OF mega codes and AED's in LTC...(kinda funny!)

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Specializes in Education, Acute, Med/Surg, Tele, etc.

So, I am crazy..LOL! My hubby, who is a paramedic, and I (I am a floor nurse at an assisted living...one nurse per shift for all 160 patients!) take ACLS together every two years...kind of like a 'date' so we can work together and see the differences in our jobs and find new respect for eachother (after 2 years, the nurse vs paramedic thing starts up a bit..LOL!). We really enjoy this time, even though I once knew this stuff like the back of my hand *SIGH*, and now a days feel like a total doofus:uhoh21: ! LOL!

So here I was, actually shaking as I entered the MEGA CODE. For those that have never taken ACLS, this is when you must be a leader for a code, and they throw you some pretty scary cases. You are not just responsible for CPR and AED/Defib, but the entubation, iv, meds (stating how much, how long push, etc). Okay..hi I am a floor nurse for an assisted living facility..not like I am running around tubing folks and doing IV's...but I was going to give it my best! (my answer to v-tack was "funny little squiglies" and normal sinus "more familiar funny little squiglies"...LOL!:chuckle ).

We got an EXCELLENT ER MD that oversaw the mega code. A pure blessing! He would ask what you do and make the situation according to what you really would see or do! So here I am...around ER nurses, cardiac nurses, paramedics..then little old me! LOL! They are going off on all the meds, tubing folks like pros (well the nurses got a bit hung up..but they don't do it all the time like the paramedics do)..and then it was my turn......LOL!!!!

SO I am asked, so what do you do...and I looked around and said "comedy relief!". I explained that I work in a assisted living facility that despite nurses pleas will not get an AED...and to be honest...he could give me a patient and I could honestly say "I would call 9-11, find the polst, and do CPR PRN". So he was so cool, said.."okay...lets pretend that your top administrators mother was just saved by an AED and you got one at your facility...lets go"...

It was still a comedy after that...I went into how I would have to get the AED which was in the middle of my facility, if even put back, that was located at the direct opposite of my location and down stairs. I would run and dodge walkers and wheelchairs the whole way, jumping over them like a clutzy gazelle, get it...do the same thing again...get the thing attached..and oh my...POLST, DNR...LOL!!!!

We had a good laugh, but really...I did okay. Memorized the algorhythms well so I knew what to give when despite never having to do it! But my mindset...at least I know, and can assist in situations where I may be the only other one there (please GOD make sure I am not alone with a ACLS kit!!! LOL!!!!!! OH that poor patient..broken teeth from tube placement will be the least of their probelms when I am done..LOL!).

Oh yeah...I aced :)..whew..I was really nervous!!!

So, this leads me to a question... do you feel that all facilities, even LTC and Assisted livings should have AEDs? (not necessarily a code cart...but at least an AED!). We discussed this as a class at length..and we all feel that it should be there..heck, people may be DNR...but are all staff DNR???? OR family visiting???

What do you think, and should it be mandatory that all medical facilities have one???

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Yes, mandatory in all facilities. Shoot, they have them in Wal-mart, airplanes and you can buy one for yourself on-line. They are so common, it's a crime not to have them in LTC facilities and assisted living areas. With all the money some of those places get, they can at least buy an AED

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Absolutely...schools have them in the hallways and available at sporting events. Not just for spectators, but for the rare sudden death of young athletes. Not that it happens often, but once is enough.

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We have them in churches in schools...why not LTC? I'm going for my CPR recert tonite...

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Good luck with your recert! I really think all facilties eventually should have one handy, but wow...really think an assisted living facility that is so large with medical staff should have one, heck...MD offices have them too!

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Specializes in Skilled nursing@ LTC.

I'll tell you this... I work at a ltc that for many years was "no code". Within the last 18 months they have put crash carts on the floors and trained all the staff (housekeeping, maint., laundry, dietary- not just nursing). We have used the crash cart one time...on a family member who had a heart attack in an elevator. They were able to revive him and he still comes to visit every day. Administration needs to remember that the residents are not the only ones in the facility.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

You nailed it LPN! This is exactly what I told my admin and they just turned away without comment (couldn't prove me wrong..must have upset them!). I mean heck...I will certainly want one if I was to need one!!!!!! Staff and family members need them present too, and not all my paitents are DNR or they can change their mind!!!!

