? about coding the post Open Heart pt???

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this question is only concerning the first 24 hour period. do you deviate from ACLS protocols or do you give 1 mg epi q3-5 mins? anyone use calcium chloride ?

The only thing I get take from your question. Is when I have my OHS I have to ask the hospital if they are going to do compressions on me if I need them. An arrest is an arrest is an arrest, ACLS no matter and that includes compressions. Please talk to your educator and have them do just a little bit of research, in order to change your policy.:bugeyes:

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An arrest is an arrest is an arrest, ACLS no matter and that includes compressions.

Unless they have a biVad.

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Unless they have a biVad.
As a nurse your responsibilities are the same and you follow acls and you apply the appropriate recovery steps. Remember as a nurse you do not diagnose nor treat. you follow the treatment directed by the diagnosing physician. As you may see I don't agree with acls. I feel it takes the responsibility off the physician and places it on the nurse. Which is not nurses role. To read an ekg and determine to give epi/atropine is a diagnosis and a treatment. I do it alot as part of the code team, but don't agree with the it.:twocents:
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As a nurse your responsibilities are the same and you follow acls and you apply the appropriate recovery steps. Remember as a nurse you do not diagnose nor treat. you follow the treatment directed by the diagnosing physician. As you may see I don't agree with acls. I feel it takes the responsibility off the physician and places it on the nurse. Which is not nurses role. To read an ekg and determine to give epi/atropine is a diagnosis and a treatment. I do it alot as part of the code team, but don't agree with the it.:twocents:

No, chest compressions are not done when a patient has a biventricular assist device.

As far as you not agreeing with ACLS, you always have the option to not obtain certification or to work in an area that does not require ACLS certification.

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not to insult your feelings. I know not to do chest compressions w/ a bivad. That is why I said you still do acls and just like any other code you use the protocol as it applies. chest compressions would not apply. Sorry, I didn't explain myself more simplistically. And where I choose to work has no impact on my personally feelings about a nurse doing a doctors job. :cheers:

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Specializes in Cardiac, Post Anesthesia, ICU, ER.
I hope thats not a policy at your place.

Time is brain. Dont twiddle your thumbs. Do compressions.

Unless you have a surgeon standiong at the bedside 24/7 with a bottle of betadine and a razor...

It's unfortunate (and kinda gross) compressing a fresh sternotomy but in the event of cardiac arrest you have no other choice. (or...if you choose to wait until someone comes and cracks the chest you'll likely just be watching the patient die...)

Ditto this, our policy is follow basic ACLS!! (and pray!!!!) As Dinith say, it is NOT fun pushing on a fresh sternotomy, however if you want that patient to live and have a normal functioning brain, then that's what you do.

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Remember as a nurse you do not diagnose nor treat. you follow the treatment directed by the diagnosing physician. As you may see I don't agree with acls. I feel it takes the responsibility off the physician and places it on the nurse. Which is not nurses role. To read an ekg and determine to give epi/atropine is a diagnosis and a treatment. I do it alot as part of the code team, but don't agree with the it.:twocents:

Its called ACLS protocol. if pt is dead -> give drugs. Do you not have protocols in place for repleting electrolytes? xfuse for Hct 38.3 give tylenol? Protocols are not dx'ing its cook book medicine that a monkey could carry out. You really don't want any kind of autonomy do you? Id also suggest not renewing your acls and working in a less acute area if it puts you out to follow protocol on a dead (pulseless/apneic) person.

Would you rather call the attending with "uh mrs. jones doesnt have any QRS complexes, isn't breathing, has no pulse, is blue as a smurf. What do you want me to do?"

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Its called ACLS protocol. if pt is dead -> give drugs. Do you not have protocols in place for repleting electrolytes? xfuse for Hct 38.3 give tylenol? Protocols are not dx'ing its cook book medicine that a monkey could carry out. You really don't want any kind of autonomy do you? Id also suggest not renewing your acls and working in a less acute area if it puts you out to follow protocol on a dead (pulseless/apneic) person.

