CPR after rigor mortis

night owl · Feb 18, 2005

:Melody: They're not only merely dead, they're really most sincerely dead! :Melody:

UM Review RN, ASN, RN · Feb 18, 2005

just curious does anyone know the success rate of cpr on the elderly? I've never known anyone in their 80's or 90's to live after having cpr

Working here in FL, I've seen a lot of patients survive CPR. We still try to call the Code before it's really needed, however, because these folks are so frail. Because the patients are monitored, we get about as close as you can get to a "witnessed" Code--their heart rhythm will change and that will alert us to the problem, sometimes before the patient even feels it.

Antikigirl, ASN, RN · Feb 18, 2005

I had one nurse that was scared to death of loss of license because she didn't do CPR on a person starting to stiffen. I calmed her and assured her that she did the right thing.

The legal red tape scares nurses some times...and sometimes you have to help others out and remind them...even if you are doing CPR..that patient is dead, so whatever you do is a bonus...but that is IF there is a bonus to have! If you are pulseless, apnec and stiff, I don't see much of a bonus you can achieve at this point.

What I have done is gone through the motions, long assessment (like I mentioned)...long enough to really establish that it isn't a case of severe bradycardia (if someone is already stiffening, got that grey look, not breathing...it is pretty much a given, but you still want to assess and document that this was not the case). Would I do CPR...not likely... I have had Doctors ask if these patients could have had severe bradycardia and we didn't do things...so that kinda scares me a bit..."no doctor...they were grey, stiff, apnec and pulseless...did not respond no noxious stimuli or voice (which my voice can be considered noxious..LOL!), Apnec pulse 0 after 2-3 minutes of careful listening!...I think they pretty much expired"....sheesh!

The only time I DID do CPR on a man who was obviously dead, it was a choice made by my EMS team and myself. This mans wonderful wife did CPR on him (with her rescently post broken hip hurting badly from compressions, poor dear!) for over 20 minutes...so we did it mainly for her...yes, it was show..but made her feel so much better about what she did (she was so scared she killed him by CPR! Poor thing). We did it for another 15 or so minutes...and that made her feel that all that could be done was done...that was worth it to us :). And we really praised her that if he had a chance..it was due to her! I really think that helped her cope much better! :)

You have to use your best clinical judgement...if you are unsure or scared...the only thing CPR will do is maybe crack some ribs, and waste some time at that point...and seeing as they are dead...I don't see where that can hurt if you really feel you need to!

bobnurse · Feb 18, 2005

I wanted to use AED's in my facility...was told by the ED that it opens us up for lots of liability...suppose, he said, someone was having chest pains and they drove here instead of calling 911 because they knew we had an AED....yikes...suppose Chicken Little was right! I'd love to have them. We have quite a few patients who are full codes...in their early 60's and in for short term rehab. I've been there for 5 years and have only once had to use the ambu bag...we are VERY good at recognizing declining health and do not hesitate to call rescue.

Why would having an AED open you up to liability? Why would a LTC advertise their AED for public use? And if a patient chose LTC over an ED, why wouldnt you provide BLS until EMS arrived, as if it were a family member of a patient already there? AED is a BLS function....I mean, if we are training store clerks and janitors to use them in malls, i would hope a nurse in a healthcare facililty wouldnt hesitate to utilize an AED.

ERNurse752, RN · Feb 18, 2005

Why would having an AED open you up to liability? Why would a LTC advertise their AED for public use? And if a patient chose LTC over an ED, why wouldnt you provide BLS until EMS arrived, as if it were a family member of a patient already there? AED is a BLS function....I mean, if we are training store clerks and janitors to use them in malls, i would hope a nurse in a healthcare facililty wouldnt hesitate to utilize an AED.

Exactly. That is just about as ridiculous as starting CPR on someone with rigor.

NurseFirst · Feb 19, 2005

Why would having an AED open you up to liability? Why would a LTC advertise their AED for public use? And if a patient chose LTC over an ED, why wouldnt you provide BLS until EMS arrived, as if it were a family member of a patient already there? AED is a BLS function....I mean, if we are training store clerks and janitors to use them in malls, i would hope a nurse in a healthcare facililty wouldnt hesitate to utilize an AED.

