Can I not perform CPR?

Farmer Jane · Oct 17, 2008

Some nursing homes have a policy of only initiating codes when the arrest was witnessed.

Personally, I'd code any patient that was a full code. It's good practice, and at least you can say you tried even though you knew darn well it wouldn't do a thing.

putmetosleep · Oct 17, 2008

If you find somebody unresponsive, first you look into the oral cavity for any foreign objects, listen for breath sounds, give 2 breaths (if pt not breathing) and then check a pulse. If no pulse, YES, you should begin CPR.

Remember the ABCs. I don't understand why he said not to check a pulse?? The new BLS protocol calls for 30 compressions:2 breaths--but I'm sure you knew that since you just took the class:wink2:

putmetosleep · Oct 17, 2008

If you find somebody unresponsive, first you look into the oral cavity for any foreign objects, listen for breath sounds, give 2 breaths (if pt not breathing) and then check a pulse. If no pulse, YES, you should begin CPR.
Remember the ABCs. I don't understand why he said not to check a pulse?? The new BLS protocol calls for 30 compressions:2 breaths--but I'm sure you knew that since you just took the class:wink2:

Oops, okay sorry, I didn't look close enough to realize you were talking about a long-term care faciltiy. I'll be interested to hear other people's input--it will be more relevant than mine, lol

LovebugLPN · Oct 17, 2008

I am actually talking about home care. The instructor said that the new protocol says that checking for a pulse is no longer instructed to do because people were trying to check a pulse and finding their own pulse by doing it wrong. I thought the whole thing was extremely stupid but I could not change the way it was taught. He said if you come along someone who is "apparently" dead not to bother. I told him as a nurse I had to do all I could in my power to revive a victim until I was relieved by EMS unless the person was a DNR.

vampiregirl, BSN, RN · Oct 17, 2008

I'm sorry that you got the response you did from your CPR instructor!

The new CPR guidelines for laypersons do not include a pulse check. However, the CPR guidelines for professionals still do include the pulse check, at least in the course I teach. You might benefit from seeking a higher "level" CPR course.

As for not "bothering" to do CPR on someone you think is dead... that definately isn't the way I'd put it! First of all, where you work would have specific policies when CPR should not be initiated. I work EMS, so the only document I can honor is a signed DNR. There are other circumstances where CPR shouldn't be initiated - unsafe scene, decapitation, obvious rigor mortis or decomposition etc. In most other situations though, I would (and have on a couple of occasions) started CPR even if I didn't know how long they'd been down or didn't have a good feeling about what the outcome was going to be. That is also what the material in the CPR course I teach encourages.

Bottom line is, I always try to base my treatment of a scene and patient on how I would treat a family member or friend. After all, every patient is someone's family member or friend.

LovebugLPN · Oct 17, 2008

I actually looked in the handbook to and the steps are: Airway, breathing, compression, defibrillation. NO CIRCULATION??? He taught it the way stated but as a nurse I can not do this and I can't understand why anyone wouldn't.

LovebugLPN · Oct 17, 2008

We also had a new LPN there. I hope he doesn't follow these instructions. This class was required by our company. If these people are going into peoples homes I would hope they are bright enough to check a pulse without screwing it up. I would hate to have that person taking care of my mom or dad.

suanna · Oct 17, 2008

I don't know for sure but I suspect your instructor is an ACLS instructor providing a BLS class. I hear echos of the current shift in the phylosophy in ACLS in his statements.

1) Checking a pulse seems like a good idea but we used to waste lots of time "holding compressions" while we checked for a pulse. This gave lots of time for the brain and other organs to die while we franticly searched for a fleeting blip that may or may not be there. Fast, hard compressions are the best way of providing for a good outcome. A weak thready maybe it's there maybe it isn't pulse is not worth hunting for - do compressions.

2) Even with GREAT CPR the recovery rate to any kind of meaningful life is very poor. As health care providers we have an obligation to consider if there are indications that CPR should not be started. Was the person down for a prolonged time?, Do they have obvious comorbidity fastors present that would preclude a reasonable expectation that they could regain some quality of life? Are there obvious signs of hopelessness - (are they cold, mottled, rigorus...) We are not boy scouts training for a merit badge - we're nurses. Sometimes CPR is just abuse of a corpse. That being said, when in doubt - start CPR.

Texas Tornado · Oct 17, 2008

I actually looked in the handbook to and the steps are: Airway, breathing, compression, defibrillation. NO CIRCULATION??? He taught it the way stated but as a nurse I can not do this and I can't understand why anyone wouldn't.

Compression is the action related to no circulation or poor circulation. This step implies that circulation was checked.

I'm not sure what your instructor is talking about. There are definitely some parts to this puzzle missing. Was the instructor an employee of the home care agency you are with? Maybe they were stating the agency policy, b/c it is not BLS. Can you contact the instructor for clarification on what they are talking about?

mama_d, BSN, RN · Oct 17, 2008

It sounds like you were at a class for laypeople, NOT healthcare providers. See

http://www.americanheart.org/downloadable/heart/1132621842912Winter2005.pdf

for the most updated rules for both.

It states that the provision that healthcare providers assess pulses has not changed.

Hope this might help you!

catlynLPN · Oct 17, 2008

I already posted this in Agency Nursing but thought I may get more replies here. I recently took a CPR class that included me (LPN) and 8 PCAs. The instructor told us we were to no longer check pulses before or during CPR. He also stated if we came upon a case and the client was dead we should not "bother" with CPR. I first am concerned because you are asking people to determine death without ever checking a pulse and also my understanding was that I was in no place to pronounce somebody dead. I brought this to the instructor's attention and got a shoulder shrug so now I will ask you guys.

I was told about the same thing you were in the last class I took.

They told us that "lay" people {non medical} are the ones being told not to check for a pulse, that some people don't know how to find a pulse and waste time in doing so because they're feeling their own pulses. They said they teach lay people to look for other signs of life, like limb movements or rising chest to indicate respirations.

Our instructor told us, that as nurses we ARE to check for a pulse, but they don't teach doing so in the class.

Anyone can be taught how to find a pulse. Why not incorporate that into their CPR class? Seems like it would be easier to teach it than to wait until a non medical person is called upon, due to circumstances, to do CPR. Seems like anything to help someone do CPR and do it correctly would help the victim.

I wouldn't want someone beating on my chest if I did have a pulse.

Just my :twocents: .