Advancements in resuscitation

[Just_A_Guy]

An interesting write-up, here

Potentially, by this means, dead time can be extended to hours and there are still positive outcomes. "The longest I know of is a Japanese girl I mention in the book," Parnia says. "She had been dead for more than three hours. And she was resuscitated for six hours. Afterwards, she returned to life perfectly fine and has, I have been told, recently had a baby."

[wyarwehere]

So where do we say enough is enough? What about it being time for a person to die? If it's not their time, they aren't going to die, regardless of whatever means are used to save them.

I guess I see problems in that people are going to say Christ didn't actually die, his body cooled in the tomb, and that is why He was seen after his "death."

Just my thoughts.

[BadWolf]

So where do we say enough is enough? What about it being time for a person to die? If it's not their time, they aren't going to die, regardless of whatever means are used to save them.

I guess I see problems in that people are going to say Christ didn't actually die, his body cooled in the tomb, and that is why He was seen after his "death."

Just my thoughts.

Enough is enough?

Never.

My grandfather was an oldschool cardio thoracic surgeon. Which meant he also made house calls, delivered babies, gave kids their shots, as well as preformed surgeries not only in the chest, but anywhere a knife could cut.

He kept journals for over 60 years of practice.

Used to be:

- Most of his colleagues let acute appendicitis "run its course" (to death)... Because it was the patients "time".

- Brought a priest in for premature deliveries (for last rights)

- and soooooany other examples.

He and others ABHORRED the practice of "giving up".

And you know what?

- Most appendix ruptures are treated surgically and have "good outcomes" (appys are now -and for decades- "bread & butter".)

- NICUs regularly save preemies only weighing 1-2 pounds

- and sooooooo many others.

We are in our INFANCY in medical science.

Our kids and Grandkids are going to look back and shrudder at the 'dark ages' & barbarism of our modern day medical practice.

We know so little.

When is it enough?

When we ALL go peacefully into this good night.

[Anddenex]

So where do we say enough is enough? What about it being time for a person to die? If it's not their time, they aren't going to die, regardless of whatever means are used to save them.

My minds eye thinks you bring up some great questions. The first question when "enough is enough" really depends on the Lord's time table.

We know enough is enough when we have done all we can and the life on the doctor's table is ready to be embraced by family after death.

With regard to it "being our time" we must always remember if we are keeping the commandments of God we will never be taken before our time, however should we do foolish stunts, or other things in life, yes, we can easily be taken before our time.

[Irishcolleen]

Wow. It is amazing technology, but it raises questions. Who should have this treatment? How do doctors know when to declare someone dead?

[Windseeker]

My wife has a patient that has been on life support for 3 weeks had several strokes and has almost no brain activity.

She was irritated when the son of this patient said if his father chooses to stop breathing then it's his time to go, but if his heart stops beating he wants him resuscitated.

When money is no object (you and I are paying for it) you'd be surprised at how many people refuse hospice and are more than happy to leave their loved ones stuck on machines with zero quality of life.

[wyarwehere]

Most medical professionals are listed as no-codes. This means that in the case of them not being able to state it, extreme life-saving procedures are not used(CPR/AED, respirators, ACLS)

DNR: Do Not Resuscitate Guidelines

Here's another article I found interesting:

How doctors choose to die | Society | The Guardian

How long can we fight death. What of the pain that they person is put in? Is it fair to make them suffer? We had a patient in the nursing home. She was getting injections of morphine every fifteen minutes, and still moaning in pain. Would you, in that situation, want your pain to continue, just so your family could keep you, but watch you in that pain.

@BadWolf--they abhorred the practice of giving up?

Most doctors these days give up on saving the lives of aborted babies who are born alive.

They have no value.

Many people see the elderly as expendable. They have no value.

Why should certain people qualify for this type of care, is it because they are more important to society? More socially acceptable?

Now a short personal story. I watched my stepdad die when I was eighteen. Because of some corrupt people in power, his mother was given the power of end-of-life decisions. For six hours I watched him fight for every breath. He had fluid in his lungs, fluid around his heart and was in so much pain. As much as I wanted to keep him, I had to accept that that desire was of my own selfishness, and wasn't for his benefit.

