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(LA Times)   911 dispatcher "Is there anybody that's willing to help this lady and not let her die?" Nurse at senior living center "Um, not at this time"   (latimesblogs.latimes.com) divider line 438
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23487 clicks; posted to Main » on 03 Mar 2013 at 9:13 PM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-03-03 09:03:37 PM
FTA: "When Halvorson asked the nurse if she was going to let the woman die, the nurse said, "That's why we called 911."


So, YES, then?
 
2013-03-03 09:09:40 PM

Amos Quito: FTA: "When Halvorson asked the nurse if she was going to let the woman die, the nurse said, "That's why we called 911."


So, YES, then?


Why bother calling 911 in the first place?

Guess I'll scratch that senior center off my list of retirement homes.
 
2013-03-03 09:15:11 PM
Well if she didn't wanna die she shouldn't have gotten old!
 
2013-03-03 09:16:41 PM
Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.
 
2013-03-03 09:16:59 PM
You guys busy privatizing your death panels down there?
 
2013-03-03 09:18:47 PM
I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

I'm guessing further information will show that the 87 year old resident had other issues that would have made it a moot point anyways.  It's not like simply doing CPR saves everyone.
 
2013-03-03 09:18:48 PM
Unbelievable. I don't care what my workplace policy is. If that lady was Full Code and not DNR, I'm a nurse, i should do CPR. I'd rather lose my job than my license.
 
2013-03-03 09:18:49 PM
It's not a TOOMER!
 
2013-03-03 09:19:15 PM

ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.

She is truly an "Angel of Mercy"
 
2013-03-03 09:19:42 PM
as a nurse is there not a duty of care? She will be lucky if she does not go to jail
 
2013-03-03 09:20:12 PM
I'm going to sound cold here, but the woman was in her late 80s. Sometimes its just a person's time to go.

The operator sounds like a spaz, from the way she's portrayed in the article. "It's a human being" Yes, and human beings die all the time. You can't be Superman and save everyone all the time.
 
2013-03-03 09:20:35 PM

Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.


A nurse in a medical facility should already have that training.
 
2013-03-03 09:20:39 PM
Perhaps the patients there have DNR orders.

If you don't know what that is, it's for people who are viewed as so close to death that they have orders for  no CPR to be performed, as they want to die "naturally".
 
2013-03-03 09:20:45 PM
The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.
 
2013-03-03 09:21:11 PM
People don't become doctors or nurses, or join the medical profession at all these day because they want to help people and save lives. These days, they do it because they want lots of money.

It's a disgrace that we even use the words "nurse" and "doctor" to describe these greedy animals. They bring dishonor to the words.
 
2013-03-03 09:21:12 PM
If I'm reading this bit on the California good samaritan law correctly, it looks to me that the nursing home could've been sued to the eyeballs - not for trying the CPR, but if something else went wrong somewhere along the line.
 
2013-03-03 09:21:46 PM
So, depraved indifference?
 
2013-03-03 09:22:01 PM
Business Opportunity: Bakersfield Ice Floe, Inc.
 
2013-03-03 09:22:21 PM

AverageAmericanGuy: I'm going to sound cold here, but the woman was in her late 80s. Sometimes its just a person's time to go.

The operator sounds like a spaz, from the way she's portrayed in the article. "It's a human being" Yes, and human beings die all the time. You can't be Superman and save everyone all the time.


The operator was asking a *nurse* to perform CPR...not open-heart surgery.

But, yeah, that's just an absurd request, huh?
 
2013-03-03 09:22:34 PM
In fairness to the nurse:

"She's yelling at me," she said of Halvorson, "and saying we have to have one of our residents perform CPR. I'm feeling stressed, and I'm not going to do that, make that call."

Do you want the nurse to have a heart attack?
 
2013-03-03 09:22:37 PM

ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.


More important is the reason behind this--no doubt, a fear of liability.

The lawyers of course don't have to pay for this woman that just died from their actions.
 
2013-03-03 09:22:52 PM
FTA: Bayless' daughter told KGET that she was a nurse and was satisfied with her mother's care at Glenwood Gardens, the station reported.

