CPR on a person who is in rigor mortis?

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One of my patients that I was taking care of was in for ETOH abuse, ascites, and cirrhosis recently passed away. He was living in a assisted living facility where I was working at and based on what I got from report, he came back to the facility the previous night intoxicated. The last time he was seen alive was today at around noon where he asked to take his lunch back to his room. When the health care provider told me to go to the patient's room stat (this was around 7 in the evening), I found him not breathing, on his side, his face swollen. We called 911 and I tried to perform CPR on the patient, but his muscles where stiff and I couldn't separate his arms (it was fixated in a overlapping position). I then attempted to open his mouth, but it was tightly shut. I couldn't even barely get him on his back. The paramedic on the phone told me to keep on doing chest compressions until the paramedics arrive on the scene. I'm still in shock by this incident (I am still a new grad nurse also working at a hospital) and I can't believe that this patient that I've been taking care of for months actually died (this patient had a very friendly and caring attitude to everyone), so yeah, I'm in the dumps right now. Sorry I got sidetracked, but I was researching online on rigor mortis, because I am assuming that this is the condition the patient was in when I arrived to the scene and I just wanted feedback if my actions were valid in this situation?

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If the patient was rigor, then he had been dead for at least a few hours.

Under normal circumstances, people usually begin to rigor 3-4 hours after death and are in full rigor mortis at around 12 hours. This man sounds as though he had been dead for some time.

Realistically, I see no reason why CPR was initiated, but I assume you were told to do it just to cover your butt.

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Rigor Mortis is one of the obvious signs of death. We typically do not do CPR on somebody in rigor mortis.

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Breathe. Relax. You meant well, and that's what counts. Yes, usually one would not start CPR on someone in rigor, but I suppose if the guy was not a DNR and was a full code, then what choice have you got? At least you should probably make an attempt, then be sure to document that muscles were stiff, etc. Your actions were valid. If you have this situation again, you will know what to do.

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Specializes in LTC.

((hugs)) it's always hard to lose a patient you've gotten to know..you did exactly what you should have...cya...cpr was so obviously not going to help this poor guy, but unless he was a dnr, you still have to give it a go...i work in long term care and 95% of my patients are dnrs, but for those few whose families want us to crush grandma's ribcage at 100 years old even if it's not what grandma would have wanted, we will always do cpr. it sucks but it is what it is...one of those realities they sure don't give us a heads up on in nursing school..

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Specializes in LTC.

And...the doc didn't notice he was dead?? That's the first thing I saw..sorry..*shakeshead* You did fine...*hugs*

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You are not the first and you won't be the last one to try and perform CPR on a person in that condition. Unless you know the person is dead, rigor does not count except for knowing that the scenario just got way worse, because.... there are several condition that present with muscle rigidity. We have also done CPR on patients that we as in the health care team, have coded or worked even though we knew they were dead. #1 small children and infants, #2 when family member are present and people become hysterical, # 3 when any part of the medical team has a family member that dies. Those are the more frequent CPR on dead people situations. In reality, if you feel strongly about your duty to act, then do it. If you were a perosn that had a loved one collapse and you saw that there was someone of medical experience on hand, you would have an overwhelming desire to see your loved one get help. Even if they are dead, you are showing that you care, your willingness to do what you can and to ease suffering is a God sent for some people.

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There is no point in doing CPR on a person with rigor mortis, even if it's to "cover your butt". The guy is dead, he has rigor mortis. There is nothing to cover at that point. But... you said you're a New Grad, so you're learning... and that's OK. I don't know why a 911 operator would say to do CPR on a guy with rigor mortis, either.

Did anyone hear the 911 call for that TV personality Billy May's? It went something like..... The wife called 911 after she woke up and noticed he was dead. The 911 operator said to do CPR. Then a family friend came on the phone and said "No, there's no point, he's gone." The 911 operator responded with "What? What do you mean he's gone? Paramedics are on their way. Just do CPR. " The family friend said "There's no point... he's stiff."..... a long pause.... "Oh, well..... the paramedics are on their way then."

If a lay person can figure this out, then certainly we nurses can! ;)

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In the state I currently work it requires 2 nurses to pronounce death. Either an Rn & Lpn, or 2 Lpns. Here, if the person is a full code status, only their primary physican can OK the cesation of CPR and allow the nurses to pronounce. I work in a long term care facility where contacting the provider may take awhile. If the case goes to court, you have no way to prove how long the patient was deceased and that rigor mortis was actually present. It is far better (in all areas of nursing) to err on the side of the patient. You will never be left trying to explain your actions. I have been a nurse for 35 years and this has ALWAYS been an ongoing issue. No one wants to define it, because of the ethical and legal implications. Even if you know the patient is long gone, do CPR. THEY WON'T CARE! As soon as the 911 crew arrives, they assume responsibility for the situation and can contact an ER physican and "call the code" per his instructions. It's not worth risking your job or your license if you make the wrong decision. These kind of issues, are what make it hard to be a nurse these days.

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Specializes in Occupational health, Corrections, PACU.

Although clearly your CPR effort was a waste of time, you did the right thing. Re: the CPR they advised you to continue, it is more for legal purposes than anything else. You should find out if your facility allows nurses to pronounce someone dead. The paramedics can when they get there, or a provider can. I am wondering, if as you said, the "healthcare provider" told you to go to the room "stat", why didn't that provider pronounce and save all the emergency nonsense on someone who is already in rigor? The first death of a patient is always unsettling, and you are likely only going through the normal emotions. It is more difficult the longer you have known the patient. You did what you had to do, and that is the bottom line. Each time there is a critical incident, you become more wise as a nurse. Good luck and keep practicing good nursing skills and good documentation. These are the things that will always stand up and will keep your license safe, and allow you to go home at the end of the day feeling good about what you have done.

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Specializes in Flight, ER, Transport, ICU/Critical Care.

Hey there ARRR10 - I think you did 1. what you were told and followed the "rules" 2. erred on the side of action

I am NOT gonna beat you up on the "should of" or "could of" or "would of". I think you were in a tough situation, contacted help and made a split second decision to act. That is what most all would have done.

Yep, it was useless. Most CPR is useless. You are a new grad in an assisted living environment. I am a flight paramedic and nurse with nearly 2 decade of mistakes under my belt. It is only reasonable that we would do some things differently. Doesn't mean I'm right or you are wrong - it just means that we have different experiences and environments.

Shame on anyone that spoils on you.

Bless you for what you do - it is a long and difficult road in gaining experience and there will mistakes. When in doubt - always choose action over observation. Action can usually be defended and observation just means you watched. (Folks - I know that certain situations are always watched - this is not even close to one of those)

You did the best you could. Bless you and may you find peace. :angel:

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A nurse can not be held liable under any cirsumstance for not performing CPR on a patient in rigor mortis. If it's an issue of trust, grab another nurse to witness the rigor mortis. There is no.way.under.the.sun. that a nurse would ever be held responsible for the death of someone who was found to be in rigor mortis.

Nurses are taught to "be careful, protect your license" but sometimes this interferes with common sense.

Talk to any legal department or person you choose, but to reiterate, a nurse will never be held liable.

This is just an "in general" statement... to the OP, you're a New Grad and you acted like one. You did the right thing given your experience level. Good job.

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