Ready for full-code residents?

We do not do CPR in our facility for our residents. We strongly encourage honest discussions, advanced directives, etc. If families don't budge, then we offer that we will call 911 and we try to anticipate problems and call EMS early on. We do have an emergency cart with suction and O2.

I stopped and looked over the crash cart one night. It is a red tool cart that held a few expired medical supplies. Maybe the new owners will improve it. We had a manual defibrilator but our former medical director took it to his clinic and still has it there. We had a full code last year on one of my days off and it was a nightmare. The CNA and CMA found him down, checked code status, called a code, and started CPR (Mouth-Mouth, No masks on the unit:angryfire ). The unit RN and charge nurse came running with an ambu bag. They pulled the headboard off the bed and rolled it under the pt. The charge nurse tried to bag him but couldn't get good air movement. She started mouth to mouth while another units CMA took over the compressions. EMS rolled in (back when they were all BLS) and took him to the ER where he was pronounced. I have never seen anyone coding, except Resuscitation Annie. She never had a good rythym to begin with. We finally got paramedics this past year at the county ambulance service so ACLS is ten or fifteen minutes away. I figure sooner or later I will have to work a code but I can definately wait.

I worked in LTC for 17 years and nothing changed in that time regarding codes and code carts. Make sure you have a FULL etank, suction that is set up and ready to go, and airways. Those will be your priorities. When you find someone down, call the code, start CPR and when you have enough folks in the room that you can spare a nurse, try to start an IV in the AC area. This will save EMS a tremendous amount of time. Also if you have EKG capability get the leads on them. Remember to help out those perfoming CPR, they tire easily and will usually have the rest of the shift to work. If you're on the floor, your knees will be the first thing to go. IF you want, volunteer a couple of the CNA's and do mock codes. We did that at night and the CNA's loved it. It allowed the nurses to develop a routine and be able to just go BOOM BOOM BOOM when we had one. Our local EMS even wrote letters telling how well prepared we were for them when they arrived. I always kept a running sheet in my pocket of my DNR's. And If I had received word in report of someone going bad, I always double checked and called the family to come in.