I have question about CPR

[tattooednursie]

Scenario: You find your patient lifeless. there is absolutley no code status on their wrist band. You ask from down the hall to the nurses station on what their code status is. 3 people yell at once "Full code." You go back into the room to initiate CPR, then tell the people behind you to grab the crash cart. They cannot find a mask or ambu bag. There is phlegm and drool all over the patients face.

Question: Are you obligated to do actual mouth to mouth on a patient who is 100 + years old who is not going to make it anyway?

Thanks

Mandi

[Whisper]

BUT....in the Uk, we are taught that under no circumstance need you expose yourself to anyone's "bodily fluids". .

Merlin, I am doing my training in the UK, and at my last BLS update we were told that refusing mouth to mouth would leave us accountable to the NMC, the trust I work in is a bit disjointed one site has many more face masks than the other.

But we are told mouth to mouth is a must unless it is an 'acceptable delay'...One of the other hospitals doesn't publish it, but I know one nurse who left/was pushed because of refusal to start mouth to mouth!

All the research we were given by the university indicated very low infection rates, but maybe it was biased!

[TREBORICUNURSE]

The key question here is : Why there was no ambubag on the crash cart? You MUST, just must know where is CPR equipment No need for mouth to mouth if ambubag is there. I also feel the patients age has nothing to do with it. If code is present, don´t think just act.

[telenurse04]

AHA did recently say compressions alone can help because it pumps oxygen rich blood into the brain...or something like that. The crash cart would be there very soon..then they can start ACLS.

[CarVsTree]

One of the hospital I work in the standard procedure is you MUST do mouth to mouth, unless there is a high risk of infection, such as TB or HIV.

I think it is assumed as this in most UK hospitals... I have a face mask that fits on my key rings just in case!!

whisper

In our litigious nation, pt. could sue you if they had so much as a sniffle after you performed MTM w/o a barrier.

[Whisper]

i never even considered patients sueing staff for performing mouth to mouth!

[Tweety, BSN, RN]

I also question why there was no ambu bag on the crash cart. Where else should it be?

Another question is why is a person who is 100 years old (presumably frail, sickly?) a full code? Maybe I'm crass, but isn't that something that ought to have been addressed?

Really. CPR on a 100 year old should be declared a crime. But of course, I'm sure you know, if there is no family, and the person has no living will, then it must be assumed they would want everything done. We ran into this situation with a confused and dying patient in his 90s. We sent him to ICU, where he was intubated, coded and died. Sad.

[pmanrnbflo]

Protocol at the hospital where I work is that ALL CPR venilations are done with a barrier device, and they are on the cart. Also, our crash carts are checked every day.

I would question why the bag/mask/ barrier device is not on the cart.

[tattooednursie, LVN]

Thank you for all your help.

I agree that a 100 year old should not have been a full code. If I live that long (which I hope I don't) I would want to be left to peacefully die. I would not want tubes down my throat, machines keeping me hanging on or people jumping up and down on my chest.

Mandi

[suzanne4, RN]

:uhoh21: It is a scary thought to think that a nurse would even consider doing mouth to mouth on a patient. Who is going to be there for you IF you actually caught something from that patient and they were no longer around for you to prove it. Why doesn't your facility provide appropriate equipment? In the US it is against OSHA standards not to provide protective gear for the staff. The facility can actually be fined.

And for the staff that worked the facility without a staff person and not knowing where emergency supplies are kept: "Shame on you." It is your responsibility to know where those things are at all times, first thing that you should find out when starting your shift. I worked agency for most of 25 years and never would even consider being on a shift without knowing how to page for an emergency, and where supplies and crash cart were kept.

Plain old common sense..............................

[Gompers, BSN, RN]

AHA did recently say compressions alone can help because it pumps oxygen rich blood into the brain...or something like that. The crash cart would be there very soon..then they can start ACLS.

Yep, when I recertified in January my instructor reinforced that information. Whether in the hospital or community, you are NOT liable if you refuse to do mouth to mouth, so long as compressions are being done.

p.s. SOOOOOOO glad to work in an ICU where each patient has bedside suction up and running, with an ambu bag connected to O2 right behind the bed. But even if these malfunctioned, we all are assigned to check the cart often enough (it's checked Q shift) and the Omnicell is pretty organized, so it would only take a minute to grab new equipment.

[kids]

I could be held negligent for driving by an accident and not stopping to help (if someone saw me and knew I was a nurse).

I know that "Good Samaritan" laws vary from State to State but it has always been my understanding that as a nurse I am under no obligation to render aid when off duty in the community.

It is also my understanding that if I do choose to render aid that the "Good Samaritan" laws protect me ONLY as long as I do not exceed the level of education available to a lay person via CPR and First Aid courses offered in the community.

[critcarenurse16]

One of the hospital I work in the standard procedure is you MUST do mouth to mouth, unless there is a high risk of infection, such as TB or HIV.

I think it is assumed as this in most UK hospitals... I have a face mask that fits on my key rings just in case!!

whisper

Our hospital has face shield at the head of every bed. In our ICU we have our cart stocked with ambus on the side but also have ambus at the HOB as well for each pt. I personally would not do mouth to mouth even with the face shield- to flimsy and not an effective barrier if the pt vomits. We follow current guidelines from the AHA stating compressions are enough initially. We just never got around to taking down the face shields from the HOB.