Would you rather call the attending with "uh mrs. jones doesnt have any QRS complexes, isn't breathing, has no pulse, is blue as a smurf. What do you want me to do?"

:yeahthat:

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Not sure if anyone will see this, BUT,,,

I work in long term care (RN - 3rd Shift) and one of our recent residents came in post CABG for rehab to home. On his code status he checked full code but then wrote no chest compressions only mouth to mouth next to it.....HUH?

I mean is this even possible? I feel like this is just setting up whoever (potentially) has to do anything for this man CPR-wise for liability. If you do as the patient wishes....well that is pointless to give breaths without compressions. And if you don't do as the resident wishes then you could also be setting yourself up for liability.

Anyone with any experience with this? I suggested that they re-talk to this person and explain what is possible and what is not, but no one wants to listen. Please help!

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Specializes in ER, ICU, Infusion, peds, informatics.
not sure if anyone will see this, but,,,

i work in long term care (rn - 3rd shift) and one of our recent residents came in post cabg for rehab to home. on his code status he checked full code but then wrote no chest compressions only mouth to mouth next to it.....huh?

i mean is this even possible? i feel like this is just setting up whoever (potentially) has to do anything for this man cpr-wise for liability. if you do as the patient wishes....well that is pointless to give breaths without compressions. and if you don't do as the resident wishes then you could also be setting yourself up for liability.

anyone with any experience with this? i suggested that they re-talk to this person and explain what is possible and what is not, but no one wants to listen. please help!

you need to get that clarified, because there is no such thing as "full code/no chest compressions."

there is "limited code status" (the name for which varies from institution to institution).

i've seen limited code status include chemical code only (no chest compressions or intubation); do not intubate (chest compressions/drugs ok). limited code status is close to pointless (in my opinion); but whatever -- it is the patient/family choice. i can follow directions.

giving mouth-to-mouth on a pulseless patient is futile. (though giving mouth-to-mouth on a patient who has a pulse, but is not breathing enough, will buy you some time until intubation can be done)

i guess what i'm saying is that if they don't want chest compressions, then they can't check that "full code" box.

ps -- you might want to put this in the ltc forum, where you are likely to get more traffic.

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Specializes in CTICU.

Sounds like it's clear he didn't get informed help to make that decision, as he obviously doesn't understand his choices. A doctor needs to explain his choices and get an informed decision.

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Specializes in Cardiac Telemetry/PCU, SNF.
you need to get that clarified, because there is no such thing as "full code/no chest compressions."

there is "limited code status" (the name for which varies from institution to institution).

i've seen limited code status include chemical code only (no chest compressions or intubation); do not intubate (chest compressions/drugs ok). limited code status is close to pointless (in my opinion); but whatever -- it is the patient/family choice. i can follow directions.

giving mouth-to-mouth on a pulseless patient is futile. (though giving mouth-to-mouth on a patient who has a pulse, but is not breathing enough, will buy you some time until intubation can be done)

i guess what i'm saying is that if they don't want chest compressions, then they can't check that "full code" box.

ps -- you might want to put this in the ltc forum, where you are likely to get more traffic.

i call "limited/advanced interventions" gravity codes. just push in the drugs and a good flush and hold that arm up in the air (hence gravity) and pray the drugs actually make it into circulation. i've seen code statuses that range from realistic (full dnr) to asinine (drugs, intubation, defibrillation, but no compressions).

on the topic of post-cabg codes, we've been trained to do compessions, so do them. besides, we're not going to open someone up on the floor (post-transfer from icu), although they do...we're going to try to get them stable enough to move to the unit instead.

and acls protocols are built so that in places ehre they don't have docs in-house, or on the floor 24-7 can actually save lives. we're not diagnosing, we're following a protocol based on the assessment info. it's not like we're standing around going, "well, is this wide-complex tachycardia caused by re-entrant impulses or..." no, we're going, "wide-complex tach, no pulse, we need electricity..."

just my thoughts...

tom

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