud of u too!!

  61. I'm a retired medic and RN. 37 years on the truck. I've done lots of peds codes. You did well, considering the deck was not stacked in your favor. If I were your chief, I'd consider awarding you a medal of valor or something else. While surrounded by idiots who were useless team members, you kept your cool and followed protocol the best you could.

  62. I really appreciate it. However I'll never actually be honest with any of my chiefs or supervisors about how it went (and didnt). I feel like that would be a huge hit to my medic partner and I just can't. I just hope it was an educational experience on what to do and what not to do

  63. Stop delegating critical tasks. Slow down. Run your arrest properly. I wont piss in your pocket and tell you that you did good on this, you know you probably didnt, but that sounds like a mix of provider incompetence and, in your case, general inexperience.

  64. Not sure you read my post. I am not a medic. I am an EMTb. It was me, my partner (medic) and the other medic. I was not supposed to be the scene controller. I was not the lead on this call. No one delegated anything to me. And yes, I know compressions and ventilations are most important. That's a lot of my frustration because in this case, they were only important to ME and it shouldn't have been that way.

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