Dying Pts who are still full codes.

[NurseyPoo7]

We see them every once in awhile - at least on our floor. The older pts who have multiple things going against them, yet either them (if they are A&O) or their family still wants to be a full code. Their choice, no problem.

But since I haven't been in any code experience yet, I was wondering how it is handled when these pts finally code, or get to the point where us health professionals know the end is coming.

I'm asking, as there's a pt who has been on our floor about a month now - He's in his 70s, has a Hx of cancer, which was treated/organ was removed, now has cancer mets in at least 2 other part of the body - also is in CHF (last BNP I remember was nearly 3500), respiratory issues (doesn't help him he is about 350lb), bed ridden, incontinent, kidneys are failing, has had multiple paracentesis, swallowing issues so he's also on tube feedings.. Poor man is a mess. He's very nice and friendly, A&O, but as his choice he's still a full code. Someone brought hospice in, but I don't think he's ready for that yet. I think his family is finally starting to come to terms with exactly what's going on.

But with a patient like that, if he did start having issues not sustainable to life and we called a blue or rapid response, how exaclty would it be handled?

[Roy Fokker, BSN, RN]

Like any other Code - by the book, mind the numbers and on the bounce.

cheers,

[XB9S, BSN, MSN, EdD, RN, APN]

With the patient you describe, where I work the medical team would sit down with him and his family for an open and frank talk, with the support of the palliative care team and how full treatment could still be given up to the point of resuscitation but in the event that he have a cardiac arrest then he would be unlikely to survive but would have to go through the indignity of a resuscitation attempt.

In the UK the decision for resuscitation lies with the medic in charge, of course his wishes would be listened to and respected if at all possible but with his condition and co-morbidities resuscitation would more than likely not be attempted.

[RosesrReder, BSN, MSN, RN]

Just like any other full code. On my floor, it's a chronic thing to have pt's like the one you just described and in their late 80's 90's.

To each their own.

[NurseyPoo7]

Like any other Code - by the book, mind the numbers and on the bounce.

cheers,

I keep hearing how people can be coded for HOURS -- Would we really code a patient like this for hours when he already had such a poor quality of life to begin with?

[NeosynephRN]

I keep hearing how people can be coded for HOURS -- Would we really code a patient like this for hours when he already had such a poor quality of life to begin with?

Yes...I coded a woman this morning for almost 3 hours...off and on of course...until the family finally understood what was really happening....and what was never going to happen. Sometimes it sucks having to do this to patients...but just be the best advocate you can!

[leslie :-D]

I keep hearing how people can be coded for HOURS -- Would we really code a patient like this for hours when he already had such a poor quality of life to begin with?

that wouldn't be your call.

some docs will call it much sooner than later.

leslie

[uscstu4lfe]

my experience so far = old people with chronic problems have a relatively short code before it's called

relatively young are coded for much longer, unless it's totally useless

[nerdtonurse?, BSN, RN]

I swear I think most of the time we're buying time for the family to realize there are worse things than their loved one dying, or for the dying person to come to grips with their own mortality. If we could somehow show them a video, show them what they are actually signing up for...but false hope springs ever hopeful....

What I do when I've had those is I go talk to the chaplain. Sometimes he's more successful at getting a patient/family to see reality than the hospice group is at our hospital.

[cariboujenny]

Would this be a topic for social work to address? In one hospital where I did my clinicals, the social worker regularly addressed this very issue with elder patients.

[WVStarFish]

Yes...I coded a woman this morning for almost 3 hours...off and on of course...until the family finally understood what was really happening....and what was never going to happen. Sometimes it sucks having to do this to patients...but just be the best advocate you can!

Im new and have not worked in a hospital, but at the risk of sounding really, really stupid...

what does it mean to code someone for so long? I always thought that the paddles were used and after a few tries, you stop. No?

[SaraO'Hara]

Look at the ACLS algorithms - essentially, IV meds, like atropine or epinephrine (kick-start the heart), bicarb to correct acidosis, various others depending on the arrhythmia, in combination with chest compressions, ventilations, defibrillation as necessary. Defibrillation is used in a relative few - v-fib, v-tach. The algorithms are a protocol of what to do, what drugs to push, in what order, depending on the arrhythmia.