IIIInteresting.
 
2013-03-03 09:23:07 PM

octopied: Perhaps the patients there have DNR orders.

If you don't know what that is, it's for people who are viewed as so close to death that they have orders for  no CPR to be performed, as they want to die "naturally".


FTA:

The patient did not have a do-not-resuscitate order, according to KGET-TV.

Helps to read the article, eh?
 
2013-03-03 09:24:19 PM
Seems like a stupid policy.  Are they worried that their staff will do it wrong?  Is it a liability thing?  I'd have to imagine they could should hire people that are qualified to do things like this, especially being a senior living center and all.

Also: The elderly woman was identified by KGET-TV as 87-year-old Lorraine Bayless. She died Tuesday at Mercy Hospital Southwest, KGET reported.

It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.  If this had been a child, or a healthy person that should have some time left on the clock, I'd be pretty disgusted.
 
2013-03-03 09:24:43 PM

Lehk: as a nurse is there not a duty of care? She will be lucky if she does not go to jail



Maybe, but at least she'll keep her job.
 
2013-03-03 09:25:12 PM

octopied: Perhaps the patients there have DNR orders.

If you don't know what that is, it's for people who are viewed as so close to death that they have orders for  no CPR to be performed, as they want to die "naturally".


This.  They still call 911 because it's a helluva lot easier when they die in a hospital.  Most of those poor old farts have been circling the drain for years and are quite ready to go.

/ my mom has a DNR, for example.
/ I have pretty specific instructions in a living will, and all you you should think about it if you don't already have one...
 
2013-03-03 09:25:32 PM

djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.


I was thinking that exact same thing...it said she was still breathing. Barely, but even so.
 
2013-03-03 09:26:23 PM

AirForceVet: Why bother calling 911 in the first place?

Guess I'll scratch that senior center off my list of retirement homes.


I could go for a place with that much restraint, if I got that old (exceedingly unlikely).  Besides being disindicated for a breathing person, basically no 87-year-old is going to survive the year of rehab from breaking every rib in her body, which would be the outcome from any CPR procedure that's worth the bother.

Why call 911?  Well, she's dying, and if she didn't write a DNR, it's easier for the hospital to deal with that.
 
2013-03-03 09:26:36 PM
Wouldn't have helped, the patient was 87 and CPR wasn't the appropriate treatment. The family is fine with the care she received, so this seems like manufactured outrage.
 
2013-03-03 09:27:03 PM
Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.
 
2013-03-03 09:27:16 PM
Can I please have the freedom to choose how and when I die and not rot to death in one of these depressing shiatholes they call a retirement community? That'd be great, thanks
 
2013-03-03 09:27:56 PM
i.imgur.com
 
2013-03-03 09:28:47 PM

ZeroCorpse: People don't become doctors or nurses, or join the medical profession at all these day because they want to help people and save lives. These days, they do it because they want lots of money.

It's a disgrace that we even use the words "nurse" and "doctor" to describe these greedy animals. They bring dishonor to the words.


Pfft. To the people of the Gamma Forests, the word "doctor" means "mighty warrior".
 
2013-03-03 09:28:54 PM
"She's yelling at me," she said of Halvorson, "and saying we have to have one of our residents perform CPR. I'm feeling stressed, and I'm not going to do that, make that call."


I hate everything about you.
 
2013-03-03 09:29:32 PM

octopied: Perhaps the patients there have DNR orders.

If you don't know what that is, it's for people who are viewed as so close to death that they have orders for  no CPR to be performed, as they want to die "naturally".


Thanks! Now can you explain a "BLT"?

mimg.ugo.com
 
2013-03-03 09:29:42 PM
I am sure a breating 84 year old is much better off without a nurse slamming on her chest.  Besides, CPR works less than 1% of the time.
 
2013-03-03 09:30:28 PM

FarkinSneakyBastage: Can I please have the freedom to choose how and when I die and not rot to death in one of these depressing shiatholes they call a retirement community? That'd be great, thanks


try smoking crack, fast cars, hookers, cocaine.
 
