DOA
To work it or not to work it, that is the question.
There are several things we can look for to confirm that someone is dead. The story, coldness, stiffness, blood pooling, etc. The guy we found the other day, sitting up on bed, still holding the magazine he was reading the night before, had most of these things. The room was about 80 degrees, so no surprise that he wasn't exactly cold.
The story was kind of weird, but added up. The night before, apparently, he had called his doctor because his chronic back pain was worse. The doctor allegedly said to "double up" on his meds. This unfortunately included putting on two fentanyl patches instead of the usual one.
I'm just going to guess that this decreased his respiratory drive until he stopped breathing altogether.
The whole thing got sticky when my partner called the ER doc (We have to get permission not to start care on patients like this. Don't even get me started.) but the doc who had supposedly advised the "doubling up" on his medications also works in our ER. In an effort, I guess to help his colleague, the med command doc ordered us to give him narcan. Thankfully I wasn't writing the call, so I didn't have to be in this conversation. I am sure that the long pause on the phone I would have given after hearing this would have been huge. "Uh.........what?!"
When my partner told me, I said "Did you mention the bit about us not starting CPR or anything? Did you mention the part about him last being seen alive more than 8 hours ago?" He had, of course, but apparently the doc didn't mind/notice/care that when we mainlined some narcan in him, and didn't do CPR, there was no way for it to circulate, which didn't matter anyway due to the fact that this guy was dead and nothing we did would change that, especially futilely poking needles into a patient that wouldn't bleed.
It was ridiculous to say the least. I was frustrated to say the least.
My partner called the doctor back to report that narcan had not magically made asystole anything but asystole, and the patient had not magically started breathing on his own.
We called the coroner, and left. How freaking stupid was that.
There are several things we can look for to confirm that someone is dead. The story, coldness, stiffness, blood pooling, etc. The guy we found the other day, sitting up on bed, still holding the magazine he was reading the night before, had most of these things. The room was about 80 degrees, so no surprise that he wasn't exactly cold.
The story was kind of weird, but added up. The night before, apparently, he had called his doctor because his chronic back pain was worse. The doctor allegedly said to "double up" on his meds. This unfortunately included putting on two fentanyl patches instead of the usual one.
I'm just going to guess that this decreased his respiratory drive until he stopped breathing altogether.
The whole thing got sticky when my partner called the ER doc (We have to get permission not to start care on patients like this. Don't even get me started.) but the doc who had supposedly advised the "doubling up" on his medications also works in our ER. In an effort, I guess to help his colleague, the med command doc ordered us to give him narcan. Thankfully I wasn't writing the call, so I didn't have to be in this conversation. I am sure that the long pause on the phone I would have given after hearing this would have been huge. "Uh.........what?!"
When my partner told me, I said "Did you mention the bit about us not starting CPR or anything? Did you mention the part about him last being seen alive more than 8 hours ago?" He had, of course, but apparently the doc didn't mind/notice/care that when we mainlined some narcan in him, and didn't do CPR, there was no way for it to circulate, which didn't matter anyway due to the fact that this guy was dead and nothing we did would change that, especially futilely poking needles into a patient that wouldn't bleed.
It was ridiculous to say the least. I was frustrated to say the least.
My partner called the doctor back to report that narcan had not magically made asystole anything but asystole, and the patient had not magically started breathing on his own.
We called the coroner, and left. How freaking stupid was that.
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