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.

[BrandonLPN, LPN]

A very wise RN supervisor once told me: "Of *course* you start CPR on a pt who is clealy dead. Isn't that the *definition* of resuscitation?"

[tinkerbell24]

You need to go back to work and face whatever happens. The least said, the better. I got good advice from my last supervisor. She said to not be defensive, nod your head yes, and learn from your mistake. The DON and the comment just prior to mine was your best advice. Take the bull by the horn, go into your supervisor and find out what he or she is thinking. It is being proactive on your part. I would not discuss this with anyone other than your supervisor. If you have any time during your day or evening, it would be best to review policy and procedure. I worked third shift when I first became a nurse. I read policy and procedure every night during down time. You never know when you may need that information. I am surprised they did not have a seasoned nurse working with you. Did you have any resources available to you? Knowledge is power. The more informed you are about policy and procedure the better it is for you. You will build you knowledge base and continue to layer it as you progress in your career.

[Meriwhen, ASN, BSN, MSN, RN]

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?????

Don't let yourself be scared off of nursing because of this. The important thing about mistakes is to LEARN from them. We all make mistakes--we're human so that is unavoidable. It's when we start making the same mistakes over and over that there's a problem there.

[Valeriaflynn]

I am an inexperienced neg grad RN but I just took an ACLS course, and they stressed to not start the code if rigor mortis has set in. However, many of you say you do anyways..and your reasons are absolutely valid and make total sense. Anyone else ACLS certified and did the instructors say the same thing? If my license is on the line, and this would get my superiors in trouble and upset the family, you bet I am going to start CPR on any patient I find that is unresponsive and pulseless even if they are cold, mottled, blue, with rigor!

[Meriwhen, ASN, BSN, MSN, RN]

Anyone else ACLS certified and did the instructors say the same thing?

Actually, that's where I got the rigor mortis/decapitation/other signs of irreversible death from--my ACLS renewal course.

I think it's safer for our jobs and licenses that if there's any doubt to the patient's state of death, to err on the side of starting CPR.

[monkeybug]

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?????

Worse mistakes in hospital? I wouldn't think so. In the hospital, you'd call a code and then the code team would swoop in and make the decisions. There would be a house supervisor or a physician to do the heavy thinking for you. I think nurses in SNFs and LTCs have it tougher because they are sort of out there on their own.

[Perpetual Student]

no respirations or detectable apical pulse.

The only real problem in the post I see is where the above was used as part of the rationale for not starting CPR. Those are indications to perform CPR, not withhold it! That said, you've received some good advice here.

[brandinalove]

In a facility I worked in about a year ago two decent nurses were terminated and reported to the BON for this exact situation. I've been in ltc as a CNA and now LPN about 4 years and each facility's policy has been to initiate CPR if they are a full code even if it's obvious they've been deceased for awhile. This is in Florida.