What to do when u find an unresponsive patient

akulahawkRN, ADN, RN, EMT-P · Jul 30, 2015

Coming from an EMS background, I would say two things: one is that the patient is likely unrecoverably dead and two is that unless the patient is a known DNR and/or there are no obvious signs of death, then start CPR, get the crash cart and start doing the full ACLS boogie, and possibly call 911 (depending upon the type of facility you're in) for backup/transport to the ED if necessary.

I've worked a few codes in my career in EMS and as a nurse. I can tell you that the first time you come upon a dead patient, making the decision to start CPR is usually the tough part. Once you've decided to start, and actually start doing it, it's not a big deal. Subsequent codes will be much easier for you to deal with as it's no longer a "new thing" that you're unfamiliar with.

I've had to coach some of my partners (EMS) through their first time doing CPR on an actual patient. After your first time, the next one will be easier for you. Just know the patient's code status and if you don't know, start CPR. You can always stop if it's determined that the patient is a DNR.

BuckyBadgerRN, ASN, RN · Jul 30, 2015

New account? Yeah, I'm suspicious. I don't know how you can be a nurse and not know the answers to your own questions.

ScrappytheCoco · Jul 30, 2015

I don't mean to be harsh...you might be a new grad but this is why you attend BLS and such before you're allowed on the floor. Isn't there a code button or a phone in the room that you can use to call for help? Even so, without a known DNR pulseless+unresponsive=immediate initiation of CPR. You can start compressions while the other person goes for help even if you have no idea what else to do. Was the CNA still in the room with you? Send her for the crash cart. The patient's nurse should have hung around to give report to the physician and RR team, but maybe he had to be running around if no one even thought to bring a crash cart to a code. Sounds like maybe your whole floor needs a huddle or something on code procedure. I feel like this is extremely basic. Good luck in the future and hope your next code goes better.

Meriwhen, ASN, BSN, MSN, RN · Jul 31, 2015

What to do if finding an unresponsive patient...

1. Call the code (and/or 911)

2. Start BLS until either the code team/paramedics arrive and takes over, or you learn that the patient is a DNR.

3. And if it's your patient, you stay with them...unless you're alone and have no one to call for help. Go call for help and then get back there and start BLS.

According to American Heart Association, you can stop or withhold resuscitation efforts if it's obvious the patient is dead (i.e. decapitated, decaying, etc.). Your facility may have a P&P indicating what you should do as well.

Otherwise, go through the motions until the MD arrives to call it.

Simonesays, BSN, RN · Jul 31, 2015

What everyone else said. But also, if you guys didn't have a post-code debrief, I would ask your manager for one. It would benefit not just you but also your colleagues. It definitely doesn't have to be the type of discussion where people get blamed and reprimanded for their actions- it can be more of a learning experience where you guys can discuss what went well and how you could have better worked as a team. You could also ask if there are mock codes you can participate in. We don't have them on our floor but we have mock trauma codes tailored for med-students/residents that we are allowed to participate in. They are pretty happy to have us because they need someone to fill the nursing roles and we get to practice in a pretty realistic setting. During the post-mock code discussion, we also go through the early S&S of the patient's deterioration (if applicable) and what could have been done to potentially prevent a code. This is especially helpful when you're new. Lastly, I would recommend taking more courses to boost your confidence. I took TNCC (an awesome course that focuses on ABCs specifically tailored to a trauma population) and ACLS (great if you work in a monitored setting. Good for understanding which drugs are used with which rhythms and why).

GhosttRN · Jul 31, 2015

Agree with everyone.

-Find unresponsive pt. -you were unable to arouse them

-pulse check - nothing?

-begin BLS/ACLS

stop when told to by Doc or when everyone is saying "He's DNR!!!" lol.

Nobody should get mad at you for starting CPR on an unresponsive pt.

Sounds if pt DNR, maybe your institution needs to come up with a labeling method to inform everyone. (sign, bracelet, whatever)

I have coded DNR PTs in the past because "check code status" is not part of the algorithm. that's something that will be determined but should be known by all ahead of time.

Lessons learned sometimes come down hard. But learning happens everyday. Don't miss the opportunity

LucasNewGrad · Jul 31, 2015

Patient was not a DNR. This was a unit where these type of situations are very rare. I have learned a lot from the experience and the advice you all have given. Thank you.

JustBeachyNurse, LPN · Jul 31, 2015

Patient was not a DNR. This was a unit where these type of situations are very rare. I have learned a lot from the experience and the advice you all have given. Thank you.

Are you a nurse? Do you not have BLS/CPR?

1 assess responsiveness

2 activate code/EMS or send someone for help or yell "I need help in room 123 now"

3 check for pulse

4 if no pulse start compressions at a rate of 100/min (Staying Alive by the BeeGees)

5 do not stop for breaths as effective compressions are current EBP

6 once AED arrived attach pads and analyze.

Why did the cna get you and not the patients nurse?

LemonMonkey · Jul 31, 2015

The patients nurse should have been running that code, not running around. They should have delegated someone to call the code, get the crash cart, so on and so on.

Are you a nurse or an aide? In my facility (ltc and short stay rehab) aides have no hands in a code except for moving things out of the way (we aren't required to have a bls cert). But I know in some hospitals they're just as hands on as the nurses.

allnurses Guide · Jul 31, 2015

As a new grad - You may have had a deer in the headlights moment - but after thar (10 seconds) your BLS traing should kick in. 1: Press the code blue button if there is one or call light if not. @ Yell HELP a loud as you can. Assess Airway, bleedin Circ. Address those problems. No Patient's code status - if not DNR begin resussetiation attempts and don't stop until Higher medical authority tells you too.

Peace

Hppy

AZQuik · Jul 31, 2015

In my unit anyone who found a pt unresponsive would have yelled for help and started compressions. Period. That said, first code for tech, and several nurses, yeah I could see people looking to others for direction frozen in their fear. It happens. We are human. Learn and move on. Gluck!

BSN GCU 2014.

Sent from my iPhone using allnurses

toomuchbaloney · Jul 31, 2015

I don't think you will suffer any serious consequences from this.

There was an experienced nurse who might not be so lucky, however, if this unfolded in that fashion with a patient who was a full resus.

I suspect you have learned a great deal from this.

Just for giggles, what is your BLS status?