[LittleWyvern]

On the subject from Handbook 2:

Prolonging Life

When severe illness strikes, members should exercise faith in the Lord and seek competent medical assistance. However, when dying becomes inevitable, it should be seen as a blessing and a purposeful part of eternal existence. Members should not feel obligated to extend mortal life by means that are unreasonable. These judgments are best made by family members after receiving wise and competent medical advice and seeking divine guidance through fasting and prayer.

Thus, I think each family needs to come to an individual answer through prayer and advice from a medical professional.

[BadWolf]

Wow. It is amazing technology, but it raises questions. Who should have this treatment? How do doctors know when to declare someone dead?

Who should have it?

Just like intubation or crash carts... Everyone who needs it.

IF its a viable method, it will be universally adopted, taught in schools & seminar, and will become as normal a thing as giving a patient jolts of electricity to restart their heart.

New techniques & tech are adopted ALL the time. It typically takes about 12 years to filter out to almost everywhere. (2 years in publication, 3 years of med students being taught, 7 years for those students to rise up high enough (residency/intern) post med school to be taken seriously by other doctors... And them a critical mass is reached of 10 years worth of new docs who have been taught something their hospital doesn't offer to be able to get the money to get the "thing" either in general use or bought/paid for.

OCCASIONALLY something catches on like wildfire, and filters top down, but more often new stuff comes from the bottom up. Which takes about a decade.*

* Things that need studies take 20+ years. The initial study (animal). The initial human trials. Peer review journals. Actual publication. THEN the 12 year bottom up paradigm. MOST things don't need studies. A doc works out a new graft technique. They publish in JAMA (or wherever), word spreads. Other doctors try it. Original doc trains more docs. This is the Lateral path that most innovations take.

There are a few specialties which have LOUSY lateral pathways. Emergency medicine is the most notable. In nearly every other specialty there is TIME for informed consent. Emed, patients are brought in often unconscious, often without next of Kim (or even ID). Which puts the hospital at extreme risk for lawsuits if new techniques are used without informed consent. Which means that in emergency medicine most changes (except in times of war) happen only after the extensive peer review process, or the slightly less tedious 12 year path.

[BadWolf]

Most medical professionals are listed as no-codes. This means that in the case of them not being able to state it, extreme life-saving procedures are not used(CPR/AED, respirators, ACLS)

DNR: Do Not Resuscitate Guidelines

Here's another article I found interesting:

How doctors choose to die | Society | The Guardian

How long can we fight death. What of the pain that they person is put in? Is it fair to make them suffer? We had a patient in the nursing home. She was getting injections of morphine every fifteen minutes, and still moaning in pain. Would you, in that situation, want your pain to continue, just so your family could keep you, but watch you in that pain.

What you're talking about here are DNRs, Living Wills, & assisted suicude. TOTALLY different. In all cases, those are people choosing their quality of life in their end days. Just because people have the right (or not) to dictate their end of days does NOT mean that we fire all the paramedics, close ERs, shut down Oncology/ Infectious Disease/ et al, and say "Just die already."

What you're implying, if not proposing here & later, that everything save OB & Hospice should cease to exist (research, advance, etc).... is ludacris.

@BadWolf--they abhorred the practice of giving up?

Most doctors these days give up on saving the lives of aborted babies who are born alive.

They have no value.

Bold being mine... There are fewer than 2000 doctors who perferom abortions in the US. Number of Abortion Providers At Its Lowest in Three Decades - The Tech. Although, I believe the number is actually below 1500, Im on my phone & its a pain to pull of documentation.

Since there are apx 691,000 practicing physicians (according to the beauro of labor & statistics . Physicians and Surgeons : Occupational Outlook Handbook : U.S. Bureau of Labor Statistics ) ...

2000/691,000= 0.0028 of "doctors", as a high estimate, MAY do what you're claiming. Although, more likely... Their beliefs & attitudes tun the standard bell curve with many a far cry different then as you portray. But for arguments sake, lets say all. It STILL less than 1/3 of 1%. LESS THAN 1 PERCENT.

0.28% of doctors is HARDLY most.

Many people see the elderly as expendable. They have no value.

Why should certain people qualify for this type of care, is it because they are more important to society? More socially acceptable?

1) I don't think anyone here, much less in the medical field has suggested the elderly are expendable.

2) I haven't seen any suggestion that there is a 'worthiness clause' attached to ANY medical procedure. In fact, there's always the "rule of inverse value" (as anyone who has worked in the ED will attest). Doctors & Nurses treat EVERYONE. Rich, poor, kind, cruel. Whether you're on trial for war crimes or a Nobel winner. Prisoners, prostitutes, pedophiles, philanthropists, priests, parents. If you're human, and need emergency medical care, you get treated.

