Can I not perform CPR?

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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.

Specializes in med-surg, teaching, cardiac, priv. duty.
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!

Yes, I think you were at a laypeople class and not one for professionals (healthcare provider) . At a past agency I worked for they "accidentally" (incompetence!) signed me up for the wrong CPR class. They sent me to the layperson class. Within a short time in the class I knew something was wrong. First I noted there were only nurse assistants in the class - I was the only nurse. I thought that was strange. And then the class began and they said the thing about not checking pulses and I was like "WHAT??!!!". I then realized I was in the wrong class. Nurses must have the healthcare provider class.

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
He also stated if we came upon a case and the client was dead we should not "bother" with CPR.

We only do CPR on dead people anyway. So, his comment was just stupid in my opinion.

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Specializes in tele, oncology.
We only do CPR on dead people anyway. So, his comment was just stupid in my opinion.

Okay, I had to laugh at that!

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Specializes in Ortho, Neuro, Detox, Tele.

Since I just did this for my card today for work...let me tell you. The AHA class for healthcare professionals says to check responsivenesss, send someone to call 911 or you call first, then look/listen/feel for breathing....check carotid pulse closest to you, and then start cpr at a 30:2 breath ratio....then compress at 100/minute.

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This sounds like a communication problem. The teaching I was taught is yes if you come upon somewhat who looks dead and you shake him look listen and feel a pulse check is not always necessary because it is true sometimes you do think you feel a pulse when you did not (usually it is your own) , do CPR often or a layman you think you feel a pulse when you don't. So what they are saying is just start CPR forget the pulse believe me if the person was only sleeping he sure will wake up. Even in our ED I remember so many times when we argue whether there is a pulse (too many times we have PEA and fully educated and experienced ED Doctors think they feel a pulse only to be proven with a doppler there is none). Now the teachings says when in doubt start CPR. We do not argue anymore we just do it and I have yet to have a pt stop me and say ow that hurts:wink2: Lets be honest, CPR on a patient who has a pulse is not a sin any more after all, look at the new ACLS teachings. Even when you find a rhythm you are to perform 2 minutes of CPR before checking for a pulse.

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Your company seemed to think it was alright for the instructor to give classes for lay people to everyone? Perhaps bring this up with the company, they may not be aware of the difference?

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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?

Definitely not trying to pick an argument, but just for clarification... this is incorrect right? In a code/CPR situation we would not be expected to consider the person's quality of life before deciding on whether to do CPR or not? I know that some people really need to be at rest and that at times it can be a blessing, but I thought that we were to just go through the motions of saving them until/unless we were told otherwise by the person who "calls the code" or by DNR paperwork?

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Regarding the pulse check:

Our BLS and ACLS instructor is also a fire chief (it's a small town).

He has mentioned in class that the pulse check should be minimal. We take too much time looking for a pulse when we should be doing compressions. I know at one point he mentioned a study on docs and nurses, and in code situations, we don't fair all that well in finding pulses.

He also pointed out that if someone's doing so badly that they look like they need compressions, and you aren't sure about a pulse, go ahead and do compressions. If you aren't sure about the pulse, then they probably aren't perfusing blood well even if they do have one--so compressions are going to support their heart's work.

Think about it--after you shock, do you check for a pulse, or do you immediately restart compressions? You restart compressions. Even if they have a pulse. Because perfusion after a nonperfusion or low perfusion state still isn't going to be adequate for several minutes. Also, I'll point out that in NRP, you start compressions when the heart rate is less than 60. So chest compressions are not entirely contraindicated even in the event of a pulse.

Re the comment that "if someone is obviously dead, don't start CPR."

One, this might have been a lame attempt at humor. Two, it's true to an extent. If you find someone who is in rigor, are you going to initiate CPR? In the hospital, of course you aren't going to find someone in this situation (let's hope). But I can imagine there are situations in a community setting, in home health, in EMS, in assisted living even where you have the potential to come across someone who has been dead a long time. Not just a few minutes. Not just a few hours. These could be the situations to which he was referring.

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That would be the difference between "dead dead" and "only mostly dead." ;)

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Just don't go through the clothes, looking for loose change!!!

I love the Princess Bride.

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"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."

Thanks for the clarification on this, it never occurred to me.

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Specializes in A little of this & a little of that.

Read your card and make a phone call to the organization that "sponsors" this instructor. He needs re-education. There have been changes to the guidelines and he doesn't seem to understand them.

Some staffing and homecare agencies do try to get away with the clas for lay persons. You should be taking the "Basic Life Support" if AHA or "Healthcare Provider" if Red Cross. These classes include use of the AED.

New guidelines for CPR have dropped the "pulse checks" after CPR is initiated. The healthcare professional always follows ABC- check Airway, Breathing and Circulation then institute treatment. If the AED is available is should be used. If your class didn't include the AED, it was at the wrong level for a nurse. Your class should also have included child and infant CPR if it was for professionals.

Some facilities have policies of only initiating CPR for "witnessed" arrests.

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