2013-03-03 09:32:20 PM

Person: Wouldn't have helped, the patient was 87 and CPR wasn't the appropriate treatment. The family is fine with the care she received, so this seems like manufactured outrage.


Exactly. Nothing like fake outrage from all those who fail to read the entire article and connect logical thoughts. I'm sure we'll here about this on the news for the next week.

/welcometofark.jpg?
 
2013-03-03 09:32:59 PM

NotoriousFire: Person: Wouldn't have helped, the patient was 87 and CPR wasn't the appropriate treatment. The family is fine with the care she received, so this seems like manufactured outrage.


Exactly. Nothing like fake outrage from all those who fail to read the entire article and connect logical thoughts. I'm sure we'll here hear about this on the news for the next week.

FTFM.
 
2013-03-03 09:34:57 PM
I read this story earlier today and immediately had some PTSD type flashback to my EMT-Paramedic days. Holy shiat are nursing home nurses worthless. I have a fairly decent sample size as I worked in a few different cities of varying sizes in a couple of different states...I can't say that I met one that was genuinely helpful or competent.

In the hospitals, there were all kinds of good nurses, but never in the nursing homes. I wouldn't put my worst enemy in one.
 
2013-03-03 09:35:22 PM

Lehk: as a nurse is there not a duty of care? She will be lucky if she does not go to jail


I think only one state (Vermont?) has a law requiring people to give aid.

My question is: why was the nurse even there??
 
2013-03-03 09:36:18 PM
So, if I was the family, I would sue the 911 dispatcher for telling someone to start CPR when someone is still breathing.

Good Samaritan Laws mean NOTHING if you are trained (or should have been trained) and do it wrong.  Heck even California knows this where a survivor sued the person who took her out of a burning car because her actions caused her injuries. (not the car crash, and nevermind that she probably would have suffered a fiery death had she remained in the car)
 
2013-03-03 09:37:08 PM

Person: Wouldn't have helped, the patient was 87 and CPR wasn't the appropriate treatment. The family is fine with the care she received, so this seems like manufactured outrage.


But it was too much trouble for the reporter to ask if the 911 operator had a damn clue what they were talking about, or ask any other medical professional if it was appropriate. KGET is pandering and has a partial transcript of the panicky operator.
 
2013-03-03 09:38:40 PM
International Council of Nurses' Pledge

"In the full knowledge of the task I am undertaking, I promise to take care of the sick with all the skill and understanding I possess, without regard to race, creed, color, politics, or social status, sparing no effort to conserve life, to alleviate suffering, and promote health.

I will respect at all times the dignity and religious beliefs of the patients entrusted in my care, holding in confidence all personal information entrusted to me and refraining from any action which might endanger life or health.

I will endeavor to keep my professional knowledge and skill at the highest level and give loyal support and cooperation to all members of the health team.


Or, you know, not...
 
2013-03-03 09:39:22 PM
this country is really going down the shiatter
 
2013-03-03 09:39:34 PM

fusillade762: Lehk: as a nurse is there not a duty of care? She will be lucky if she does not go to jail

I think only one state (Vermont?) has a law requiring people to give aid.

My question is: why was the nurse even there??


To dispense meds, usually. As mentioned in some of the other posts, if the victim was still breathing shallowly, you're not supposed to do CPR. They want that person in the hospital so the doctor can diagnose/prescibe/treat. Not up to the nurse to make that call. Emergency dispatch can have a crew then in under 10 minutes(well they can here), They're allowed to administer oxygen and transport the person to hospital where they can be fully examined.
 
2013-03-03 09:39:46 PM

fusillade762: Lehk: as a nurse is there not a duty of care? She will be lucky if she does not go to jail

I think only one state (Vermont?) has a law requiring people to give aid.

My question is: why was the nurse even there??


So the rest home can advertise that they always have a nurse on staff, 24/7.  Most people won't see the fine print that says the nurse will do nothing in an emergency.
 