Totally agree, bobnurse. Totally. I don't see any liability there at all. The amazing recovery rate of people treated with AEDs is just phenomenal. That is why there is such an effort to get more of them out in every public place. The only thing that may be a bit disconcerting for the lay person using an AED is that the AED usually says "check for pulse", and, in AHA guidelines, only the healthcare provider checks for a pulse; all other levels of training the students are told to "check for signs of circulation." (Can you tell I had cpr instructor class last night??)

NurseFirst

leslie :-D · Feb 19, 2005

i think this has to be one of the most ludicrous threads i've ever read.

i can see cpr when death is recent.

but since it takes a couple of hours to rigor mortis set in, i would bet my bottom dollar there is NO ONE that has been resuscitated once rigor mortis set in and being dead at least a couple of hours.

it is physically impossible to bring them back at that stage and truthfully it makes anyone performing this cpr as questionable in their judgement skills.

leslie

Antikigirl, ASN, RN · Feb 19, 2005

Oh sheesh..get this..how cheep my facility can really REALLY be! They have denied our facility AED's because they are a liablity! WHY I asked?!?!?!

Okay..their excuse, in order to have an AED we have to train everyone in the facility to use them or if someone fails without proper training...they are held liable! OH give me a break..what can't tell whether the machine says "shockable rhythm press shock....stand back...shocking...." vs "non shockable rhythm"???????

I think it is a fancy way to say they don't want to buy one, and not pay for classes like CPR for my CNA's anymore!

In fact, it was JUST announced yesterday that all RN's must have the CPR course the facility is giving...but it is no longer open for CNA's or caregivers!!!! WHAT? It is the caregivers/CNA's that are doing most of the care, will be the first ones to find a patient down, and the ones that will have to support the patient while I try to get there to their rooms and help me! I am sooooooooo mad!

Our CNA's (and the nurses) are furious...they need their current CPR to have their licenses...so now they get to go out and pay for them! I think that is horrid, rude, and downright disrespectful towards their employees!!!!!

knockandhello · Feb 19, 2005

Correct me if I'm wrong, but doesn't rigor mortis set in 6-12 hours AFTER death? And the passing of it occurs in another 24 or so hours, depending upon the environmental conditions...

I think I was told that the process of rigor mortis can start 10minutes after death and that stiffness is apparent after about 3 hours and that the stiffness remains about 36 hours.Whatever, if someone was easily recognized as being at the stage of rigor mortis,I dont think I would attempt resuscitation.Would feel most uncomfortable, and disrespectful to the persons body.The mind boggles.

payday · Feb 19, 2005

Only if the patient's name is Lazarus.

Salty you are hilarious!

SusanJean · Feb 19, 2005

i think this has to be one of the most ludicrous threads i've ever read.
i can see cpr when death is recent.
but since it takes a couple of hours to rigor mortis set in, i would bet my bottom dollar there is NO ONE that has been resuscitated once rigor mortis set in and being dead at least a couple of hours.
it is physically impossible to bring them back at that stage and truthfully it makes anyone performing this cpr as questionable in their judgement skills.
leslie

I agree that it would be impossible once RM has set in. That was the point of my post w/ the times of onset for RM.

I do believe (not cking tho) that the OP was told to perform CPR even w/ RM.

(Contrary to what is taught in CPR classes.)

stevierae · Feb 19, 2005

I thought AEDs were soon going to replace the old style hospital defibrillators, IN hospitals, anyway--that they are so user friendly that the people that are freaked out by codes could easily gain more confidence--they have a simple machine that guides them, by voice, every step of the way, should they need guidance.

Where I live, AEDs are advertised in the newspaper to anyone who wants to buy one--they are marketed to elderly couples and people that live in rural areas, where EMS might take too long to get there, or even get lost.

My mom arrested at home in '82--she was only 47-- when she was babysitting a neighbor's toddler, but she had called several neighbors (should have called EMS!) before it occurred, saying she felt "funny" and asking could they please come over---by the time they got there, she was already down. None of them knew how to do CPR. EMS got lost! No one's fault--at least it never occurred to me to "blame" anyone--they just got lost--by the time they got there, she had been down 10-15 minutes--they defibrillated her and got a rhythm back, but she died of cerebral anoxia and pneumonia several days later in ICU. Imagine, had the technology been available, how many people like my mom may have been saved.

Thankfully, as AEDs become more available, more people can be saved, nowadays.