Ready for full-code residents?

BBFRN, BSN, PhD · Jul 19, 2004

You should have everything you need on the crash cart (O2 equipment, meds, etc). If you don't feel prepared for a code, and are unfamiliar with the crash cart, you might want to consider ACLS certification- especially if you will be in charge of the code. Check with your local AHA or Red Cross- they'll be who you want to talk to about that.

BHolliRNMS · Jul 19, 2004

we have a crash cart on each nursing wing. We only initiate CPR until the paramedics arrive and they take over. If you know CPR, you should be fine. Play out the scene in your mind a few times and prepare yourself. It will happen sooner or later. Just plan, example, can you instruct a cna to call the ambulance? Is there another nurse there who can call the doctor for you? And brush up on what you will want to chart.

Long Term Care Columnist / Guide · Jul 20, 2004

The 'crash' cart in the LTC's where I've worked are a joke......equipment's outdated or missing, drugs are down the hall in the e-box instead of in the drawers where they might do someone some good, and half the time the 02 tank's either empty or it's been borrowed for another emergency. Believe me, LTC is NOT where you're going to run a real code.......that's why you call 911 and get the EMTs out there on the double! In the meantime, the CNAs keep compressions going and direct the paramedics to the scene while you manage the airway, make mental notes for documentation purposes, and pray you can keep the resident going until they take over. :uhoh21:

I HATE full codes in the frail elderly, anyway......I'm sorry, but I don't think we're doing them any favors by cracking fragile ribs and putting them on ventilators. Heck, I made myself a DNR right after the very first code I was involved in---the victim was a 90-something ORIF patient (fx hip) who weighed maybe 80# wringing wet, and she'd started going downhill fast right after the first couple sets of vitals were taken.

When she coded, her family and the surgeon were arguing over her full-code status; the family, of course, wanted 'everything' done for Mama, and the doc was going, no, this is a BAD idea, you don't want to put her through this etc. It was my luck to be on the code team that night, and CRUNCH! I must've broken every rib she owned on the first compression......I'd never done CPR on a real person before, and I wasn't prepared for the shock of it.

The family, however, REALLY wasn't prepared for it, and they immediately changed their minds when they saw what we were doing.....what a mess that was.

Destinystar · Jul 20, 2004

i will have to give you credit for making this a priority. it is always good to know what a persons code status is, especially if they dont look to good to begin with. make sure you locate your crash cart, cpr board, ambu bag, suction machine with all the connections at the beginning of each shift. find out who else feels comfortable with performing cpr. you can carry a mask. make sure someone calls 911 right away so you wont have to resucitate for too long.

i'm a new charge nurse in ltc, night shift. i wonder how ready i would be is something happened to a resident that is not a dnr. i am cpr certified, but, i don't feel this really prepares me for a real event. i should carry a list of my full-code residents in my pocket.
do you carry masks in your pocket? i would have to run down the hall to the med room to get one. a full-code could easily turn into a slow-code.

leslie :-D · Jul 20, 2004

oh marla, :imbar :angryfire :crying2:

what a nightmare! i assume this patient died? let's hope so.

anyway and what marla said, the crash carts in ltc are a joke. but it is vital that you do know who your dnrs and full codes are. and call 911 or whoever the facility is contracted with.

much luck to you.

leslie

Long Term Care Columnist / Guide · Jul 20, 2004

oh marla, :imbar :angryfire
what a nightmare! i assume this patient died? let's hope so.
anyway and what marla said, the crash carts in ltc are a joke. but it is vital that you do know who your dnrs and full codes are. and call 911 or whoever the facility is contracted with.
much luck to you.
leslie

Yes, she was, of course, dead when we started coding her, and dead she stayed even though we flogged her poor, weak heart for at least 20 minutes while the doc and the family argued over the code status. :stone

I agree: everyone who works in LTC should be able to ascertain a resident's code status within seconds of finding him or her down. That's why color-coded dots on the room door, and on the cover of the chart, are very helpful; it's too bad state surveyors tend to dislike that system ("it violates their privacy", I've been told........well, how much more does it violate their privacy to have half the facility's employees pawing through their personal effects or tearing apart their charts in a vain attempt to find the advanced directive?? :rolleyes: ).

BHolliRNMS · Jul 22, 2004

Not ALL crash carts in long term care are a joke. As a nurse, I feel it is my responsibility to check the crash cart at the beginning of the shift to be sure O2 etc is on it. Let's face it. People come to LTC to stay til they die. The families say to do a "full code" Do the families really expect the person to survive it? No. They just want to feel that something was done.

CapeCodMermaid, RN · Jul 23, 2004

Unfortunately,BHolli, most families DO expect that their loved one will be saved by CPR. I had a family member not believe me when I told her her husband had died because she was sitting in the room and didn't hear "the alarm go off". I asked her what she meant---this was LTC ---all he had was an O2 concentrator in his room...and she said "When someone dies, an alarm goes off...I saw it on ER". It was really very sad. At least the man had decided on his own that he didn't want to be coded if he died.

burger914 · Jul 24, 2004

Hi Betty,

I feel the same way as you. I work in a very small facility, with many "full codes" and a pretty pathetic crash cart. We are expected to start CPR and call 911. I was wondering what everyone had on their crash carts? Our crash cart is not even checked every shift or everyday for that matter! I don't mind being the one to straighten it up, any suggestions???

BBFRN, BSN, PhD · Jul 24, 2004

Hi Betty,
I feel the same way as you. I work in a very small facility, with many "full codes" and a pretty pathetic crash cart. We are expected to start CPR and call 911. I was wondering what everyone had on their crash carts? Our crash cart is not even checked every shift or everyday for that matter! I don't mind being the one to straighten it up, any suggestions???

I could tell you what we keep on ours, but it might be a little different for LTC (I'm thinking you might not have an emergency trach kit on yours, for example, but I don't know...).

burger914 · Jul 24, 2004

Yes, our cart is very basic. No meds,or trach kits. I just wanted to know what others had on the LTC carts. I am sure that some facilities are more acute than our facility. We don't have an EKG or anything.