Are some procedures not given to certain patients? ABSOLUTELY. Because not all treatments are right for all patients. Infants & the elderly are 2 such classes that certain aggressive treatments will kill. Infants and the elderly are also 2 classes of patients that can handle other aggressive treatments that the average adult cannot. (Because of underdeveloped or deteriorating nervous systems). Its not because an elderly patient is unworthy of a treatment. Its because that treatment is "unlikely to have a good outcome". Aka will kill them. Doctors are not only sworn against such things, but in many states, performing a procedure that WILL kill the patient, lands them in civil & criminal court. For either a gross breech of ethics/negligence, or assisted suicide.

3) You may find reading or doing some research into Medical Ethics informative. Not the journals of medical ethics (which are most often articles to challenge existing ethics, a "What if/ thought exercises sort of thing, that laymen get ahold of occasionally and think are "real")... But the actual ethics. Any campus bookstore & a lot of online sources will have medical ethics textbooks available to rent/ buy/ download.

Now a short personal story. I watched my stepdad die when I was eighteen. Because of some corrupt people in power, his mother was given the power of end-of-life decisions. For six hours I watched him fight for every breath. He had fluid in his lungs, fluid around his heart and was in so much pain. As much as I wanted to keep him, I had to accept that that desire was of my own selfishness, and wasn't for his benefit.

I'm truly sorry for the loss of your father.

However, my son spent 6 months struggling to breathe (atelectasis, uncontrollable bronchiospasm, pneumonia, pleural effusions), fluid in his heart, abscesses throughout his abdomen. Should I have just let him die? At the first code just said "stop"? No surgeries, no restarting his heart, no draining fluid, no a-z?

He was 8 years old.

He's 11, now. We just wrapped up a ski season, and he's a short stop on his baseball team.

Or how about the millions of people, every year, for whom medicine saves their lives?

Does everyone recieved the best available care? Nope. We try, but no. They don't. Does this mean no one should recieve the best available care? That sounds like what you're proposing.

Hospice & end of days & removal of care, and the particulars in those situations are VALID. But they don't translate across every avenue of medicine.

Just because its time to let go, to stop fighting, for ONE patient... Doesn't mean we quit fighting for every other patient. Just because some people are marginalized or unlucky, doesn't mean that we level the ball field by ceasing all research & treatment (the opposite, we attempt to demarginalize). Just because a life saving technique hasn't been invented, yet, doesn't mean we stop trying to find new & better ways to save life & quality of life. Just because its too late for me, doesn't follow my grandchildren will suffer my same fate. I pray not. I pray we keep using these amazing minds, following inspiration, and working toward better outcomes.

[Just_A_Guy]

More from Dr. Parnia, via Wired Magazine:

I decided that we should study what people have experienced when they’ve gone beyond cardiac arrest. I found that 10 percent of patients who survived cardiac arrests report these incredible accounts of seeing things.

When I looked at the cardiac arrest literature, it became clear that it’s after the heart stops and blood flow into the brain ceases. There’s no blood flow into the brain, no activity, about 10 seconds after the heart stops. When doctors start to do CPR, they still can’t get enough blood into the brain. It remains flatlined. That’s the physiology of people who’ve died or are receiving CPR.

Not just my study, but four others, all demonstrated the same thing: People have memories and recollections. Combined with anecdotal reports from all over the world, from people who see things accurately and remember them, it suggests this needs to be studied in more detail.

His summation of near-death-experiences he's reviewed on page 2 of the article are fascinating.

[talisyn]

BBC News - Bringing people back from the dead

I like this article, too

"As Parnia explains in his new book the Lazarus Effect (the US title is Erasing Death), after the brain stops receiving a regular supply of oxygen through the circulation of blood it does not instantly perish but goes into a sort of hibernation, a way of fending off its own process of decay.

The process of "waking up" this hibernated brain may well be the riskiest time of all, since oxygen can potentially be toxic at this stage.

The effect, Parnia says, is like that of a tsunami following an earthquake, and the best response is to cool patients down, from 37C to 32C.

"Cooling therapy, the reason it works so well, is that it actually slows down brain cell decay," says Parnia."

[Just_A_Guy]

And the BBC wins the 2013 award for coolest-Zombie-reference-in-modern-media.