Doppler during Code

Keep your Liability Insurance up to date.

Palpation, capnography, doppler, bedside ultrasound... they are all simply tools to provide as much information as possible to a clinician running a code. Each supplies different information and together help paint a more complete clinical picture of the event.

Legally you should always stick with established protocol. Always think to yourself how would this look in court? Time wasted running for the doppler can be a real monkey bar for the right lawyer in court. "So nurse Jenkins you ran for the doppler and that took you an additional one minute of time, is that in the ACLS protocol?"

Nurse Jenkins: "Ah, well...no but that other nurse is mean and rude to me if I don't do that."

Lawyer: "There is no law against being mean and rude Nurse Jenkins, we are here today because my client suffered a major brain trauma due to LACK OF OXYGEN during cardiac arrest while under YOUR CARE."

Lawyer: "We have experts here to testify that the additional minute or so of time that you took to run over and get the doppler, put it on the client and WAIT to see if there was a valuable pulse, in fact wasted the time my client needed to receive viable CPR as set by the national standards under ACLS protocol".

Nurse Jenkins: "Oh, well I see where this is going, I'm going to quit nursing today and go work in the potato field. Thank you your honor".

DONE DEAL. Lawyers can be like tigers. Never forget the tiger in the corner.

The person who gets the doppler is not active in the code. My ICU is HUGE and we have plenty of staff members to jump in and help when things are going south. Nothing is delayed when somebody runs for the doppler or even one of our step stools. We use the doppler when doing compressions and when we do a pulse check we have the doppler on one femoral artery, another nurse checking the other femoral artery, and one of the residents is typically checking a carotid. We run our codes very similarly to what EllaBella described in a previous post.

I haven't read previous posts, so I apologize if this has been said. But just last night I saw a news report on a patient who was declared dead after two pulse checks. Then two hours later, they found a pulse and he went to surgery, but too much time had passed. I wonder what the outcome would've been had a doppler been used.

We use a doppler on the femoral all the time during our codes. Saves so much time during pulse checks. We also frequently grab our ultrasound for a quick bedside echo if a code is "never-ending" to evaluate intrinsic cardiac activity.

It has some value in verifying that compressions are effective. The hospital I worked in uses a femoral Doppler for that purpose. It's just a tool and of course doesn't substitute for other measures