They also made the choice not to train CNA's in CPR anymore and I was quite upset!!!! I told them, what will happen if I ever had two emergencies at one time...with only one nurse I can't be two places at once...they said that would never happen (also resuggested the AED deal in this situation too!).

WELL GUESS WHAT!!!!! Happned this weekend!!!!! First time in history of my facility. I was called to one end of the facility (huge facility) for a chest pain with altered consciousness, and just as I closed a chart to go running there, another...blue and not breathing in the absolute opposite end of the building!

Blue won my attention by my triage, but I called 'any caregiver that has CPR experience please report to room ___, if the situation is serious, call 9-11 immediately do not wait for my arrival!!! Stablize and keep me up to date on the walkie". Then I ran to the room with the blue one...yep, shallow breaths at 44 pulse ox at 45%, starting to loose consciousness (I was suprised she was conscious!!! But she was able to answer YES!!! when I asked her about 9-11 intervention, IV's and potential entubation! I mean she said YES!!!).

9-11 was activated, they got there started handling that case, I gave them a print out a sweet caregiver got for me with all her current meds and the POLST, and ran off to the other room. Lucky for me the gent was on his second nitro and was doing fine...just some angina! So across the entire facility again I ran to help paramedics and answer their questions.

I was exausted and still had 6 hours left of shift. Thank GOD my caregivers had their CPR still from last year or I could have been sunk! My caregivers for the blue lady were smart and remembered to sit her up, establish airway and then go on to B and C!!! (Great gals!!!!). We saved the lady..and she will be returning home in a few days from the hospital..but they said 10 more minutes and it would have been a very different situation!!!

WELL...go figure...all the administrative board was present during this time, and my manager!!!! WOW..never will happen huh!?!?! They asked me what was going on and I said I could only tell my direct supervisor (the others are not medical and more board for the franchise) and told her within earshot of the board..."I am good at emergencies, that is why you hired me...but in no way can I ever be this good. We need to fix this, I almost had to choose who lived or died because I couldn't be in two places at once...I couldn't live with myself if that happened!"...

Hey, maybe I will get the CNA's their CPR class, and maybe...just maybe an AED...but heck...knowing them I still won't..but I will still hope!!!!!!!

Heck...bet I would have both if it was a board memeber that was in trouble!!!!!!

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Specializes in Hemodialysis, Home Health.

Wow... they should ALL have CPR training and annual refreshers..regardless. How absurd not to !

Good triage, and good save ! :balloons: What an experience, huh? :uhoh3:

I presume your facility thinks they are saving a few $$ by foregoing the CPR training for the CNA's and others.. but when that first lawsuit hits, they'll be wishing they hadn't been so stingy ! :angryfire

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Yeah..and my luck, despite my suggestions..that one lawsuit will be my patient and I will be the sacrificial lamb...uhhhgggggg!

Guess that is why I document my suggestions at home by typing them up on my computer....at least I have them dated :)

Thank you very much for the cheer...that was one heck of a call..and well...I am surpised I did as well as I did! Guess I do have it in me somewhere to be able to handle it...I just forgot..LOL!

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Specializes in Hemodialysis, Home Health.
Yeah..and my luck, despite my suggestions..that one lawsuit will be my patient and I will be the sacrificial lamb...uhhhgggggg!

Guess that is why I document my suggestions at home by typing them up on my computer....at least I have them dated :)

Thank you very much for the cheer...that was one heck of a call..and well...I am surpised I did as well as I did! Guess I do have it in me somewhere to be able to handle it...I just forgot..LOL!

Good for you. I hope it never occurs again, but knowing that you pulled it off and did WELL must be a real confidence booster! Kudos to you ! AND your aids !

Always good to document these things along with your suggestions.. you just never know...

And this facility certainly SHOULD purchase an AED !!! How ridiculous not to. :stone

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