LTC CPR on pt with rigor mortis and lividity

Nurses General Nursing

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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.

Specializes in Ortho, Case Management, blabla.

Gross :crying2:

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The Code of Virginia 54.1-2972 (B) states that a Registered Nurse may pronounce death if the following criteria are satisfied: (1) the nurse is employed in this Commonwealth by a home health agency, hospital, nursing home, state-operated hospital, or the Department of Corrections; (2) the nurse is directly involved in the care of the patient; (3) the patient’s death has occurred; (4) the patient is under the care of a physician when death occurs; (5) the patient’s death has been anticipated; (6) the physician is unable to present within a reasonable period of time to determine death; and (7) there is a valid Do Not Resuscitate order for the patient who has died. The nurse shall inform the patient’s attending and consulting physicians of the death as soon as possible.

This sounds to me that if the death isn't anticipated that nurses must continue CPR and CANNOT pronounce death... Of course this is only Virginia.

I still can't find anything saying one would have to START cpr...

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Specializes in ob/gyn med /surg.

well , i have seen some horrible codes in my 23 years , the policy of the hospital where i work is if the pt has a full code status and they are dead we run the code...

we found a guy dead about a week ago and he was really dead , we called the code and did cpr and intubated him and did of course he was still dead... the daughter came in and was very angry that he died because she stated " i was just talking to him 2 hours ago" and what did you do for him?? i was in charge of course and i was the one who found hm ... just my luck.. she was upset .. of course he was only 47... she started yelling.. did you do all you could for him??? or did you just let him die?? i explained to her yes we did cpr on him ( i know i was the one who started it and cracked his ribs) and ran a code,and i am sorry he passed away.. she then calmed down and went into see him after we cleaned him up...

in all the hospitals i have worked in .. and thats alot in all these years.. there has always been a policy that if a person is found down and there is a code status we do code them ... you have to show that you did something for that pt..

i've done many slow codes.. where we go through the motions , esp if the pt is old , well i mean elderly or really sick .. in one hospital i worked in we had a over head page " dr heart please walk slow to room 466 " ment a slow code.... not that is not done anymore ... ever ..

it's just a policy .. i would really ask the nurse why she did it and is it a policy.. i am sure she will tell you ,,, it makes since to me i would of done CPR on the pt..

find out your hospital or nursing home policy on the running a code policy....

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Specializes in ob/gyn med /surg.
The Code of Virginia 54.1-2972 (B) states that a Registered Nurse may pronounce death if the following criteria are satisfied: (1) the nurse is employed in this Commonwealth by a home health agency, hospital, nursing home, state-operated hospital, or the Department of Corrections; (2) the nurse is directly involved in the care of the patient; (3) the patient's death has occurred; (4) the patient is under the care of a physician when death occurs; (5) the patient's death has been anticipated; (6) the physician is unable to present within a reasonable period of time to determine death; and (7) there is a valid Do Not Resuscitate order for the patient who has died. The nurse shall inform the patient's attending and consulting physicians of the death as soon as possible.

This sounds to me that if the death isn't anticipated that nurses must continue CPR and CANNOT pronounce death... Of course this is only Virginia.

I still can't find anything saying one would have to START cpr...

this policy is pretty much a standard i think ... this has been pretty much been the polciy of hospitals i have worked in utah , nevada and utah...

well running a code is cpr you hae to start doing something while someone gets the crash cart , i always start cpr,, in the end the er doc or i pronounce if there is an order for RN to pronunce.. I only pronouce if the box is checked for RN to pronouce...

i am so glad you found this... this may only be for va but it is pretty standard... awesome:yeah::nurse::bow:

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Our policy is that if they are full codes you do CPR, unless they are rigor or have mottling. In MI RNs can call time of death.

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Specializes in Rehab, Infection, LTC.
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:

I agree!

However, I had this happen to me a few years ago. Patient was a full code. When he was found he was really really really dead (like the witch in oz, lol). I felt CPR shouldnt be started because of obvious rigor mortis. I pronounced him dead, called the doc on call and called the funeral home to pick him up.

Few weeks later the family's attorney sent a letter wanting his chart. It was a mess!

so now...if you die, i dont care how dead you are...if you are a full code, i'm coding your butt. it may be a "slow" code by by golly i'm doing it.

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Specializes in HH, LTC.

This makes me CRAZY!!!!! it is the same at my job. if they are full code we have to start cpr no matter what!!!! even if they are stiff and pooling until EMS comes. Yes I feel like an idiot because obviously it is not going to do any good and just abuse the corpse and waste a lot of time but that is the way it is. When I first started I did not know this and a few we found already dead and GONE and so I just calle the family and the mortuary and it was fine but then we had an incident and I was informed of the policy!!! If they are a full code we start CPR No Matter What..... STUPID. I can tell when someone is dead dead.

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

I completely understand. I've worked 13 yrs in the hospital and thats the way it is.

Iv'e been in the NH for 5 mos, and we are told to do CPR on an obviously dead person because she is a full code. I've never heard of it either. I thought maybe the LTC nurses could explain why this is,

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

Yeah, I'm new to the NH and this doesn't make sense to me either. I've never heard of it in 13 yrs of hospital nursing. Even tough the pt was a full code.

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We are told that we still need to do CPR. I would refuse to on an obviously cold, dead and rigored resident. They are like family to us LTC staff and I couldn't abuse them like that.

IN PA we prounounce too.

Now...if it is iffy on time of death...yep...we are starting CPR.

Why it is like this in LTC?? I dunno. Maybe CPR is the first and just about only thing that can be done in the LTC setting and people feel that we "must" get it started if there is any hope in saving the life and being sent off to the ER so a TV code can be done and the person will wake up and be okay (like on TV) and if it isn't done...well, the person died in the LTC because of that.

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Specializes in Geriatrics.

Here in Massachusetts, we have a new law that states we do not have to do CPR if the pt is in rigor, pupils fixed & dilated, pooling of blood, another words if they are undeniably dead. Even if they are a Full Code. Even an LPN is allowed to make this determination, you just have to chart everything from body condition to lack of life signs. This is a good thing as we have many pt's who are over 80, have many comobidities and family that refuses to make them DNR's. The sad part is that I would have had to attempt CPR on people who really would have no chance to survive. This does not mean that I would withhold CPR if I find them before the guide line have been met, just that I would not have to try to revive a pt who is already talking to St. Peter.

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Specializes in neuro, critical care, open heart..

This reminds me of a code I worked on a pt as an orderly several years ago. They called a code 99 to this room. When we walked in, the pt was in the semi-fowler's position and when we laid the bed flat, he STAYED in the Semi-Fowlers position!!:eek: So, we did CPR for about 10 seconds until the attending walked in on called it! Even as an orderly, I could have pronounced this pt.

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