When is it too late to intiate CPR?

[myschuler]

I am a fairly new nurse (graduated in June, started working at the end of August) in a rehab facility. I had a recently admitted resident 10 day s/p CABG x 4 who was found dead in his room during my NOC shift. He was full code but I did not initiate CPR because it was clear that he had been dead for more than a few minutes (he was mottling, the blood was pooling under his head, no respirations or detectable apical pulse. I've had a few days to think about what happened and I'm starting to wonder if I should have started CPR anyway. When is it too late to start CPR? If a resident is full code, should I have started compressions regardless of how cold or blue he was? He was last seen breathing an hour or 1.5 hours before he was found. So he wasn't left alone all night but we don't have one-on-one with a resident unless they have other indications that they are having issues, which he did not. I would like to know what other, more experienced nurses think about this issue.

[xoemmylouox, ASN, RN]

Always check your facilities policy. Everywhere I have been (LTC, Assisted Living, or Home Care) if a resident is a full code you start CPR until the ambulance arrives for transport.

[NurseCard, ADN]

If someone is a full code and I find them "dead", I start CPR, I don't check any of that

other stuff first. I'm freaking out way too hard to even think about checking to see

if they are mottled or whatever.

[Aliakey]

I'm not an experienced nurse, but in our area, most care facility policies require a 9-1-1 call and have EMS determine if CPR should be ceased, unless very obvious rigor is present. Other cities may differ. Our EMS protocols are very specific to what criteria are required for halting CPR, and the ER physician is just a portable radio transmission away for any concerns or unusual situations.

If you initiate and continue CPR until we arrive, the responsibility is now on our (EMS') shoulders with the continue or halt decision. One of the things I am *required* to document is whether CPR was in progress when I first stepped foot into the patient's room. I also have to inform police about this information when they arrive. Much easier if I can attest that CPR was performed and keep the nursing staff in good light. You folks have a tough job as it is, and have my respect. You don't need any additional headaches.

[TheCommuter, BSN, RN]

I've known of nurses who have gotten into trouble and had their license numbers referred to the state board of nursing for not initiating CPR on full code patients, even if the patient is obviously not going to be saved by the efforts.

In the area where I live and work, we perform CPR in the nursing home setting until EMS arrives and takes over, even if livor mortis has set in.

[NewbieNeedsHelp]

Don't beat yourself up about it...

The end result would have been the same. It sucks to wonder what if especially as a new nurse.

But you and everyone around you obviously knew it was futile.

[NurseCard, ADN]

Don't beat yourself up about it...

The end result would have been the same. It sucks to wonder what if especially as a new nurse.

But you and everyone around you obviously knew it was futile.

The big picture... it most likely was futile.

However, the protocol in most facilities is to start CPR in a case like this.

[traumaRUs, MSN, APRN]

Where do you all work? If there are obvious signs of death, including dependent mottling, rigor mortis, cold to the touch in an environment where the ambient temp is normal, of course you wouldn't start CPR. That's just a waste of resources.

[katiedid53]

I have been a nurse for 29 years and it is always the policy that it the patient is a not a DNR, then CPR is to be started. Now, just to ease your mind, if the patient was as far gone as you said, the possibility of him actually being resuscitated is almost impossible and if he had been revived, the brain damage would be so significan

[katiedid53]

I have been a nurse for 29 years and it is always the policy that CPR is started if the patient is not a DNR, even in a nursing home. I want to say do not beat yourself up over it, but this is a big deal, CPR should have been started. Now on the other side, the outcome would have been the same, he would not have been able to be resusitated. My advice for you is to never do this again, it can and will land you in court, being sued and possibly losing your nursin license. You worked too hard to get to where you are today. As a D.O.N. I would be having to do major damage control with this if you were one of my nurses. Take this as a learning experience and do not ever do this again. I am saying this for your protection, because if you are making these kind of judgements early in your career, what other unsafe judgements are you making in your daily work day. Stick to the policy and procedures and the Nurse Practice Act and if in doubt check with your supervisor. But if you find someone dead, and they are to receive CPR then do it, there is no exception to the rule. Now go out and be the best nurse you can be, learn from your mistakes because, guess what, this will not be your first mistake that you will make in your career, welcome to nursing.

[Meriwhen, ASN, BSN, MSN, RN]

My understanding from the AHA is that unless there are obvious signs of irreversible death (e.g., rigor mortis, decapitation), CPR should be initiated until a higher care of level arrives to take over OR a valid DNR order is produced.

However, the most accurate source for your answer would be your facility's P&P manual.

[myschuler]

Advice noted everyone. I did ask about the policy and apparently it is not as clear as it is in some other facilities. I am sure this will be changed. I just wish I had had more experienced nurses I could have asked during the crisis. I just wish I didn't have to make such bad mistakes to learn from them. I'm scared to go back to work. Bad things can happen even in an SNF. I'm rethinking my desire to work in acute care. If I can do this in a rehab facility what other worse mistakes could I make in a hospital?????