My first CPR.

[CodeSurfer]

Ok, so my partner and I are taking a regular from the ED to a SNF and when we arrive on scene the SNF tells us they have a code going in another room and we should expedite and go work it. So we get the pt we had off of the gurney finish the run and proceed the the room wth the code in it.

We walk in to a single nurse straddling the pt doing one person CPR, and like 5 other people watching him. So as soon as we got in there the nurse jumped up and was glad to pass the reins. So of course we go to check for a pulse and continue CPR except for the fact that the patient is obviously dead and has been for a while. I went to open the airway and he had rigor so bad I couldnt tilt his head and he had lividity up to his neck.

My question is... since the nurse had started CPR, did we have to continue it until the paramedics got there? What is everyones protocol on this?

 

[DT4EMS]

Obvious signs (rigor mortis) I would stop.

 

[Flight-LP]

Your protocols should clearly cover this topic, but if there are obvious signs incompatible with life, termination of efforts should be considered...............

 

[Jon]

once CPR is started, youy must continue until command tells you to stop.

My uncle worked in a homeless shelter in Boston years ago... He tells that SOP was that when one of their clients did the "wake up dead" bit, they did CPR and called 911, and medics came and took the client away, even if he had been "good and dead" for many hours.... the "client" got out of the facilitiy, instead of sitting around for hours until the coroner showed up.


Jon

 

[TTLWHKR]

Originally posted by MedicStudentJon@Jul 30 2005, 10:40 PM
once CPR is started, youy must continue until command tells you to stop.

depends.


If you are at the scene of an MCI, you can stop if you have too many patients.

Or.

If you are alone, and become exhausted, you can stop then too.

Most protocols are pretty clear as to why you should not begin resuscitation. If there is any question in your mind against what is in the protocol - contact OMC; if you have doubts that your patient does not fit the no cpr protocol - do cpr.

 

[Jon]

good point

 

[KEVD18]

i would never have started. clear the nurse or whatever off the pt, check for pulse and breathing, notice obvious signs of death(rigor, pml, etc) and call it a day

 

[Chimpie]

Originally posted by CodeSurfer@Jul 30 2005, 08:13 PM
My question is... since the nurse had started CPR, did we have to continue it until the paramedics got there? What is everyones protocol on this?

What is your protocol for: arriving on scene, cpr in progress but rigor mortis was too far along ?

That should answer your question. Don't try to make it more difficult that it is.

I agree with KEVD18 though.

 

[vtemti]

Our protocols state that once CPR has been started it should be continued, BUT in this case it should never have been started and I would have contacted Med Control.

 

[rescuecpt]

In this case, to CYA, I would have the nurse continue, contact your medical control (don't touch the patient!) and get an order to stop.

We had this conversation the other day, and it was something along the lines of if it's another EMT that started, you need to continue and call medical control to get a discontinuation. If it's not another skilled provider (passerby, nurse's aide, etc) you don't have to start if there are obvious signs. The debate comes into whether this "nurse" was a skilled provider or not. By the definition in our discussion the other night, they are not, the only skilled providers we talked about were other EMT-B's, D's, CC's, or P's.

 

[SafetyPro2]

To add to what's been said, here in CA, there is no "control" for EMTs (just medics). An EMT in the field can only respond based on policy and transport. Not sure about down in SD, but in LA, EMTs can determine death in the field for certain obvious signs, such as rigor.

I've run into the same situation described above, and I'd have gone ahead and "determined" the PT. We get called out frequently for "not breathing" calls around 7 AM (shift change at the facility, hmmm) and find a PT who obviously hasn't been breathing since the middle of the night.

We've also run into staff doing CPR on a PT and then been handed a DNR by that same staff member when we take over.

Most of the staff in the SNFs around here have minimal medical training...basically just CPR and able to take some simple vitals. Hate to say it, but we've gotten used to just treating them like bystanders as if we were in a private house...they're rarely worth more than that as far as assisting with our care.

