CPR after rigor mortis - page 4

Hello All, Do u know where I can find information referring to Long term care scope of practice for RN's? What is the policy on starting cpr after rigor mortis set in? Thank you:)... Read More

  1. by   donmomofnine
    Do y'all use AEDs? Those are what really save lives, more than CPR, according to what I read.
  2. by   rbrown74
    Quote from healinghandsRN
    Hello All, Do u know where I can find information referring to Long term care scope of practice for RN's? What is the policy on starting cpr after rigor mortis set in? Thank you
    We have to obtain an order to stop cpr if someone is a full code and they are noted without vital signs--no matter if rigor mortis is set in or not. This is a protective documentation to prevent lawsuits and survey issues from the board of health.
  3. by   Antikigirl
    I agree with the CYA bit! BUT, we have had this happen to me on occasion where the patient was obviously dead beyond chance of revival. At that point I did a very good assessment, documented what I saw, smelled, heard, felt..the whole bit before choosing not to perform CPR, including a very long search for pulses and respirations (part of CPR ).

    Luckily for me, I have tried very hard to get all my patients POLSTS in order so we know what to do! So far I have only had to work with people with DNR's in place..whew!

    I can't dx someone as dead...not my scope, but I can dx a severely terminal failure to thrive..LOL!

    IF worse came to worse, I would take the assessment time while waiting for Paramedics to arrive...by the time they get to us (which is usually within minutes), I will have completed a good assessment and let the EKG prove it .
  4. by   TracyB,RN
    At a facility I worked at, we had a "presumed death" policy.. Must be 2 nurses, one MUST be an RN... some of the criteria... pupils fixed & dilated, absence of BP, P, R, mottling.. I can't think of anymore, but there were several. I'll look around & see if I can find it.
    I also wondered about the time frame & how often these residents were checked.

    The facility Presumed Death Policy states that:
    I. CPR will not be performed after an
    unwitnessed cardiac arrest if the following is
    present:
    A. Pupils fixed and dilated
    B. Mottled discoloration of the body
    C. Absence of reflexes
    D. Bowel and bladder sphincter control gone
    E. Absence of vital signs (pulse and blood
    pressure) with the presence of the other
    symptoms listed above.
    II. Before a decision to not resuscitate is made,
    A through E must be verified by two licensed
    nurses, one of which shall be a Registered Nurse
    .
    III. The findings shall be documented in the
    nursing notes, along with the signature of both
    licensed nurses. The Attending Physician will be
    notified.
    Last edit by TracyB,RN on Feb 17, '05 : Reason: found what I was looking for
  5. by   SmilingBluEyes
    AFTER rigor has set in????? Am I reading this right???
  6. by   bobnurse
    unfortunately you are..........
  7. by   CapeCodMermaid
    Quote from donmomofnine
    Do y'all use AEDs? Those are what really save lives, more than CPR, according to what I read.
    I wanted to use AED's in my facility...was told by the ED that it opens us up for lots of liability...suppose, he said, someone was having chest pains and they drove here instead of calling 911 because they knew we had an AED....yikes...suppose Chicken Little was right! I'd love to have them. We have quite a few patients who are full codes...in their early 60's and in for short term rehab. I've been there for 5 years and have only once had to use the ambu bag...we are VERY good at recognizing declining health and do not hesitate to call rescue.
  8. by   donmomofnine
    "we are VERY good at recognizing declining health and do not hesitate to call rescue"

    We are too!
  9. by   ernurseok
    When rigor has set in, they are DEAD!!!!!!!!!!!!!!


    Quote from healinghandsRN
    Hello All, Do u know where I can find information referring to Long term care scope of practice for RN's? What is the policy on starting cpr after rigor mortis set in? Thank you
  10. by   night owl
    :Melody: They're not only merely dead, they're really most sincerely dead! :Melody:
  11. by   UM Review RN
    Quote from deegale
    just curious does anyone know the success rate of cpr on the elderly? I've never known anyone in their 80's or 90's to live after having cpr
    Working here in FL, I've seen a lot of patients survive CPR. We still try to call the Code before it's really needed, however, because these folks are so frail. Because the patients are monitored, we get about as close as you can get to a "witnessed" Code--their heart rhythm will change and that will alert us to the problem, sometimes before the patient even feels it.
  12. by   Antikigirl
    I had one nurse that was scared to death of loss of license because she didn't do CPR on a person starting to stiffen. I calmed her and assured her that she did the right thing.

    The legal red tape scares nurses some times...and sometimes you have to help others out and remind them...even if you are doing CPR..that patient is dead, so whatever you do is a bonus...but that is IF there is a bonus to have! If you are pulseless, apnec and stiff, I don't see much of a bonus you can achieve at this point.

    What I have done is gone through the motions, long assessment (like I mentioned)...long enough to really establish that it isn't a case of severe bradycardia (if someone is already stiffening, got that grey look, not breathing...it is pretty much a given, but you still want to assess and document that this was not the case). Would I do CPR...not likely... I have had Doctors ask if these patients could have had severe bradycardia and we didn't do things...so that kinda scares me a bit..."no doctor...they were grey, stiff, apnec and pulseless...did not respond no noxious stimuli or voice (which my voice can be considered noxious..LOL!), Apnec pulse 0 after 2-3 minutes of careful listening!...I think they pretty much expired"....sheesh!

    The only time I DID do CPR on a man who was obviously dead, it was a choice made by my EMS team and myself. This mans wonderful wife did CPR on him (with her rescently post broken hip hurting badly from compressions, poor dear!) for over 20 minutes...so we did it mainly for her...yes, it was show..but made her feel so much better about what she did (she was so scared she killed him by CPR! Poor thing). We did it for another 15 or so minutes...and that made her feel that all that could be done was done...that was worth it to us . And we really praised her that if he had a chance..it was due to her! I really think that helped her cope much better!

    You have to use your best clinical judgement...if you are unsure or scared...the only thing CPR will do is maybe crack some ribs, and waste some time at that point...and seeing as they are dead...I don't see where that can hurt if you really feel you need to!
  13. by   bobnurse
    Quote from CapeCodMermaid
    I wanted to use AED's in my facility...was told by the ED that it opens us up for lots of liability...suppose, he said, someone was having chest pains and they drove here instead of calling 911 because they knew we had an AED....yikes...suppose Chicken Little was right! I'd love to have them. We have quite a few patients who are full codes...in their early 60's and in for short term rehab. I've been there for 5 years and have only once had to use the ambu bag...we are VERY good at recognizing declining health and do not hesitate to call rescue.
    Why would having an AED open you up to liability? Why would a LTC advertise their AED for public use? And if a patient chose LTC over an ED, why wouldnt you provide BLS until EMS arrived, as if it were a family member of a patient already there? AED is a BLS function....I mean, if we are training store clerks and janitors to use them in malls, i would hope a nurse in a healthcare facililty wouldnt hesitate to utilize an AED.

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