Question of “what is the worst thing you have ever seen” from non-medial people and for some practitioner’s death in children and infants can be the hardest most emotional calls.
When dealing with poor outcomes in children it can have long standing effects.
Don’t be caught off guard by the magnitude of the emotional impact and the length of time to process.
Debrief – within first 24 hours and follow up within a few days to answer any additional questions maintain open dialogue
- Debriefs help to bring some degree of closure
- Don’t underestimate the impact of a debrief and different needs/care that members of the care team may or may not need
- hold space for them when they do need help
Case
Only Anesthetist on call in community, at home and called in for 10week old not breathing that EMS was transporting to hospital.
6 min drive along highway and made it to hospital in 4 min and arrived before the ambulance. But outcome made no difference driving to save seconds or min not worth the risk.
15min to prep – grabbed neonatal warmer for resuscitation.
- Try to think about all equipment you need and different possible outcomes to be ready if you have time to prepare.
- Assign roles
- Able to get PICU team on phone and consult
EMS arrived – iGel in place, ventilating, CPR in progress, cardiac monitor stickers applied.
Scooped baby and brought into ED and placed in warmer – rather than trying to move giant stretcher and then move.
Baby is pale, cyanotic, no tone.
Continuing with resuscitation. IO placed, labs drawn.
Following PALS and consulting with PICU
History – family put baby to sleep around 4:30 and check on her an hour later pale and not breathing and call 911.
- CPR given by EMS for approx. 25 min
Parents confirm patient is healthy to best of knowledge. Considering SIDS as cause of death
Intubated pt, managed to maintain continuous CPR and follow PALS algorithm on point.
- Blood work had no major clues as to cause of patient condition
- Ultrasound – looking for reversable cause
Two sides of being a doctor – Doctor mode – 99% of the time. Resuscitation mode 1%
Attempted resuscitation mode for approx. 25 min longer
At one point during resuscitation had a moment of human connection and realized emotions were starting to get higher and had to turn resuscitation switch back on.
Colleague who was on phone with PICU ultimately stated they did not think there was more to be done. Asked the room if there is anything else that can be done before ending resuscitation. Parents were in different room – went to talk to parents and see if they wanted to witness resuscitation and parents did want to see what was happening. After a few min of touching babe while continuing with the resuscitation asked the parents if it was ok to stop and dad nodded yes.
Hardest part of resuscitation is dealing with the parent’s reactions to the news.
Removed IO, monitor, ET tube removed so the family could hold baby
After family had time with baby, protocol followed to transport to morgue.
Found EMS crews and had a debrief for crew. Be mindful of the different scopes of practice that rural communities have and the power differential for each profession. You may have people with basic training and minimal exposure to these types of events.
After a few days found all the staff and checked on them.
***If you are struggling don’t suffer in silence and reach out to a trusted colleague who understands your situation.***
If you are struggling with anything work related reach out to any of the numerous mental health supports in your area. DON’T suffer in silence.
