CPR in LTC

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Hi. I have been working in an Alzheimer Unit for almost 5 years and I have never performed CPR because of the Advance Directives. Lately, we have been getting new admissions psychiatric younger patients but very sick and full code. Please can you share your experiences with me performing CPR in LTC . Also, we only have 1 AED in the facility of 140 residents is this normal? Thanks in advance.

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Specializes in LTC.

I have no comments on CPR in LTC. When I worked assisted living occassionally we wouldn't be able to find paperwork for the medics right away and they'd be stuck coding the resident until we could find the DNR order. All parties involved weren't happy with that. (Messy facility.)

The AED thing is pretty amazing though. From what I understand many if not most LTCs don't have AEDs. 1 AED in a central location is awesome. I've been in hospitals where not all units had defibrillators. That was a bit mind boggling.

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Specializes in ICU, ER, EP,.

One AED is fine, I swear. I just did the new ACLS guidelines a month ago (I work ICU). So what I want to impress upon you, is simply, simply excellent firm, strong and slow enough chest compressions. Your adrenaline is running high, your running around like crazy (mean this nicely to prove a point) and NO ONE is compressing!

The latest studies have shown that the patients current O2 in their system lasts over 15 minutes. Just Jump on the chest, compress and scream for help. First person that responds, you shout, "you, get the AED, tell the first person you see to call 911... or what ever you call.

You simply keep compressing, firm, strong and rhythmic, allowing the chest a full rise and fall (gotta fill the heart with blood).... what you think is slow in this situation is probably right.

Have the AED person put the pads on around you, never, ever stop compressing until the AED tells you to.

So I swear, you've got a good five ten minutes in, before anyone pushes the cart in and needs rescue breathing.... have someone stay on the chest at all times.

All you need to know is how to push on a sternum and scream for help and not stop until the AED tells you while 911 is called. Next year, I swear we won't use any drugs in the ICU, studies are proving they deprive the brain as well as stopping to get breaths or an airway is killing our patients. I know it sounds crazy... but the new guidelines are out.

Seattle Wa, has the highest rate of "witnessed arrest success stories", because every single high school kid has BLS to graduate, they simply compress and get the AED

NO worries, you'll do fine, because you have a basic lifesaving thing to do, forget the cart.

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Hi. I have been working in an Alzheimer Unit for almost 5 years and I have never performed CPR because of the Advance Directives. Lately, we have been getting new admissions psychiatric younger patients but very sick and full code. Please can you share your experiences with me performing CPR in LTC . Also, we only have 1 AED in the facility of 140 residents is this normal? Thanks in advance.

I work LTC and have no AED in the facility..at all..anywhere! The first thing I do after getting report is pull up the advanced directives on the computer, write down all my full codes and place that paper in my back pocket, lab coat or scrub pocket. I had the horrifying case with a person found unresposive and not breathing. I had NO idea if the person was full code or not as I had just gotten report and the person was a new admit a day or so after the last time I worked, so I had no idea of the code status. The charts and computer were at the opposite end of the hall as was my "brain sheet" that I had marked my full codes on . From then on I always, always, always keep a list of my full codes on my person! And to be sure I didn't mark someone as a full code when they are DNR or didn't list someone who is full code, I have another nurse double check.

Your chances of having two full codes running at once and both needing the AED are slim to none, so having 1 AED is fine, however where that AED is placed and how your facility is set up can mean a matter of minutes to get the AED to the person. Have to agree with Zoo, keep doing those compressions, the latest guidelines stress compressions over rescue breaths.

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Specializes in Critical Care.

Really? New "guidelines" are out? What is your supporting reference for this? The new BLS guidelines come out this fall but I think it's a bit early to say we will eliminate using drugs in hospital codes.

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Specializes in Critical Care.
I work LTC and have no AED in the facility..at all..anywhere! The first thing I do after getting report is pull up the advanced directives on the computer, write down all my full codes and place that paper in my back pocket, lab coat or scrub pocket. I had the horrifying case with a person found unresposive and not breathing. I had NO idea if the person was full code or not as I had just gotten report and the person was a new admit a day or so after the last time I worked, so I had no idea of the code status. The charts and computer were at the opposite end of the hall as was my "brain sheet" that I had marked my full codes on . From then on I always, always, always keep a list of my full codes on my person! And to be sure I didn't mark someone as a full code when they are DNR or didn't list someone who is full code, I have another nurse double check.

Your chances of having two full codes running at once and both needing the AED are slim to none, so having 1 AED is fine, however where that AED is placed and how your facility is set up can mean a matter of minutes to get the AED to the person. Have to agree with Zoo, keep doing those compressions, the latest guidelines stress compressions over rescue breaths.

The issue of compressions vs. rescue breaths is more for lay people, not healthcare professionals. The issue was risen because lay people as a whole were delaying compressions trying to assess pulse and respiratory status. HCW are still to provide rescue breathing but it's to be done with as little interruption to compressions as possible, for example as the chest is recoiling from the compression.

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The issue of compressions vs. rescue breaths is more for lay people, not healthcare professionals. The issue was risen because lay people as a whole were delaying compressions trying to assess pulse and respiratory status. HCW are still to provide rescue breathing but it's to be done with as little interruption to compressions as possible, for example as the chest is recoiling from the compression.

I was speaking more of, if she were alone and waiting/yelling for help. With no rescue breather, no CPR mask etc, its best to do the compressions until either you get help or the crash cart is brought in and the rescue breather mask is hooked up to the 02 and have a second set of hands. But honestly even with a perfectly run full code, with all the modern tools and gadgets, in LTC, its very rare that the person is revived and survives.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I've worked in several nursing homes, and none of the facilities have had defibrillators. The codes in which I've participated have been disorganized and frantic. It's prudent to immediately notify the attending physician and EMS when you find a resident with full code status who is clinically dead.

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Specializes in Peds Homecare.

"The issue of compressions vs. rescue breaths is more for lay people, not healthcare professionals. " Exactly what I was taught 3 weeks ago when I recertified. I made a point in my course to ask about it, and was told by the instructor that this does not apply to healthcare professionals.

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"I know it sounds crazy... but the new guidelines are out."

AHA won't be releasing the new guidelines until October 18, 2010. NO ONE has the new guidelines-there is speculation though....

cheers,

otessa

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Hi. I have been working in an Alzheimer Unit for almost 5 years and I have never performed CPR because of the Advance Directives. Lately, we have been getting new admissions psychiatric younger patients but very sick and full code. Please can you share your experiences with me performing CPR in LTC . Also, we only have 1 AED in the facility of 140 residents is this normal? Thanks in advance.

Do you have a policy about how to deal with emergency situations, including codes?

Mock codes-practicing emergencies before they happen-is very helpful to know what to do when something real happens :tornado drill, fire drill, code, etc.....

otessa

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Do you have a policy about how to deal with emergency situations, including codes?

Mock codes-practicing emergencies before they happen-is very helpful to know what to do when something real happens :tornado drill, fire drill, code, etc.....

otessa

Only fire drill. I'll check the policy. Thanks.
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