2013-03-03 09:40:03 PM

fusillade762: Lehk: as a nurse is there not a duty of care? She will be lucky if she does not go to jail

I think only one state (Vermont?) has a law requiring people to give aid.

My question is: why was the nurse even there??



Like to assist the residents in wiping their behinds, walking them back and forth to the dining and bingo halls, etc. So the ADLs (activities of daily living) and such. Better that than an inappropriate treatment such as CPR, right?
 
2013-03-03 09:40:28 PM

Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.


You don't do breaths any more.
 
2013-03-03 09:41:38 PM

WhoGAS: You don't do breaths any more.


That isn't true everywhere.
 
2013-03-03 09:42:13 PM
http://comfortcarechoices.com/index.php?option=com_content&view=artic l e&id=59

How successful is CPR?
Myth: That CPR is a simple procedure to revive a stopped heart and helps most everyone.  This is a TV perpetuated myth as evidenced by one study which found that on three popular prime time TV shows, 75% of patients survived cardiac arrest with 67% leaving hospital. [Diem SJ, et al. NEJM 1996]

Reality: CPR is a harsh procedure usually incompatible with a peaceful death - for those adults in hospital who are over age 70, only 2-17% will survive to be discharged and half of them have a worsened quality of life or are worse than before being resuscitated and regret having CPR.  [(1) Murphy DJ.  Outcomes of CPR in the elderly. Ann Intern Med. 1989; (2) Waisel DB.  The CPR-not-indicated order:  futility revisited.  Ann Intern Med. 1995.  (3) Brindley PG. Predictors of survival following in-hospital adult CPR. CMAJ 2002.  (4) Peberdy MA. CPR of adults in the hospital. Resuscitation. 2003.  (5) Swor RA. Does advanced age matter in outcomes after out-of-hospital cardiac arrest in community-dwelling adults? Acad Emerg Med. 2000.]

For those in nursing homes, the attempt to resuscitate has an even worse record with no one surviving in one large survey. [(1) Gordon M. Poor outcome of on-site CPR in a multi-level geriatric facility. J Am Geriatr Soc 1993.  (2) Benkendorf R. Outcomes of cardiac arrest in the nursing home: destiny or futility? Prehosp Emerg Care. 1997.]
 
2013-03-03 09:43:09 PM
CPR is surprisingly not very effective:
"So, if an average adult keels over in the street, is found unresponsive and pulseless by a bystander, and is administered CPR while a 911 call is made, the odds that such a person will emerge from the eventualities of the resuscitation effort healthy and with a normally functioning brain are about 2%. "

http://www.kevinmd.com/blog/2012/06/cpr-effective.html
 
2013-03-03 09:43:59 PM
*shakes fist at Kif_D*

Dammit, you beat me to hit :P
 
2013-03-03 09:44:16 PM

djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather. CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.


THIIIIISSSSSS
That was the first farking thing I thought when I read this article. Why in fark's name would you do CPR ON SOMEONE WHOSE HEART IS BEATING AND THEY ARE STILL BREATHING?
You DO NOT do chest compressions on someone whose heart is still beating!
You DO NOT do rescue breathing on someone who is still farking breathing on their own!

The funny part is, I haven't had a CPR course EVER and I farking know this!
 
2013-03-03 09:44:17 PM
I smell attorneys.
Seas of Attorneys.
I hear their salivations.
The shuffling of papers.
Someone gunna get paid.
 
2013-03-03 09:45:24 PM
So when the person stopped breathing/went unconcious the nurse still didn't perform CPR until the ambulance arrived.
Ridiculous, as, yes CPR has a low (1%) chance of revival on its own, the stuff the paramedics bring in returning a person to life to around 30-40% chance and CPR for 4 to 6 minutes keeps the body and brain oxygenated enough to allow for less overall damage to those organs.
FInally getting to the hospital, your rate of coming back can be raised to 80% and with the cryobaths and other treatment capacities they can mitigate a lot of damage to the body and brain after returning to a state of life.
CPR isn't really for reviving the corpse, its keeping the corpses organs alive long enough for the body to get to improved treatment facilities so that there is a greater capacity for the victim to be revived successfully and with less overall damage.

