"Limited Resuscitation"

Beary-nice · Jul 21, 2006

Our patients who are "limited resuscitation" are patients who want CPR but not to be intubated or sometimes not intubated or defibrillated. Don't know if that is what it is like all over but that is what it means at my place of employment. We don't even have armbands to denote "Limited" which is kinda asking for a problem.

TazziRN, RN · Jul 21, 2006

Chemical code only

rninme · Jul 21, 2006

Every patient admitted to our facility has to have a code designation....full code, DNR, or a code limited to: meds, cpr, airway with no intubation, defib. The doctor checks the boxes next to the limited to....whatever the patients or family's wishes are. We pass it on in report. We don't have armbands for code status nor do we designate it in anyway in the patient's room.

SilentfadesRPA · Jul 21, 2006

Fluids and IV medication only

Marc

tridil2000, MSN, RN · Jul 21, 2006

Fluids and IV medication only
Marc

the american heart association, who sets the standard for resuscitation, condems this practice. it is completely negligent to push epi and not to compressions. you're interventions, or lack of, are cancelling another right out.

anything less than the works is a not resuscitation and the one running it will be held accountable to acls standards.

the ONLY exception, and really it is a clarification, is for the COPD pt who may need to be intubated during times of resp distress. that is NOT resuscitation but intervention to avoid a resuscitation.

tvccrn, ASN, RN · Jul 21, 2006

the american heart association, who sets the standard for resuscitation, condems this practice. it is completely negligent to push epi and not to compressions. you're interventions, or lack of, are cancelling another right out.
anything less than the works is a not resuscitation and the one running it will be held accountable to acls standards.
the ONLY exception, and really it is a clarification, is for the COPD pt who may need to be intubated during times of resp distress. that is NOT resuscitation but intervention to avoid a resuscitation.

However, a code status is whatever the patient says it is. If that is fluids and IV meds only, do you override the patient's wishes because it's ACLS protocol?

tridil2000, MSN, RN · Jul 21, 2006

However, a code status is whatever the patient says it is. If that is fluids and IV meds only, do you override the patient's wishes because it's ACLS protocol?

then their doctor needs to educate them on what works and what doesn't.

a pt, or family, could sue you easily when they turn around and say "no one told me THAT" ....

when pop survives after 3 runs of epi, but he's brain dead!

remember, you're the trained and educated one. you know better. you're held to proper standards, and the court will say the lay person didn't fully understand the implilcations.

call your bioethics committes on these 'gray dnr statuses.'

TiffyRN, BSN, PhD · Jul 21, 2006

Limited resuscitation varies patient to patient and is determined by each physician, patient and family. In my experience it is a way to alleviate family guilt; and completely pointless. Most of the time the family changes their mind when push comes to shove. Their ambivilence is already reflected by their wanting a "limited code".

soliant12 · Jul 22, 2006

What a bunch of gobbledy goook you are either a full code or no code all of this other inbetween stuff is a bunch of nonsense.

tridil2000, MSN, RN · Jul 22, 2006

What a bunch of gobbledy goook you are either a full code or no code all of this other inbetween stuff is a bunch of nonsense.

i agree and so does the aha.

Dx: spinal cord injury

would you like the steriods but not the stabilization surgery?

it's not burger king.

you're either going to be revived FULLY or not at all. no one should suggest to the pt, or family, that some things can be done and not others. to do less than a full code on anyone who does not want to die is unethical.

resuscitation includes a, b, and c. no one, and certainly no literature, supports deciding at any given time that 'well you can just skip a for this person."

steelydanfan · Jul 22, 2006

Tridil2000 raises a fascinating point. We also have the "checklist".

And quite often, patients and the family don't seem to understand the implications, despite our best efforts. Most often, it seems that families express the pt.s wish to avoid the "pounding on the chest scenario".

I often feel they choose "limited code" because they want SOMETHING done, in order to not feel as if they are not abandoning the patient. It is up to us to educate the families at to what their decisions may result in. The problem often seems to lie in the information coming from the physcian, who feel the need to present all possible scenarios to the family, regardless of the benefits.