OMG! *I* cannot pronounce death but a paramedic can????

  1. Oh wowwww....forgive me for FREAKING OUT, but I know some (or ALL??) of my fellow nurses will understand my stress, shock and amazement!!! I experienced my FIRST death of a resident withOUT a DNR tonight and I still can NOT believe this!!! First, I have to explain, his death was SOOO unexpected, NO warning signs, etc!!!!!!!!

    To make a long story short (I'll TRY....LOL!!!)......I knew he was definitely DEAD, and as I called my DON to report it, she said we HAD to begin CPR since there was no DNR. Trust me, I did already (kind of) know this, and I've talked to SOOOO many experienced LTC nurses about this, and many explained the term "slow code", etc.....Co-workers (I wasn't there!) recently had a HORRIBLE experience with an emaciated, cancer-riddled resident who refused to sign a DNR, and a new grad was absolutely traumatized when she heard ribs cracking during the CPR, when the resident was CLEARLY already dead. She said the paramedics wanted to cease the CPR, but she yelled at them and said she was NOT losing her license over it, so I'm pretty sure the paramedics took over.....Why didn't they just pronounce the resident dead like the paramedic who did that for us tonitght?? can EMTs also pronounce?

    ANyway, as we waited for the paramedics, the other nurse and I totally agreed that starting CPR was LUDICROUS.....but we started placing the board, setting up suction, etc. Thank Goodness the police officer who arrived WAY before the paramedics totally understood why we were NOT actually going to dishonor this sweet person's body by
    starting compressions and breaths. I was SO torn on what the RIGHT thing to do was.....I figured legally, in a courtroom, I / we could get in HUGE trouble if we never actually did CPR.????? (could we?)

    The paramedics arrive, and they pronounce him. I had NO idea paramedics could do that!?!"!?!???!!! And not the two of us LICENSED NURSES can do that????? (I'm an RN, my coworker an LPN).........

    Aside from all the emotions and my stress level---again, this was my FIRST death, was kiiiiiinda stressful!!!.......It ticks me OFF that a police officer and THREE Paramedics/ EMTs had to waste their time, wear and tear on their vehichle, gas, etc....when if I or my coworker could've just prounouned him, call the doc, call the fam, do post-mortem care, call the funeral home, etc......WHY make the paramedics/ EMTs come out???? What if someone else needed them WAY more than this resident did?

    I'm just blown away....and, hate to say it, but the waste of our time with all the PAPERWORK that the Paramedics need?!!???? They're not even taking him with them......also, legally, if WE had to start CPR, why didn't they have to continue?

    My other concern and I'm also so curious........**IF** we had actually done CPR, his body would be so bruised, ribs possibly broken, etc. How on earth does the mortician handle all of that for viewings (if that's what the resident wanted?) What if the ambu bag broke some of the bones on his face? I know they do all kinds of makeup and have prosthetic implants to make the cheeks / neck, etc look nice if they;re traumatized by CPR, etc.....? How do they get the hands to look folded and peaceful if CPR was done and the arms are bent out to the side, etc? Rigor Mortis had already begun in this man's jaw when the paramedic pronounced him----can you imagine what damage the ambu bag would've done???

    I appreciate stories/ experiences/ thoughts/ etc.......Also curious ( I know things vary by STATE!!!), where you work, does the doctor require you to tell them WHO pronounced them dead? Does it always have to be a paramedic? What if we'd found him even later and there was more rigor mortus? Do they still require us legally to begin CPR since there's no DNR? Seriously????

    Can an LPN/ RN pronounce death where you work and avoid the WASTE of time having the paramedics and poilce come out? Does a police officer always have to be at a death? Thanks! ***oh em gee, wonder if I'll EVER get to sleep!!!****
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    About nervousnurse

    Joined: Jan '04; Posts: 292; Likes: 246
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  3. by   Silverdragon102
    Check facility policy as well as state code of conduct. I know here in Canada I can verify someone is dead but the death certificate can only be signed by a NP or MD
  4. by   Esme12
    I am on the run...I will be back. Get some sleep this is one of those grey areas.....however if someone is clearly deceased CPR is not indicated and medics can decide to pronounce/indicate code not is made official by the coroner. Some stated allow nurses to pronounce. Morticians put together accident victims for viewing.....with makeup, fillers and other tricks and most people have their chests covered with clothing....((WINK)).