Whether or not the person would have survived at the hospital isn't the question, the real question is why the nursing home has the policy of not performing CPR, even when the victim does not have a DNR request on file. Also how does this nurse retain her credentials when she fails to perform her duties as a nurse regardless of the policies of the facility that she works at?
 
2013-03-03 09:45:47 PM
Fell In Love With a Chair:
You DO NOT do chest compressions on someone whose heart is still beating!
You DO NOT do rescue breathing on someone who is still farking breathing on their own!

The funny part is, I haven't had a CPR course EVER and I farking know this!


Tell that to the seemingly 80% of Americans (and Fark posters apparently) who don't seem to understand this.
 
2013-03-03 09:45:48 PM

gwendolyyyn: djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.

I was thinking that exact same thing...it said she was still breathing. Barely, but even so.


Enough of your "facts"!  This is FARK.
 
2013-03-03 09:46:00 PM
I'm sure it's in the pamphlet. Now is it in back in fine print, or on the cover with a starburst graphic.

/some heirs might see it as a feature. Just sayin.

//a corrupt nursing home would want to keep them alive and sedate until the money is gone.
 
2013-03-03 09:47:03 PM
If we're ever going to bring the population down this kind of "heartless callousness" is exactly what we need.

Of course we could teach and encourage birth control in schools starting in 6th grade and make sure abortion is safe, legal and easily obtainable on demand for every pregnant female. Oh, and "doctor assisted suicide," "death with dignity" and/or "voluntary euthanasia" might help too.

But failing those common-sensical measures, yeah, let's stand idly by while somebody's granny keels over. Maybe we can herd everybody over 50 into death camps (starting of course with me after friday). "Boots on the ground" anywhere Islam runs rampant would help too. We might also use subliminal programming to encourage people to gun down strangers at shopping malls, theaters and (even better) elementary schools. After all if we're not going to limit births we should encourage deaths, right? "Viva la muerte!"

I remember when the world's population hit 3 billion, 4 billion people ago; I was entering puberty then. Now I'm almost 50 and you breeders STILL haven't learned restraint. God must love stupid people, He increases them exponentially. After all when we've picked this planet clean we can just move the rich & famous to another planet a few hundred light-years away and start the cycle all over again. AMIRITE?!?!?!!?

/ Drunk and cynical. And constipated.
 
2013-03-03 09:47:04 PM
thishumanscondition.files.wordpress.com

Dispatcher: "She could die."
Nurse: "Yeah, maybe..."
 
2013-03-03 09:47:48 PM
If you've ever spent time around retirement homes and assisted living, you've detected the barely concealed contempt most people working there have for their charges.  Definitely a class thing.  They pretty much are all making this shiat wage to take care of these white hairs who are staying there for tons of money each year, decrepit and prompted to keep living deep into their eighties and nineties for no apparent reason.

Not saying it's right, but I'm less than shocked some nurse found a way not to save a life.  There's always waiting lists and more coming through the door.
 
2013-03-03 09:47:49 PM

Fell In Love With a Chair: djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather. CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.

THIIIIISSSSSS
That was the first farking thing I thought when I read this article. Why in fark's name would you do CPR ON SOMEONE WHOSE HEART IS BEATING AND THEY ARE STILL BREATHING?
You DO NOT do chest compressions on someone whose heart is still beating!
You DO NOT do rescue breathing on someone who is still farking breathing on their own!

The funny part is, I haven't had a CPR course EVER and I farking know this!


Actually, the National Institute of Health or whatever only says to avoid it if breathing is normal, or if there is coughing or movement.  I think instructions differ, though.

Anyway, all of this is hardly why the nurse wasn't doing anything.  The nurse was just afraid her boss would be mad.
 
2013-03-03 09:48:00 PM

Acravius: So when the person stopped breathing/went unconcious the nurse still didn't perform CPR until the ambulance arrived.


Sorry, I missed this in the article. When was this said in the article/other articles? Thanks.
 
