Didnt attemp CPR to a rigor mortis patient

Nurses General Nursing

Published

Hello,

I am here for a co-worker that's very stress out regarding the incident that just happened at the facility where we're working for. Per her statement, she walked in to a patient's apartment and found him laying on his side unresponsive, blue-purple in color, very stiff and cold. She called for help from co-workers that was working that time but nobody responded. She called 9-1-1 and stated resident wasn't breathing and the operator told her lay the resident flat and perform CPR (operator didn't know that patient is in rigor mortis). Also, she was all by herself by that time. Few minutes later, helped came and turned the patient on his back. She explained to the operator that patient is very stiff (one arm on the air, one leg is on the other, other arm is curled next to head). The operator then stated "oh so he's beyond cpr?" and she answered "yes!". Then operator transferred call to fire department and give same information. But the fire department didn't instructed her to perform CPR. No CPR attempted until paramedics came When they arrived, they announced that patient is in rigor mortis and called fire department no need to come.

Police Dept came for investigations, family and RN came (it happened weekend so no RN on duty).

Later, DSHS was involved and did an investigation. DSHS arrived in our facility and asked questions for protocol for unconscious patient. Then, DSHS representative asked to talk to my co-worker regarding what happened. Also she (DSHS) asked her (co-worker) if CPR was attempted.

Now, my questions is. 1 Is it serious (bad) when DSHS involved? OR is it just a standard procedure for them to get involved? 2 Is she gonna lose her license for not attempting CPR as CNA (since the protocol in our facility to perform CPR until paramedics arrive) even resident is in rigor mortis ? Resident signed for DNR on his POLST form.

Please help! She's very stressed out and I felt bad for her being concerned that she might lose her job. She's been working in the facility for 5 years.

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I don't understand why anyone would do CPR on a person in rigor mortis who has a DNR order. Am I missing something here?

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Specializes in Acute care, Community Med, SANE, ASC.

I cannot speak to anything about requirements of being a CNA or DSHS involvement but I know of no protocol for nursing or paramedics that requires CPR on a patient who has been dead long enough for rigor mortis. That person is far beyond CPR. Anyone asking questions about protocols for an unconscious person is asking the wrong questions as unconscious people are alive. People with rigor mortis are dead usually for at least 3-4 hours if rigor mortis has set in.

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Hello! My co-worker didn't state to the 911 operator that the patient is in rigor mortis. Though she stated "he's not breathing" That's why operator instructed her to do CPR. But when she explained that patient is in purple color, cold and purple in color, the operator stated "Oh! So, he's beyond CPR?" Then transfered the call to fire department and reminded her that they'll ask the same information. The concern that she have is if she's gonna lose her license or job. Especially when DSHS got involve with the investigation.

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I cannot speak to anything about requirements of being a CNA or DSHS involvement but I know of no protocol for nursing or paramedics that requires CPR on a patient who has been dead long enough for rigor mortis. That person is far beyond CPR. Anyone asking questions about protocols for an unconscious person is asking the wrong questions as unconscious people are alive. People with rigor mortis are dead usually for at least 3-4 hours if rigor mortis has set in.

Yes, according to her when she asked both paramedics and police department the estimated time with that situation, they responded 3-5 hours "maybe". The protocol in the facility though is to attempt CPR until paramedics came which she didn't do. Was that an error on her part?

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Specializes in Med/Surg, Ortho, ASC.
I don't understand why anyone would do CPR on a person in rigor mortis who has a DNR order. Am I missing something here?

Apparently, English is not OP's first language. Perhaps there are missing details.

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Apparently, English is not OP's first language. Perhaps there are missing details.

SHe was instructed to do perform CPR to the patient due to her statement "Patient is not breathing" instead of stating "patient is in rigor mortis/dead" . No CPR attempted though. And that's her main concern. For not performing so, will there be a possibility of losing her license or job? Protocol at our facillity is to perform/attempt cpr no matter what until paramedics come

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Specializes in MDS/ UR.

An investigation can happen for any number of reason.

What you describe being done in the investigation is standard operating procedure.

We don't have a crystal ball to answer the outcome. It's all hear say at this point.

I think there is more scrutiny on ALFs, people and the resuscitation process in recent months.

I have seen more substantiated complaints on failed/botched code statuses in my state in recent months for both ALF and SNF.

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An investigation can happen for any number of reason.

What you describe being done in the investigation is standard operating procedure.

We don't have a crystal ball to answer the outcome. It's all hear say at this point.

I think there is more scrutiny on ALFs, people and the resuscitation process in recent months.

I have seen more substantiated complaints on failed/botched code statuses in my state in recent months for both ALF and SNF.

The thing is, we saw this patient day before he died. His vitals is elevated. oxygen level down to 84-85%..pulse up to 100s..b/p is normal. He was whizzing really bad. He was brought to urgent care. He came back in the facility with a prescription for albuterol and anti-biotic (for bronchitis, per urgent care staffs). Also, he used to take lasix,pottasium and metropolol medications which got discontinued few weeks before he died. We assumed it contributed to his death? Maybe...maybe not...

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Specializes in NICU.

Regardless if the person went into cardiac arrest 3 minutes ago or 3 hrs ago, they have a DNR, so no CPR. Add to the fact that have been dead for 3-4 hrs and even if they were a full code, there is nothing that can be done. You can not revive a dead person. There is a saying in EMS "You can't shock a rock". If there is no electrical activity in the heart, no amount of shocking will ever bring the person back. Same goes for CPR.

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Regardless if the person went into cardiac arrest 3 minutes ago or 3 hrs ago, they have a DNR, so no CPR. Add to the fact that have been dead for 3-4 hrs and even if they were a full code, there is nothing that can be done. You can not revive a dead person. There is a saying in EMS "You can't shock a rock". If there is no electrical activity in the heart, no amount of shocking will ever bring the person back. Same goes for CPR.

Thank you for this response. I will let her read this. She's more concern of losing her job that she loves to do just because she didn't attempt cpr even though its our facility protocol to still attempt cpr until paramedics arrive.

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If the patient signed a DNR, one shouldn't have done CPR (even if it had worked)

I'm surprised that any facility's policy would have employees doing CPR on someone with a signed DNR.

Am I missing something?

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