 

[CodeSurfer]

Thanks guys... I am going to have to find out exactly what my protocol is here. The nurse was an RN not an LVN, just to clear things up. RN or not he was obviously stupid for starting CPR on such a dead person. It just makes me realize how important it is to be up to date on protocol because the FF/EMT's that showed up about 3 minutes after us were pissed that we had continued CPR. Their captain made them continue until the medics arrived, so that didnt go over very well. Oh well... I wont make that mistake again.

<_<

 

[Margaritaville]

OK kids- remember its called "resuscitation" not "ressurection". Obvious rigor -let them stay that way!!!

The nurse should have known better. And if your protocol required you to keep up CPR - Don't spend a lot of energy on it!

 

[Jon]

Originally posted by Margaritaville@Jul 31 2005, 09:54 PM
OK kids- remember its called "resuscitation" not "ressurection".

Nah.... Intercardiac Epi!!!

 

[Jon]

Originally posted by CodeSurfer@Jul 31 2005, 07:31 PM
Thanks guys... I am going to have to find out exactly what my protocol is here. The nurse was an RN not an LVN, just to clear things up. RN or not he was obviously stupid for starting CPR on such a dead person. It just makes me realize how important it is to be up to date on protocol because the FF/EMT's that showed up about 3 minutes after us were pissed that we had continued CPR. Their captain made them continue until the medics arrived, so that didnt go over very well. Oh well... I wont make that mistake again.

<_<

The nures may have done CPR to cover herself, so that she didn't get "busted" for not catching that uncle albert had died 6 hours ago....

 

[CodeSurfer]

That is so true... I cant believe I didnt realize it. The nurse was supposed to be off at 6, so he probably noticed he was dead when he went to give report before leaving. Niiiice.

 

[CanuckEMT]

If that would have happened at our facility here I would have D/C'd CPR as soon as I found the rigor and lividity. We as EMT's here have that in our protocol as well and do not have to contact Med Direction.

I would have also documented the heck out of it just to CYA.......

 

[medicstudentchris]

Originally posted by SafetyPro@Jul 31 2005, 05:57 PM
To add to what's been said, here in CA, there is no "control" for EMTs (just medics). An EMT in the field can only respond based on policy and transport. Not sure about down in SD, but in LA, EMTs can determine death in the field for certain obvious signs, such as rigor.

In MS, at my service we only have ALS response, but basics and medics can use med control. However, we must continue cpr and work the code (once it is started) unless med control gives us the order to stop.

 

[Beegers]

I was dispatched at work for a "lethargic" patient at a nursing home....

Yes a nursing home idiocy call....

SO we pull up to the facility (we didn't know what the nature was at the time, just told to go lights and sirens) and there is an ALS unit pulling up asking which room we're here for....mind you, we were hearing tones for the city's volunteer corps going off from their truck.

As we're getting info (on our way into the facility) we find out we're there for the same patient and the nurse is standing on the side of the bed, doing compressions with one arm. ALS asses the patient and finds rigor mortis and another type of mortis i forgot what the name was and I noticed lividity all the way from the doorway.

I know a few nursing home RNs and know they know what they are doing and I respect them.....But I cannot stand the RNs (Reject Nurses) that shove macaroni and cheese down a pt's throat laying supine in bed.....(we also were dispatcehd once for 'difficulty breathing' on the mac&cheese incident)

 

[Jon]

Originally posted by SafetyPro@Jul 31 2005, 06:57 PM
To add to what's been said, here in CA, there is no "control" for EMTs (just medics). An EMT in the field can only respond based on policy and transport. Not sure about down in SD, but in LA, EMTs can determine death in the field for certain obvious signs, such as rigor.

I must have missed this.... Chris.... you have NO way to get command for anything? All medication administration / assistance (Nitro / epi pen / Inhaler) is all protocol only??? Same with refusals???

Here in PA, BLS doesn't call command except "complex" refusal (Minor, intoxicated, SERIOUS medical problem), Medication assistance / admin (Can usually give x1 before command, then more per command), and I think DOA's.

Jon