2013-03-03 09:48:23 PM

NotoriousFire: Fell In Love With a Chair:
You DO NOT do chest compressions on someone whose heart is still beating!
You DO NOT do rescue breathing on someone who is still farking breathing on their own!

The funny part is, I haven't had a CPR course EVER and I farking know this!

Tell that to the seemingly 80% of Americans (and Fark posters apparently) who don't seem to understand this.


Heaven help us if we fall unconscious in public, this thread is scaring the shiat out of me!
 
2013-03-03 09:48:59 PM

WhoGAS: Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.

You don't do breaths any more.


Yes, you do.  30 to 2 is the new standard.  The emphasis is on compressions, now, but breaths haven't been completely cut out, unless you don't feel comfortable doing them.
 
2013-03-03 09:49:06 PM
I once was admitted to a hospital for what I thought would be 1 or 2 days. I was asked if I had a living will and did I want a dnr. I told them to keep me alive until my insurance was exhausted. I spent a month in that place and came out 60 lbs lighter and covered in bed sores..

Then I had to go back to that he'll hole and when they asked me the dnr question, I advised them to pull the plug immediately and OD me on morphine.

Life ain't that good.
 
2013-03-03 09:50:39 PM

The One True TheDavid: But failing those common-sensical measures, yeah, let's stand idly by while somebody's granny keels over. Maybe we can herd everybody over 50 into death camps (starting of course with me after friday). "Boots on the ground" anywhere Islam runs rampant would help too. We might also use subliminal programming to encourage people to gun down strangers at shopping malls, theaters and (even better) elementary schools. After all if we're not going to limit births we should encourage deaths, right? "Viva la muerte!"


This would probably increase the population.
 
2013-03-03 09:51:41 PM
The nurse needs to lose her license, and the facility needs some serious sanctions if not being shut down
 
2013-03-03 09:51:47 PM

quizzical: Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

A nurse in a medical facility should already have that training.


Arguably an assisted living facility is not a medical facility (or more appropriately... a nursing facility). It's a place for people who need a little help, not full care or rehabilitation. Think of it as an apartment complex that cooks you food and has someone to pick you up if you fall in the shower.
 
2013-03-03 09:52:39 PM
CPR doesn't work very well, not well at all.

Well, it does sometimes work - but does very little lasting good. IIRC, one month after having received CPR, less than 8% of of CPR recipients are alive, most of those are in a persistent vegetative state.

3% of CPR recipients have a good outcome one month out. 3 farking percent, and most of those aren't infirm nursing home patients.

/In this case, wouldn't have mattered, CPR doesn't work.
 
2013-03-03 09:52:45 PM
Since I don't want my research to go to waste, here's a random quote:

"CPR stands for cardiopulmonary resuscitation. It is an emergency lifesaving procedure that is done when someone's breathing or heartbeat has stopped. This may happen after an electric shock, heart attack, or drowning."

http://www.nlm.nih.gov/medlineplus/ency/article/000010.htm
 
2013-03-03 09:53:28 PM

RandomRandom: CPR doesn't work very well, not well at all.

Well, it does sometimes work - but does very little lasting good. IIRC, one month after having received CPR, less than 8% of of CPR recipients are alive, most of those are in a persistent vegetative state.

3% of CPR recipients have a good outcome one month out. 3 farking percent, and most of those aren't infirm nursing home patients.

/In this case, wouldn't have mattered, CPR doesn't work.


None of that being relevant to why this particular person did what they did.
 
2013-03-03 09:54:50 PM

NotoriousFire: Since I don't want my research to go to waste, here's a random quote:

"CPR stands for cardiopulmonary resuscitation. It is an emergency lifesaving procedure that is done when someone's breathing or heartbeat has stopped. This may happen after an electric shock, heart attack, or drowning."

http://www.nlm.nih.gov/medlineplus/ency/article/000010.htm


Same site, under "adult":

If the person is not breathing or has trouble breathing:Cover their mouth tightly with your mouth.Pinch the nose closed.Keep the chin lifted and head tilted.Give 2 rescue breaths. Each breath should take about a second and make the chest rise.
 
