CPR on a person who is in rigor mortis?

[ARRR10]

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?

[leslie :-D]

we found a patient dead (LTC patient). he obviously had been dead for a few hours. he was a full code. i didnt start cpr because it was obvious he was very very dead. i called the family, told them and then just called the funeral home after letting the doc on call know.

about a month later we got a letter from the family's attorney. nothing came of it as the man was very dead and i had done some good documentation but our medical director and i were grilled for some time.

from now on..i dont care how dead you are...if you are a full code, i will call ems and initiate cpr, no matter what.

what kind of grilling did the atty do, that had you nervous?

i guess what i'm trying to get at, is w/rigor mortis, you are soooooo dead that the body has initiated its series of chemical changes that inevitably result in decomposition.

i challenge anyone to bring a case of negligence to court, for not performing cpr on a person w/rigor.

in essence, the case would be laughed out of court.

this type of rampant paranoia, only serves to perpetuate the comedy of errors that we nurses are inevitably mocked for.

dead is dead is dead, aeb rigor mortis.

let them sue me.

leslie

[fridayannelpn1974]

Thanks for the comment. There have been a lot of comments on when, where, & what rigor mortis is. These things are all self evident and of course true. But the issue is not if the person was dead or not, of course he was! The problem for nurses TODAY is the ever changing attitudes toward the medical profession and the legal implications. I understand what you meant by the grilling from the family's attorney. What was once common place practice, is NO LONGER valid. Nurses, CURRENTLY working today, face a much different reality than nurses did even 10 years ago. Advanced directives, living wills, DNR, DNH, DNI, g-tubes and many other issues are extremely complex. The social worker at most facilities is required to address these issues (time available). This takes the "conflict of interst" out of the equation. Nursing employees are discouraged from witnessing or participating in the formation of these documents. Once these documents are in place it is best to adhere to them to the " letter of the law". Or, as you found to be true, expect to face the deposition. I have even run into nurses who want to do a "slow code". They want to circumvent the Full Code status by delaying CPR, because they feel the patient should be allowed to die, even though the family and/or the patient doesn't want this. They say " Oh Well, He has no quality of life". I work in Arizona where there are a lot of Hispanics and Native Americans, who's religious beliefs require CPR be done. I think as nurses we are obligated to respect all peoples beliefs. Also I am pretty sure that most funeral homes are able to aestetically reverse ANY damage to a body from CPR.

[Commanderzoom]

I was just using the McDonald's coffee thing as an example of how sue happy our society is. You don't need to defend McDonald's to me. I eat there. Sorry if you took it personally.

LOL, I didn't take it personally. I don't even eat at McDonald's unless I'm desperate, away from home, and extremely low on cash. The food makes me physically ill for some reason and has since my second pregnancy. I was pointing out that in that situation, the woman wasn't sue happy. McDonald's had already been sited for keeping their coffee way too hot and she suffered, what, 3rd or 4th degree burns? I'd at least expect them to pay for the medical bills.

We're going to sue the neurosurgeon who ***** up DH's nerve stimulator implant--he implanted it incorrectly and has all the electrodes wired to one nerve instead of multiple nerves so it would cover his entire back and upper legs like it's supposed to. He has it so screwed up that the electrodes are touching and shorting out, so the manufacturer had to deactivate it. He's lucky it didn't kill him. You want to know why he has the nerve stimulator in the first place? It all started with a herniated disk that needed to be replaced because it was pinching a nerve and progressed from there. The neurosurgeon told him (it's even in the medical files) that he was going to replace the disk but instead shaved it. He didn't shave it enough and the nerve damage became more severe. Without yet another surgery in the near future, my husband is going to be paralyzed. All he needed was to have the disk replaced and instead, he's 25 years old, permanently disabled, going paralyzed, and has a hunk of metal in his back that he can't even use. At first we thought we were going overboard with the lawsuit but the manufacturer of the nerve stimulator and the neurosurgeons he's seen for second and third opinions agree with us. Sometimes people need to be sued when they cause permanent damage to a person.

Sorry for the book. I tend to get upset about "frivolous lawsuits" that really aren't. If someone sues because a nurse doesn't perfom CPR on a body that's already in Rigor Mortis, that's frivolous. If some sues because they've received a permanent injury from something beyond their control, that's not frivolous.

[Commanderzoom]

I wanted to add that I've seen the horrifying effects of CPR on a person when there's no hope. I was at work (LTC) when the nurses had to perform it on a woman who was already dead but was a full code. They did it to cover their butts. This poor little old lady was in her late 90s, skinny as a rail, and was in "good" health but died suddenly. I could hear the ribs breaking and I was out in the hallway. Her entire chest caved in. It's something that will probably haunt me forever. Did it hurt her? Nah, she was already gone. It traumatized her family and it messed with all of our heads.

