"Thumping" out the door....?

[optimist]

Ok so Im in SNF. We had a code today. By the time we get to the room with the crash cart its obvious we're too late to do any good but because she was a full code we jumped in (or on) full steam ahead until EMS can get there.EMS rolls in, hooks up the monitor....flat line. They shock...nothing. They do all they could possibly do but like I said, it was obvious we were too late. So then they hook up this thing they called the "Thumper" that performed mechanical compressions and was basically hands-free CPR. They prepared her for transport with this attached and loaded her into the truck. My question is, why did they continue these compressions when it was clear that she was gone? My first thought was that perhaps it was to keep the circulation going in case she was a doner. But if that were the case wouldnt they be bagging her also? and are the elderly with multiple chronic diagnosis even eligible to donate? It was just disturbing watching this little ole lady convulse as shes being pounded on leaving our facility instead being treated gently in her passing.

[caroladybelle, BSN, RN]

EMS rigs have radios. Call the doc on the radio?

And most will not pronounce a body until they personally assess it, due to liability issues. Calling makes no difference.

Even in facilities/states where nurses cannot pronounce, even a DNR. Time of death is when the MD says it is, even if that is after hours waiting for him- some will use the time that nurse marks it out, but others won't.

Please also recall a recent incident, where someone that was pronounced by EMS, was found alive in the morgue.

Many MDS prefer in court, I saw this, not I took the EMTs word for it.

[casi, ASN, RN]

My question for you is why DID YOU even start CPR and call EMS in the first place? Ambulances CANNOT transport dead bodies so if they were not going to continue efforts they would have had to leave the dead body with your facility.

Because if you don't start CPR and call EMS on a full code there are a lot of unfortunate legal issues a nurse could run into. If medics were able to pronounce on site SNF could and would happily handle getting the body released to the mortuary.

[akulahawkRN, ADN, RN, EMT-P]

Because if you don't start CPR and call EMS on a full code there are a lot of unfortunate legal issues a nurse could run into. If medics were able to pronounce on site SNF could and would happily handle getting the body released to the mortuary.

Where I'm at, a medic can determine death... and then Law Enforcement can be called as some can legally pronounce death or they need to at least determine the circumstances surrounding the death, to be certain that foul play is not involved in a particular death.

Some EMS systems have a dedicated procedure for the appropriate disposition of deceased persons...

When it comes to someone being determined dead only to be found to be alive at the morgue... When all the appropriate procedures are followed, that would be exceptionally rare.

And yes, withholding CPR on a Full-code... could be bad for you...

[~Mi Vida Loca~RN, ASN, RN]

I just had to add that those auto pulse machines are horrific looking in progress. I think that was the name of the machine, I can't remember. I hear they are quiet good and accurate but man they seem super rough.

[hiddencatRN, BSN, RN]

EMS cannot decide when to pronounce a patient.....that will be up to the doctor at the hospital. I once rode with the ambulance and we pulled a very dead body from a pool......the body went on the thumper until we got to the hospital.

In my state paramedics can call medical command and get the go ahead to pronounce on the scene in certain instances. The physician might tell them to continue to work the code and transport to the hospital or the physician might tell them to cease resuscitation efforts. There are also a few specific situations where EMS can declare a patient deceased without having to call medical command first.

[psu_213, BSN, RN]

It was just disturbing watching this little ole lady convulse as shes being pounded on leaving our facility instead being treated gently in her passing.

Sorry if this comment offends anyone....just soemthing to remember when someone is a full code at the end of their natural life...

[geekchic]

In New Jersey Paramedics can declare on the scene but once CPR is started by EMS (that is to say EMT-Basics) CPR cannot be stopped because that would be patient abandoment.

[akulahawkRN, ADN, RN, EMT-P]

In New Jersey Paramedics can declare on the scene but once CPR is started by EMS (that is to say EMT-Basics) CPR cannot be stopped because that would be patient abandoment.

Here's a prime example where states can be very different. A couple counties that I'm familiar with (and most probably are similar here) in California, once CPR starts, yes, you do keep going... but once the Paramedics have run the code for 20 minutes, they can determine the patient deceased and stop all resuscitation efforts. The patient often remains on scene. If EMT-B's start CPR on a patient that is later found to have a valid DNR... the EMT's can stop. If the providers become too exhausted to continue CPR... they can stop (that'd be pretty rare though). In those cases, abandonment is not an issue.

Coroners and Deputy Coroners (who often are also the Sheriff and Deputy Sheriffs) can legally pronounce death. Paramedics and EMT's can determine death on their own, under specified conditions, but an actual pronouncement of death must be done by either a Physician or someone duly authorized via the Coroner's Office... who may have less training/education than the EMT-B.

My understanding is that Hospice RN's can also determine death and set the appropriate events in motion for disposition of the body, but prehospital personnel won't likely deal with those situations very often because of the nature of Hospice... unless someone panics and calls 911.

[Anna Flaxis, BSN, RN]

My questions are

1) Why in the world are they shocking asystole?

2) Why is a LOL living in a SNF even a full code????

[CT Pixie, BSN, RN]

My questions are

1) Why in the world are they shocking asystole?

2) Why is a LOL living in a SNF even a full code????

I'm assuming you never worked SNF. You'd be surpised at how many of the residents are full codes. Of 32 residents, 17 of mine were full codes!

To the poster asking about why 911 would be called, In LTC/SNF if a resident is full code..we HAVE to initiate CPR and call 911 regardless of us knowing they are gone or not. Sadly, even if we come upon a full code resident who is stone cold, with all the other signs of death, we STILL must initiate CPR and call 911 Our EMT's and medics must continue CPR and transport.

There are only a few reasons a medic can pronounce death..obvious rigor, burned beyond recognition and decapitation..(those were the only ways a medic could pronounce during my time as an EMT in the early 2000's in Connecticut, I could be mistaken but i don't believe they have added any other reasons)

[Anna Flaxis, BSN, RN]

It was a rhetorical question, Pixie. What also gets me are the Limited codes who want drugs but no compressions or shocks.

[~Mi Vida Loca~RN, ASN, RN]

Ok I am finally asking. What is LOL referring to in the medical world?? I have wondered for well over a year and asked someone and they didn't know either.