2013-03-03 09:55:10 PM
No good deed ever goes unpunished.
 
2013-03-03 09:55:41 PM

Relatively Obscure: WhoGAS: You don't do breaths any more.

That isn't true everywhere.


True, only in the areas that adhere to the AHA guidelines.
 
2013-03-03 09:56:51 PM

WhoGAS: Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.

You don't do breaths any more.


That's only in certain situations. There is a somewhat different technique to it as well, which is exhausting.  I think the Red Cross stopped teaching compression-only for basic cpr certification last year, as they found people with only that much training could get confused and use it when it wasn't appropriate.
 
2013-03-03 09:57:13 PM

foxyshadis: Person: Wouldn't have helped, the patient was 87 and CPR wasn't the appropriate treatment. The family is fine with the care she received, so this seems like manufactured outrage.

But it was too much trouble for the reporter to ask if the 911 operator had a damn clue what they were talking about, or ask any other medical professional if it was appropriate. KGET is pandering and has a partial transcript of the panicky operator.


Yeah, she's getting a little full of herself, isn't she? Saying "are you going to let her die" is emotional blackmail. The old lady was dying suddenly, and it sure as hell wasn't the nurse's fault, but the 911 person was insinuating that it was. That's a terrible thing to do.
 
2013-03-03 09:57:48 PM

catzilla: Relatively Obscure: WhoGAS: You don't do breaths any more.

That isn't true everywhere.

True, only in the areas that adhere to the AHA guidelines.


Yeah, I believe AHA says no breaths, while Red Cross and others say yes.  And the pros have gear that does a better job anyway.
 
2013-03-03 09:57:58 PM

RandomRandom: CPR doesn't work very well, not well at all.

Well, it does sometimes work - but does very little lasting good. IIRC, one month after having received CPR, less than 8% of of CPR recipients are alive, most of those are in a persistent vegetative state.

3% of CPR recipients have a good outcome one month out. 3 farking percent, and most of those aren't infirm nursing home patients.

/In this case, wouldn't have mattered, CPR doesn't work.


Those numbers are from all incidents of type of arrest, including when the person's collapse wasn't witnessed, when CPR didn't start until first responders got there, etc.

Witnessed in-hospital and witnessed by medical professional have much higher rates of survival, somewhere around 20%.
 
2013-03-03 09:58:19 PM
Fell In Love With a Chair:

The funny part is, I haven't had a CPR course EVER and I farking know this!

I can tell.

http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/dow nl oadable/ucm_317350.pdf

Notice, that rescue compressions are appropriate even if the victim is "not breathing normally." For example with choking, you may be able to dislodge the blocking object with compressions.
 
2013-03-03 09:58:21 PM

Acravius: So when the person stopped breathing/went unconcious the nurse still didn't perform CPR until the ambulance arrived.
Ridiculous, as, yes CPR has a low (1%) chance of revival on its own, the stuff the paramedics bring in returning a person to life to around 30-40% chance and CPR for 4 to 6 minutes keeps the body and brain oxygenated enough to allow for less overall damage to those organs.
FInally getting to the hospital, your rate of coming back can be raised to 80% and with the cryobaths and other treatment capacities they can mitigate a lot of damage to the body and brain after returning to a state of life.
CPR isn't really for reviving the corpse, its keeping the corpses organs alive long enough for the body to get to improved treatment facilities so that there is a greater capacity for the victim to be revived successfully and with less overall damage.

Whether or not the person would have survived at the hospital isn't the question, the real question is why the nursing home has the policy of not performing CPR, even when the victim does not have a DNR request on file. Also how does this nurse retain her credentials when she fails to perform her duties as a nurse regardless of the policies of the facility that she works at?



Unconscious has nothing to do with CPR.  There is nothing in the article that I read that says the patient actually stopped breathing at the facility.

re: credentials:  Generally speaking (and each state is different) nurse practice acts declare what you are legally capable of doing, not what one should do in a situation.  Facility rules and procedures trump practice acts so long as facility rules do not force one to violate practice acts.  Sounds like in this case, they have an R2 or R2 on site somewhere who is supposed to be doing these kinds of things.

