"Thumping" out the door....?

Nurses General Nursing

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Ok so Im in SNF. We had a code today. By the time we get to the room with the crash cart its obvious we're too late to do any good but because she was a full code we jumped in (or on) full steam ahead until EMS can get there.EMS rolls in, hooks up the monitor....flat line. They shock...nothing. They do all they could possibly do but like I said, it was obvious we were too late. So then they hook up this thing they called the "Thumper" that performed mechanical compressions and was basically hands-free CPR. They prepared her for transport with this attached and loaded her into the truck. My question is, why did they continue these compressions when it was clear that she was gone? My first thought was that perhaps it was to keep the circulation going in case she was a doner. But if that were the case wouldnt they be bagging her also? and are the elderly with multiple chronic diagnosis even eligible to donate? It was just disturbing watching this little ole lady convulse as shes being pounded on leaving our facility instead being treated gently in her passing.

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EMS rolls in, hooks up the monitor....flat line. They shock...nothing.

Flat line? That means no shock.

CPR is continued to maintain circulation until they get to an ER with more resources to attempt resuscitation.

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Well, you don't shock Asystole. It has to be a shockable rhythm. Did anybody push drugs? ACLS? What was your facility P&P, what was in her advanced directives?

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EMS cannot decide when to pronounce a patient.....that will be up to the doctor at the hospital. I once rode with the ambulance and we pulled a very dead body from a pool......the body went on the thumper until we got to the hospital.

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Specializes in ER, Trauma.

Like nurses, EMS people work under Dr's orders. With EMS, their local medical director has signed off on a stack of standing orders that the medics MUST follow. Some states allow EMS to call it on their own. Many states say that even if a person is DNR, any call for help means that EMS must do all they can until a Dr tells them to stop.

Let me stress that, because it causes some really stupid codes, Any request for help requires the medics to provide the full meal deal no matter what till a Dr calls it! Depending on the state and the EMS system, sometimes a doc wil call it when EMS requests by radio.

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Specializes in Oncology/Haemetology/HIV.

I believe that an MD has to pronounce and that once CPR starts it has to continue until the MD pronounces, or rigor sets in ( signs of incontrovertible demise).

If she wanted her treated "gently" she should have been a DNR. Barring that, once the ambulance is called, they carry certain legal obligations, especially in our sue happy society. That generally means full out resuscitation.

Current CPR regs are pushing for compressions to the main component of CPR even to the point of possibly compression only CPR. The compressions, if adequate ( meaning 60 to 90 lbs of pressure in adults) provide some in and out of air. And are often more effective.

Elderly can be donors of certain tissue products.

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Specializes in ER, Trauma.

Next time you see the medics, ask them how the standing orders and state laws work in your state. You'll probably be shocked, but the knowledge will be useful.

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Specializes in Emergency Department.

Each state and each EMS system within each state is different. Paramedics do work under a Physician's orders... and they will generally NOT follow yours, as your orders do NOT normally supersede a Physician's Order... While an unsync defib attempt is not normally done with a patient in asystole, I've seen where it can be considered, in the event that it's fine V-Fib. Thumpers (those CPR machines), if applied properly, do a much more consistent job of doing compressions. Positioning of the device MUST be checked very frequently.

In any event, the Medical Director for the 911 system may have decreed that all Full Code patients under CPR who do NOT meet certain "determination of death" criteria must be transported. Some systems want their Paramedics to work the code on scene and only transport under specific circumstances.

Yes, this may lead to (generally) obviously dead patients being flogged for a while... but that's so that even remotely viable patients aren't missed...

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Something else to consider (broken down into two scenarios):

1- You explain to the family that you did everything to save the patient.

2- You explain to the family that you did not try to save the patient based on your personal judgement.

You always assume the patient is a code unless you have laid eyes on the DNR order. If there wasn't a DNR order present, full code is expected.

I'd rather be in the first scenario.

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Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

My question for you is why DID YOU even start CPR and call EMS in the first place? Ambulances CANNOT transport dead bodies so if they were not going to continue efforts they would have had to leave the dead body with your facility.

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Specializes in ICU.

EMS rigs have radios. Call the doc on the radio?

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Specializes in Trauma, Teaching.

Not trying to seem callous, but if she was indeed gone, then the thumper isn't going to affect her at all. Her passing was already "gentle", in that she died before all the CPR etc. was done.

Hugs to you, I know it's hard to see someone you've cared for and had a relationship with be "mistreated", but in reality neither you nor the EMS had a choice under our scope of practices. :hug:

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