CPR after rigor mortis

[HealinghandsRN]

Hello All, Do u know where I can find information referring to Long term care scope of practice for RN's? What is the policy on starting cpr after rigor mortis set in? Thank you:)

[St.rein]

i think i know that rigor mortis. hes a good friend of mine back in high scool.

[debRN0417]

hummmm when I worked the ER we had a volunteer ambulance crew bring in a DOA...that they were doing CPR on...been dead say long enough to have dependent levity and rigor...found in a hotel room overdosed. :rotfl: I asked them what was going on and they said "well we couldn't get an airway so we had to just bag him...." no clue :deadhorse hehe I was amazed :rotfl:

[Aneroo, LPN]

We don't provide CPR at our facility, but when we did I always thought it was ironic that an RN could pronounce someone dead, yet some of my staff felt we still had to jump on them and do CPR!

You don't do CPR at your facility??? Where do you work?

There are some places where an RN can pronounce, esp if a patient is a DNR. However, if you're talking about LTC, many patients have severe contractures, which could be mistaken for rigor mortis, or make rigor harder to distinguish. For EMS, CPR is not started if rigor mortis has set in, or if there is an obvious injury that in incompatiable with life (decapitation, anyone?). However, we were taught that no one is dead until they were warm and dead! Esp for near-drowning or hypothermia cases. -Andrea

[gwenith, BSN, RN]

I might have the definitive comeback and article for your Nurse Educator. In 1986 this exact question was raised at the American Heart Foundation Conference on CPR and subsequently published in the JAMA July 1986 (you will probably have to access a hard copy through your library) Forgive me but my memory does not extend to the exact page however I seem to remember it was in the "introduction" section (the whole journal for that month was devoted to CPR) from memory it stated

"CPR neeed not be started if there is evidence of dependent lividity, rigormortis, tissue decomposition or decapitation as these are usually reliable criteria for death".

I remember it so well because I used to teach CPR back then and used to use this quote a LOT.

[deegale]

I work in longterm care in mich.. Our socialworker and DON say if you didnt see they're last breath don't start cpr. Have only ran one code in 5yrs i've been there. If they're a full code we try to ship them as soon as we can if they have a change in cond. I would never do cpr on someone with rigormortis.yuck

[Fiona59]

To quote my teenager "like isn't that beating a dead horse?"

[donmomofnine]

Aneroo ~ I work in a faith based community where residents and families are comfortable with death and dying and not doing heroics. We openly discuss these things with our residents and families! Does it really make sense to do CPR in this population?

If someone absolutely insists, we tell them we will call the EMS. And we do, well before they are ready to code!:)

This has never been a problem.

[Ruby Vee, BSN]

years ago, i was working in a ccu in a large hospital, and a ccu nurse was always assigned to the code team for the whole house. i got called to a code on the rehab floor. it seems that mo had been in the bathroom at 3pm, so the nurse deferred his vs. at 5pm, the na left his tray on the bedside table, but he was in the bathroom. at 6:30 pm, they picked up his tray and he hadn't touched it. still in the bathroom.

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[color=#4b0082]at about 9pm, i responded to the code. mo was lying on his back in the doorway to the bathroom . . . legs up, knees bent. it looked like someone had taken a plaster statue of a sitting man and laid it on its back.

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[color=#4b0082]we coded him for almost an hour.

[proudmommielpn]

CPR after rigor? That's just nuts! The facility where I worked for about 5 years allowed LPN's pronounce death. I have done numerous. At our facility nursing would set the families down upon admission and explain to them EXACTLY what a "full code" entails and alot of them changed their mind and changed their family to DNR. I personally have expressed my wishes to my hubby to be a chemical code only. I know what it entails and I don't want to have to be kept alive by machines. I have been sick biggest part of my life and when it is my time I am ready to go. I was born with a birth defect called TE Fistula and I have suffered with numerous lung infections and the sort so I have been there and done that and I don't want to have to go through it again. But I just can't get over some facilities not doing CPR. I mean upon admission do you tell the families that CPR will not be done, you just hope that the ambulance gets there quick enough or what?

[donmomofnine]

Leading them to believe that CPR will "work" sure doesn't seem right! We tell them the truth. Getting EMS here in time has never been a problem. As I stated before, we are a faith based community and death and dying are accepted as natural....

[Alicia18]

Yes, death and dying is natural and faith is a great thing, but if there is a chance to save a life by CPR, and the patient is not DNR, I think that CPR should be a step taken. The idea of having to wait for the ambulance is CRAZY! What if the ambulance gets stuck in traffic and can't get there in time? No offense toward your facility, but I would not appreciate that if my family member lived there. Yes, the families must be told that CPR won't always work, but they should feel confident that if it could work, their loved ones would be resusitated whether or not the ambulance can make it in time.

[donmomofnine]

I guess we just have to agree to disagree.:) I am at peace with my decision for now and I guess I am open to changing my mind!