    This resident is at peace ...had a full life....we are there to provide care and comfort. The police does not have to be at every death. Take a hot bath......listen to some peaceful music. Watch and old movie.

    ((HUGS)) I'll be back to talk about options/policies later. GET SOME SLEEP!!!
  5. by   nervousnurse
    THANK YOU!!! I DO need a hot bath, and I have already read some celeb gossip to get my mind OFF of this! I have now
    been awake for 27 hours! I'm too hopped up to read what I posted before, but if I didnt say it, I KNOW this young person
    (56) is at peace and having a GREAT time up in Heaven!

    I also HAVE to say, I really, realllllly respect Paramedics/ EMTS and I have ALWAYS said they do NOT get paid enough
    when they are the ones who are there when people are in their WORST traumas!!!!!!! I also realize Paramedics have
    WAYYYY more autonomy than we LPNs/ RN's do......!!! I know they can intubate and they can do allll kinds of life-saving
    things we cannot, (and I'm pretty sure without all the ORDERS that we have to have!!!!??) so I honestly respect that!
    I have a dear, dear friend who's been an EMT / Paramedic (she's never been clear on what her title is???) for years, and a couple years ago, she vented that she only makes
    years ago, she vented to us that she makes TEN dollars an hour?!?!?!!??? REALLLY!!!????

    Anyhoooo.....I also don't think I mentioned in my original post that once I finally LEFT the BUILDING and drove home, about
    10 minutes later, it finally dawned on me (thank you, Holy Spirit!) that he was at PEACE and having a GREAT time! And **IF**
    there is a lawsuit, gossip from coworkers, whateverrrr....even if I lost my license....I have total peace now.......It doesn't matter! I was NOT doing CPR on him, and that is THAT.

    OMG, now if I could only "get over" all the other horrible things I saw in the last 3, dietary personnel quitting in the middle of a meal, (the poor residents will get late/ crappy food---how sad!!), CNAS walking OUT within a few hours of their shift,
    Families demanding answers RIGHT Now!!!?? Resident with hardly ANY urine output for FOUR DAYS and no one has called the doc?
    Resident re-admitted after a new A/V shunt put in and only a few of us are checking/ charting the surgical site, changing the dressing, checking for bruit and thrill, etc.

    Oh em gee, it is just SOOO sad for these people!!! It is sooo depressing!!!!!! I sincerly LOVE many of these residents and only want the best for them, and sometimes, it is NOT possible!!!!!!. Lady with stage 3- going into stage 4 deccubs and I'm the only one giving Morphine before dressing changes......Resident actively dying and practically drowning in her own secretions, yet it takes hospice nurse almost 24 hours to get her suction set up, Atropine, etc...serrrrrrrriously????