[fridayannelpn1974]

Check out the new guidlines for CPR for Healthcare Providers. (not basic CPR for anyone). It gives specifics about how aggressive CPR should be. The adrenaline rush that we all get when we kick into CPR mode sometimes causes too aggressive CPR. The amount of pressure required and many other changes are now in place. I just took a course and after many years of CPR training - my eyes were opened. If you heard ribs breaking you were doing too deep of a compression (according to the latest course I took). I too have broken a few ribs over the course of my career. This course I took opened my eyes about the damage that is done by over aggressive CPR. Not placing any blame. Been there, done that.

[PostOpPrincess, BSN, RN]

Sometimes prudent nursing/judgement comes into play.

The next time you find someone in rigor mortis, don't bother. THINK about it...what would it really do?.......Nothing?

Yup...nothing.

Leslie is right--dead is dead is dead.

Unless a lawyer is related to Lazarus and can prove he has raised someone from the dead, I wouldn't worry too much--prudent nursing/common sense.

Let's use our smarts, peeps.

[tewdles, RN]

As a hospice nurse I frequently perform "death calls" for our patients. One in particular comes to mind. This was a 65 year old woman who was admitted into our hospice care less than 1 week prior to her death. She lived in subsidized housing in the meto Detroit area and her adult son had moved in with her to provide for her daily care. She had lung cancer. When I arrived at the home for a "suspected death" I discovered this unfortunate woman in advanced rigor in a very odd position in bed. Oh by the way, she had NOT signed a DNR, she was a FULL CODE. I arrived, assessed the situation, advised the son that his mother had died, called the appropriate authorities and DID NOT INITIATE CPR. The distinction for me is this...resusitation is designed for people who are in cardiopulmonary arrest...not for people who are dead. Rigor is not a symptom of arrest it is a sign of death. Would I fault a new grad for making a different decision? Absolutely not! I would view it as an opportunity for that nurse to learn something new. The great news is that this particular lesson is learned without anyone being put in harms way. Someday the OP may be able to look back and laugh about this...in my social group it would be over a martini or glass of wine while we review our lives as nurses and very fallible angels of mercy.

[GilaRRT]

Sometimes prudent nursing/judgement comes into play.

The next time you find someone in rigor mortis, don't bother. THINK about it...what would it really do?.......Nothing?

Yup...nothing.

Leslie is right--dead is dead is dead.

Unless a lawyer is related to Lazarus and can prove he has raised someone from the dead, I wouldn't worry too much--prudent nursing/common sense.

Let's use our smarts, peeps.

Agreed. Families and lawyers will always be out and about, and you can easily be sued for any number of things. I absolutely agree that common sense and nursing judgment should be exercised. Responded to an arrest while I was overseas. The patient was mottled with post mortem lividity in addition to no pulse, responsiveness, respiratory effort and asystole in all XII leads. We called it over the phone with a doc. Sure, we were grilled and had to answer for our decision. However, I would do it the same way again. We as nurses must also consider the best interest of our patient. Falling into the defensive medicine trap (CPR on every full code no exceptions) is not playing it safe. We put our selves at risk for injury and put EMS as risk when they rush to the scene. More is at risk than the fear of lawsuit.

[steelydanfan]

Gila had a good point about lawsuits-ANYONE can sue you over ANYTHING. Because you are named in a lawsuit does not mean you have done anything wrong, it just means you were involved in that pt'.s care. Lawsuits are like a fishing net, they cast over a large area.

I have been involved in 2, both times because the doctor decided to blame the nurse, but because of excellent charting, I was able to clear myself of involvement.

What I found most amazing each time was how little the hospital attorney really KNEW about medical/nursing practice, and how much I had to walk him through the chart.

I would be very disappointed if any nurse would be so silly as to perform CPR on a REALLY dead person because of fear of being sued. I know you have pressures of many kinds, and I cannot blame a new grad for not being so discerning. BUT, this kind of thinking is what causes our judgements to be second guessed during those 3am telephone calls. Because, believe me, that incident made the rounds.

[fridayannelpn1974]

Why should patients bother to fill out advanced directives and CPR wishes if the nurse in charge can just decide, not to do CPR? I have never seen an advanced directive that specifies: Do CPR unless the nurse in charge of my care decides it's not necessary! We ALL know nurses who's judgement is questionable. This is the last post I am going to make about this, since I think that we are" beating a dead horse." The difference is that the dead horse doesn't have any one to champion his cause. Patient's have family members who may feel differently. I still say there is NO reason to not perform CPR on a patient who is listed as a full code. Why not? Does it take too much of our very valuable time? H-m-m-m?

[leslie :-D]

I still say there is NO reason to not perform CPR on a patient who is listed as a full code. Why not? Does it take too much of our very valuable time? H-m-m-m?

performing cpr on a pt with rigor, makes us look like idiots.

pure and simple.

leslie:nurse:

[JomoNurse]

why yes, that's it. it makes nurses look like absolute uneducated idiots when you perform CPR on a person with rigor mortis. (which means they've been dead at least for SEVERAL hours).