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One of the scariest things I've seen as a CNA is an emergency occur with a resident and the nurse looking dumbfounded and lost. I am going to be an LPN in a few short weeks and plan to work in a Nursing Home (preferably on an Alzheimers unit, I
If a patient is having trouble breathing, not breathing (and it's unrelated to choking- where obviously you would preform the heimlich and reasses from there), having what appears to be a MI, is unresponsive.. what do you do?
I know first I would check for a pulse/preform CPR if needed, and call for the house manager/unit manager or whom ever is looking over the nursing home at the time... but then what? Should I wait for him/her to show or should I be dialing 911? I have seen emergencies like this happen and the nurses on the unit become frantic and just don't know what to do and I believe if they had a clue before this rare situation occured that residents would have better outcomes.
*I am not asking if I should dial 911 before or after I start CPR. I am asking WHEN is it appropriate for ME to have the call placed. Before the Unit Manager arrives or after.
You said you were going to be an LPN in a few weeks? Are you certified in CPR yet? ( I ask because when I went to LPN school it was done in the last week of school). If you are already certified, the answer to your question is in the BLS protocol. If you follow it there isn't any step in there about waiting for the house supervisor!
I second the folks who said to check the code status, especially in LTC. If you would feel more comfortable and you don't know the code status, go ahead and have someone call 911, but PLEASE, PLEASE, PLEASE assign someone to find out the code status ASAP (and if it IS a DNR, let EMS know and CALL THEM OFF)! I work with some families who would be VERY upset if their loved ones had to go through having their sternum cracked (by chest compressions), an ET tube shoved down their trachea (by EMS), shocked with electricity (AED and/or EMS), and needles stuck in them everywhere (EMS and/or ER). I know _I_ would be upset if that happened to MY loved one after I made sure to complete all the necessary paperwork to ensure that their end-of-life wishes were honored.
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Call Supervisor, check the resident's code status; apply O2. I know a couple of incidents when the nurse performed CPR and the resident was DNRCC! Of course if they are a full code you would start the CPR and call 911. Some facilities have their own ambulance service. Working in the same unit will allow you to know well their medical history.
To Harmonpa: Check out the "Long Term Care" specialty area of this site for a lot of feedback. As someone who went from hospital to LTC, it is VERY different. There are some good things and some bad things, just like with every job. Just make sure if you go to LTC that you like elderly folks! :-)
Let's set up a scenario - say diff breathing.
Assess patient, apply 02, while I do the transfer paperwork CNA gets the vital signs, call report to receiving ER, call 911, stay @ bedside to report off to medics. May call 911 first if serious situation. Please note that our EMS squad is 5 blocks away.
Dixiecup
659 Posts
I have worked in LTC for years. We do not call 911 for DNR's