LTC CPR on pt with rigor mortis and lividity

icunurse42066 · Sep 22, 2008

One morning I went to work and 30 min into the shift, we found a pt with rigor mortis, and lividity - why would the DON tell us to do CPR? I felt like a complete idiot when EMS showed up.

2 reasons.

1) The DON didn't know what they were doing, or

2) The pt wasn't a DNR and the DON wanted it to look like they were doing something about it.

May be another reason, but those two came to mind first.

ohmeowzer RN, RN · Sep 22, 2008

if the pt was a full code you have to code the pt even if they are very umm ... gone....

mondkmondk · Sep 22, 2008

Perhaps the patient was a full code...which means you HAVE to do CPR despite the obvious fact that he/she has been gone for some time. I know this is probably against a rule....but if we did bed check at night and I knew the resident had been "gone" a while...we would look up their code status and if they were full codes, we would call EMS, but not start CPR until we knew the ambulance was on its way...just so they could document that we did follow the code orders, KWIM?

Blessings, Michelle

Trauma Columnist · Sep 22, 2008

Can I ask why you would do CPR on an obviously dead person? That doesn't even make sense to me....

Atheos · Sep 23, 2008

Can I ask why you would do CPR on an obviously dead person? That doesn't even make sense to me....

Doesn't it come down to who can call time of death? I have been places where they had to do CPR until EMS came if the patient was a full code no matter what.

Babs0512 · Sep 23, 2008

DNR or not, you don't do CPR on a pt with rigor mortis or lividity. They are way too dead to ever come back. That's just ridiculous.

:twocents:

icunurse42066 · Sep 23, 2008

Doesn't it come down to who can call time of death? I have been places where they had to do CPR until EMS came if the patient was a full code no matter what.

Could be, never thought about that.

Atheos · Sep 23, 2008

Could be, never thought about that.

It's just what I have seen and been told. Never have seen it written down anywhere. As to ridiculous, I see nurses do ridiculous things everyday. We'll not speak of my ridiculous things...

icunurse42066 · Sep 23, 2008

It's just what I have seen and been told. Never have seen it written down anywhere. As to ridiculous, I see nurses do ridiculous things everyday. We'll not speak of my ridiculous things...

Let's not get into our personal ridiculous moments!!LOL:chuckle

robred · Sep 23, 2008

One morning I went to work and 30 min into the shift, we found a pt with rigor mortis, and lividity - why would the DON tell us to do CPR? I felt like a complete idiot when EMS showed up.

Please give a copy of the American Heart Association/ECC guidelines for Withholding and Withdrawing CPR to your DON. They can be found here:

http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-6

I'm sorry this happened to you.

J.

flightnurse2b, LPN · Sep 23, 2008

One morning I went to work and 30 min into the shift, we found a pt with rigor mortis, and lividity - why would the DON tell us to do CPR? I felt like a complete idiot when EMS showed up.

she was probably trying to cover her rear and did not know what else to do, as im assuming the pt was a full code?

ideally, if a patient in an LTC is not a DNR, the LTC staff initiates BCLS procedures until an ACLS EMS unit arrives. usually we like to get them to the hospital ED to get the doc to withdraw CPR and call the time of death.

depending on the circumstances though, a paramedic in the field can pronounce time of death without initiating life saving intervention, if there are visible signs of irreversable death, such as you described. also, the DON, who i am assuming is an RN or LPN, can make the assessment, if the patient is a full code, to withdraw life saving intervention for the same reason.

i guess the real question here is.... was the pt actually a DNR???