ABG's in CPR

RN92 · Dec 18, 2004

Quick question. i had a chemical resus only pt the other day. Did not want to be intubated under any circumstanes. Well, sure enough, she coded on my shift. Some nurses were insisting on getting ABG's. Doc/intern said there was no need. She didnt want to be intubated anyway. The one nurse said - 'what about her bicarb?." I said, 'we're going to give her bicarb anyway." The Doc agreed. The other nurse just got all upset. Whats your opinion? Would getting abg's be uneccesary sticking/time consuming objective in an already busy situation? We gave the pt bicarb anyway. She had been struggling all morning to breath. Even if we could have saved her, she would have crashed again before the day was over. She was 77. Would appreciate any constructive criticism. I just dont believe in doing things just because thats the way we always do it. There has to be a reason, each case should be individualized.

Dixielee, BSN, RN · Dec 18, 2004

If she was struggling to breathe all day, then you KNOW she was going to be acidotic without drawing ABG's and if you were not going to improve her respiratory effort then all the HCO3 in the world would not make a difference. The only way that might have improved things if it had been a metabolic not a respiratory problem. Bagging her might have helped, but if she did not want to be intubated, there was nothing you could do. I think you were definately right.

Dixielee, BSN, RN · Dec 18, 2004

If she was struggling to breathe all day, then you KNOW she was going to be acidotic without drawing ABG's and if you were not going to improve her respiratory effort then all the HCO3 in the world would not make a difference. The only way that might have improved things if it had been a metabolic not a respiratory problem. Bagging her might have helped, but if she did not want to be intubated, there was nothing you could do. I think you were definately right.

begalli · Dec 18, 2004

For a real opinion on this, I'd have to know more. What was her underlying disease process, her history? Renal failure? ARDS? Was she past the point of bronchodilators? Were her electrolytes/blood sugar checked? If she was in respiratory distress all day, then I'm sure all of that was covered and she had on O2.

Giving the bicarb was good. But generally, what would have been the reason to draw an abg in a DNI? All it would have done is confirm that her respiratory status was the circling the drain. Maybe knowing that her po2 was 30 or something may have been a comfort to the caregivers because then it would have confirmed the poor woman probably didn't even know she was having these difficulties due to lack of O2 to her CNS (senorium changes, somnolence, semicomatose - comatose).

Hopefully she was made as comfortable as possible during her respiratory failure with other "chemicals" if need be.

I think witnessing the respiratory difficulties at the end of life is probably the most distressing thing for everyone involved.

I have to deeply admire this woman who knew what she didn't want and commend the caregivers for not giving in to their own discomforts with the situation.

Elenaster · Dec 18, 2004

I had a medicine patient one time that was a DNI. Of course she went straight down the tubes respiratory-wise and I think we wasted a tremendous amount of time getting gasses on her. Her pH continued to decrease and she had an enormous base deficit, despite a truckload of bicarb.

I'm of the belief that if you can't correct the source of the acidosis via patent airway and oxygenation, there's no amount of bicarb that's going to correct it and the patient will deteriorate anyway.

RN92 · Dec 19, 2004

Hopefully she was made as comfortable as possible during her respiratory failure with other "chemicals" if need be.
I think witnessing the respiratory difficulties at the end of life is probably the most distressing thing for everyone involved.

I have to deeply admire this woman who knew what she didn't want and commend the caregivers for not giving in to their own discomforts with the situation.

thanks. If anything, she was taken great care of - because we knew how miserable being in resp failure would make her. How hard it must have been for her having people dangle a promise of relief (being intubated) in front of her- to say NO.I have all the respect in the world for people like that. She died fairly fast - one minute she's breathing and then all of a sudden she wasnt anymore.I agree that ABG's would have been an empty gesture.!