I had a patient who checked in the ED for chest pain (felt like indigestion but he was intelligent enough to know it wasn't). Arrested just as we were getting vitals. CPR and shock -> came back awake and asked what happened. EKG after ROSC indicated STEMI. Arrested again, this time we just shocked right away before CPR and he awakened with ROSC. Eventually the cath lab was no longer occupied (this was a small hospital) and he went and got taken care of. Even if he arrested once and awakened it would have been amazing. But twice, I had never seen that in my years working in various emergency departments. That story had a happy ending (or continuation, as life moves on to new seasons), something I don't see very often.
Other than that, my experience matches up mostly with yours in that for patients who arrest, happy outcomes are rare. One medic called 911 for his wife who had arrested - luckily he had witnessed it and went straight to the chest while his teammates on duty came to bring her in. I can't remember if they got ROSC or if we did, but she had a fair outcome. She had a long rehab time but was able to live a mostly normal life after that. The ones who just don't have a good ending are too many to count.
I agree - the comment tree has been baffling to me too, but rather amusing. I understand that some people disagree with your original post about using a particular book to sound people out, but I don't understand the harsh reactions to the method itself (it seems some were against the method rather than the book?). That kind of thing sounds to me like an interesting conversation starter or prompt!
Anecdote: At an ED I used to work at, our cardiac monitors got "upgraded" to another manufacturer. Silencing false alarms was a black hole of a game of whack-a-mole. You could never silence them all, another would just pop up to spite you. Anyway, one night, it was continuing to alarm and being ignored (with a glance occasionally to make sure). Except somebody was in v-tach and the person who noticed was a medic bringing a patient in. Thank goodness they noticed amid the noise! (We had as good of outcome as could be expected with that patient, and they went to the cath lab and lived).
What would have happened if the medic didn't notice and the patient died? Would you have got the blame for ignoring it, or management for creating a situation where you had no choice but to ignore some alarms because of false positives, or the manufacturer, or would it have been swept under the rug as "the patient was having heart failure and unfortunately even our state-of-the-art medical care couldn't save him"?
All of those sound superficially plausible to me, although I have my ideas on which are more likely... Would you even do an, um, incident post mortem for something like that or would it just be a statistic?
There would definitely be an investigation, as all sentinel events are investigated. Management would do their RCA and I'm sure the issue with alarm fatigue would be ignored or underplayed (Something bad happen? make sure an alarm sounded. If staff ignored it, it must be the fault of the staff). I doubt any one person would be in trouble as it was a collective/systemic failure, but I don't know exactly what would have come of it. Likely a policy change or daily reminders for the next few weeks about not ignoring the monitors even if it has been going off nonstop for hours. Maybe extra charting or peer audits. It's a lot less expensive and effort to put pressure on staff than it is to change technology (even if it is as little as setting different, more sane, defaults). Depending on what was recorded from the monitor to the chart, if it looked like there wasn't a delay in resuscitation/cardioversion (like if the lethal rhythm wasn't recorded initially), it may have been just put down as clinical course for the patient, like you suggested. My perspective of that place is a bit jaded (and therefore biased), that place was a toxic burn-out factory.
BTW, "post mortem"? Thanks, the morbid humor made me laugh!
They will try as hard as they can to pin system failures on the unfortunate person who was in charge of the system.
Or, a local case, the nurses were complaining about shoddy supplies. Eventually the holes in the swiss cheese lined up and a baby died. The hospital tried to treat it as a murder by the nurse. (Claiming the line was cut, rather than it broke.)
Related, when I had to live in a certain area that had a high bike theft rate, I got myself a pink bicycle. In the year I was there, it was never stolen. Well, except for the seat (which was black).
I appreciate the Star Trek reference (V'ger incase somebody doesn't know what I'm talking about - Star Trek, The Motion Picture). That movie awed me as a kid.
