Code Blue: Pt was breathing, but Dr. pronounced dead - page 2

by Bugaloo 5,335 Views | 13 Comments

I have a question: On our Med-Surg floor, we had a 80 year old patient that was A&Ox3. Her nurse had been talking to her, left the room for about 3 minutes, and when she came back, the patient had resp. of about 3 per minute, and... Read More


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    Did she have a pulse after the 2 minutes of compressions?

    Was she truly breathing or was it agonal respirations?

    (3 breaths a minute, sounds like agonal to me, which could be a sign there was already cerebral ischemia)

    What was the pt's admitting diagnosis, underlying history, and cardiac status and her prognosis to begin with?

    Was her pacemaker in good condition?

    And what was the rhythm on the monitor after compressions?

    (If the rhythm showed asystole with pacemaker spikes without capturing a beat...he may have decided to let her go without traumatizing her body more.)
    RNSC, Libitina, Jo Dirt, and 1 other like this.
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    I think the doctor was using his better judgement in this case. You may think he called it too quickly but would proceeding with the code have changed the outcome? Likely not for the better. I think he was being compassionate. I would hope a doctor would do that for me when I'm 80 and have a cardiac arrest.
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    Quote from Bugaloo
    I have a question: On our Med-Surg floor, we had a 80 year old patient that was A&Ox3. Her nurse had been talking to her, left the room for about 3 minutes, and when she came back, the patient had resp. of about 3 per minute, and she appeared to be dying.

    Code Blue was called, we initiated CPR. We had done about 6 compressions, she had a faint carotid pulse, and was still "gasping". The Code Team arrived, and we told the physician that she still had a few respirations when we arrived (about 3 minutes before he did). She had a pacemaker, and it appeared that it was trying to "kick in" and do it's job.

    He looked at her, felt for a radial pulse, and noted that it was faint. About 2 minutes later, he "called it", stating that her pupils were fixed and dilated, and that she had been dead "a while". We tried explaining to him that about 10 minutes prior to all this, she was absolutely fine. He did not listen and left the room.

    My question is this? Did this physician pronounce this patient dead too quickly? We all felt very badly after this and felt that the code was not handled well at all. Did we do all we could for this patient, or did we let her die? Personally, because she still had a few respirations, I felt that we should continue, and so did the other nurses, but the doctor has the final word.

    If the code team arrived about 3 minutes AFTER you started CPR then I do not understand why only 6 compressions were done and no drugs given while awaiting the code teams arrival. The way I see it even though the patient had a faint pulse and a few respirations without adequate perfusion during those 3 minutes that you and your coworkers found her and initated CPR then she did not receive adequate perfusion to her brain. 3 minutes is a very long time and CPR (compressions, airway and bagging, drugs) should have been given during those 3 minutes and when you say the pacer looking like it was "kicking in" was you seeing pacer spikes with no underlying rhythm? Sounds to me like CPR was not effectively performed prior to the code team getting there so there really was no brain left to think about saving and the MD made the call based on that fact.
    Based on the info that I've read I agree that the code was not handled well at all however I do not think it was the MD or code team that mishandled the situation.
    I know I wasnt there so I can only see the situation in my head based on the facts written here however I've been to enough codes that I think I have a pretty clear picture of the event.
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    Now that I have had a few days to think about it, I am apt to agree with the doctor. When I review everything in my mind, a few things pop up.

    1. The pt's nurse did not immediately start CPR when she found her. She came to the desk and was not sure if she was a DNR or not.

    2. The ward clerk took her sweet time calling the code overhead. It was 0600.

    3. It is a small rural hospital, and the "Code Team" consists of a nurse and doctor from ER and maybe ICU if available. The house super can come IF they choose too.

    4. Very few nurses are ACLS certified and just freak out during a code.

    I am a traveler at this hospital, and I have learned that it is very low tech here; classes are not offered for furthering the education of the nurses. The nurses are discouraged from being assertive, so a lot of them just do not care anymore. The nurses here are treated as 2nd class citizens, if that.

    I think that the doctor was correct in his judgement. The other nurses do not agree, but they have never seen how codes are run elsewhere, either.

    I just wanted to get the input from other nurses, to see what they thought. Thanks so much to those of you who replied.


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