    Yeaaaaaaaaa, lemme go into that hot bathtub now...thanks for "listening" .....
  6. by   ktwlpn
    It sounds like you need debriefing-maybe you could suggest that someone from the local emergency services come out to your facility and inservice your staff? This could be a great learning experience. You also should brush up on your policy and protocol-many of the answers to your questions should be found there.
    This has happened at out facility.CPR is initiated while someone gets the doc on the phone who then calls it. You won't go to jail for abuse of a corpse because this person had a romantic idea of CPR from watching too much TV, they wanted CPR. Ribs DO fx frequently in this population if you are performing compressions correctly but I don't think you could fracture bones in the face with an ambu bag. Bottom line -it's our policy that if the resident wanted CPR they get it.You can't let your personal feelings enter into this or worry about the wasted resources. If the resident is in rigor the doc is called and we are "slow coding" until we reach the doc and they always call it. This just illustrates our culture's view on death. I feel that we are partly responsible when our patients/residents keep making this choice for futile care. We need to educate from day one and the docs need to join in but they never do.That's everyone's job and it should start the minute someone enters a facility and you have to be graphic and explain exactly what the process entails.In my experience every time I have done that the family /resident makes themselves a DNR after they have thought it over for awhile.It is helpful for them to know they will be kept comfortable,too at end of life
    As for your hospice resident if the agency is not responding to the residents needs in a timely manner you can certainly call their doc (in my facility the hospice consults,the staff doc has the final say) You can't have a delay in treatment like that.Let your management know that you have a problem and advocatefor this resident .
    You can only do the BEST that YOU can do and not waste your good energy worrying about the decisions that others make.
  7. by   doppelganger2
    You do CPR even if they are cold and blue, simple as that. Have someone call the doc while initiating cpr and give them the situation and they will call it. You can't take it upon yourself to disregard the person's wishes. Because family members will ask questions and a response of we didn't even try wouldn't fly with most.
    All that being said I completely understand your situation and feelings. You just have to be able to cover yourself legally, especially in LTC situations and unexpected deaths.
    Best of luck you. Take a deep breath and try to relax
  8. by   CapeCodMermaid
    In Massachusetts, RNs can pronounce IF the person has a DNR and they are found pulseless. Once CPR has been started, we have to keep going until an MD tells us to stop or the EMTs show up and take over. Regardless of our feelings, we have to honor the resident's wishes. It was only recently that the Massachusetts BON and DPH decided we didn't have to do CPR on someone if they'd been decapitated.
  9. by   ClearBlueOctoberSky
    Quote from CapeCodMermaid
    It was only recently that the Massachusetts BON and DPH decided we didn't have to do CPR on someone if they'd been decapitated.
    This is truly disturbing.
  10. by   Glycerine82
    First of all there is a huge difference between a paramedic and an EMT. EMTS most certainly can't pronounce death. In my state only a medic or an MD can do that. Rns and LPNS cant. I know medics have much different training and school than RNs because of what they have to do.. MVAs wi th DOAs etc. At least thats how it works here. All the RN can say to MD is my pt has no pulse no resp etc and the MD has to pronounce them.....

    also have seen RNs doing slow codes on pts who were completley and totally dead....was horrible.

    Had medics take a 93 y/o cva with r side hemi who was a full code and had already died and do cpr all the way out the door. It was so awful. All I could think was she is going to be soooo ****** if you bring her back!!
  11. by   BrandonLPN
    I've always been confused by what people mean exactly when they say "pronounce dead".

    If I have a resident who dies a non-coded death I simply chart that I found the resident without pulse or respirations, I call the doctor for an order to release body, and then I begin all the other stuff like calling the family, calling the funeral home, post mortem care, etc.

    Never once have I ever involved a RN, or even another LPN, in this process, nor have I ever been told I was supposed to. From the moment I determine they're dead to the moment the funeral home picks them up, no RN or physician comes to "pronounce". I've always been the only licensed person involved.

    The offical "pronouncement of death" is when the physicain signs the death certificate. The time that I chart as having found the resident to be pulseless and breathless has always been listed as the offical time of death.
  12. by   Glycerine82
    Here in SC thats just what its refered to as. Only the MD can "call it" its as if theyre the onlynones capeable of verifying the pt indeed has no VS......
  13. by   BrandonLPN
    Quote from Glycerine82
    Here in SC thats just what its refered to as. Only the MD can "call it" its as if theyre the onlynones capeable of verifying the pt indeed has no VS......
    Right, but on 3rd shift there is no physician. Sometimes not even a RN. LPNs are often the ones who have to verify that the pt has no VS.

    Maybe we're not the one's offically pronouncing, but we're definetly the ones calling it.

    Or is this one of those "I dont't really assess, I just gather data" things?
  14. by   lindseylpn
    When I was in ltc any full code had to be sent to the er and pronounced by a dr, dnrs could be pronounced by an rn and then sent straight to the mortuary. If there wasn't an rn on duty then the ambulance or hearse would have to swing by the er to have a Dr pronounce before they went to the mortuary. If we had a patient on hospice their personal hospice nurse on call would come out and pronounce and then take care of all the mortuary arrangements etc.