It's very easy to jump on the bandwagon here, but there is quite a bit of data missing.
 
2013-03-03 09:58:31 PM

Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

I'm guessing further information will show that the 87 year old resident had other issues that would have made it a moot point anyways.  It's not like simply doing CPR saves everyone.


I found a guy lying next to my neighbor's house (it was the pest control guy).  No pulse, no breathing, no heartbeat, ashen gray in color.  911 dispatcher talked me through CPR (had never done it before, but sort of new the basics) which I performed on the guy until the EMTs arrived.

Dude died.
 
2013-03-03 09:59:35 PM

Relatively Obscure: NotoriousFire: Since I don't want my research to go to waste, here's a random quote:

"CPR stands for cardiopulmonary resuscitation. It is an emergency lifesaving procedure that is done when someone's breathing or heartbeat has stopped. This may happen after an electric shock, heart attack, or drowning."

http://www.nlm.nih.gov/medlineplus/ency/article/000010.htm

Same site, under "adult":

If the person is not breathing or has trouble breathing:Cover their mouth tightly with your mouth.Pinch the nose closed.Keep the chin lifted and head tilted.Give 2 rescue breaths. Each breath should take about a second and make the chest rise.



Guess it depends on your definitions of "barely breathing" and "has trouble breathing." Clearly we and every other armchair nurse in here know far better than the nurse on-scene, right?

Still think if something was fishy with the way this whole thing went down, the family would be out for money from the home. They're already guaranteed the inheritance - why not go for the extra if something was odd with what the nurse did? Sounds like a non-issue.
 
2013-03-03 09:59:57 PM

chookbillion: Yeah, she's getting a little full of herself, isn't she? Saying "are you going to let her die" is emotional blackmail. The old lady was dying suddenly, and it sure as hell wasn't the nurse's fault, but the 911 person was insinuating that it was. That's a terrible thing to do.


Withholding care when you're technically a medical professional is a kind of a terrible thing to do.
 
2013-03-03 10:01:13 PM

Gulper Eel: If I'm reading this bit on the California good samaritan law correctly, it looks to me that the nursing home could've been sued to the eyeballs - not for trying the CPR, but if something else went wrong somewhere along the line.


That's my thought too.

The home is trying to save itself from lawsuits, which is a sad fact in today's world.
 
2013-03-03 10:03:06 PM

NotoriousFire: Guess it depends on your definitions of "barely breathing" and "has trouble breathing." Clearly we and every other armchair nurse in here know far better than the nurse on-scene, right?


I don't know, but nothing indicates that the patient's condition was motivating her actions except for talking on the phone.  The rest was "it's not our policy to do that."  Which it sounds like is true.

NotoriousFire: Still think if something was fishy with the way this whole thing went down, the family would be out for money from the home. They're already guaranteed the inheritance - why not go for the extra if something was odd with what the nurse did? Sounds like a non-issue.


There may or may not be people in my family to whom I'd have different reactions to different levels of care.
 
2013-03-03 10:03:18 PM
Recently did a networking project for a nursing home chain.  All I can say is, please bring on the death panels.  Because at the point that I need to be put in one of those places, I would rather be dead on my own terms.
 
2013-03-03 10:03:19 PM
ByOwlLight:
Withholding care when you're technically a medical professional is a kind of a terrible thing to do.

But the issue here is CPR wasn't appropriate, and likely wouldn't have done squat, anyway.  I mean, what next, you yell at the tow truck driver for not jump starting your car when it has a flat tire?
 
2013-03-03 10:03:22 PM
finnished:
http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/dow nl oadable/ucm_317350.pdf

Notice, that rescue compressions are appropriate even if the victim is "not breathing normally." For example with choking, you may be able to dislodge the blocking object with compressions.


From your article, "not breathing normally" is defined as "ie, not breathing or only gasping." Barely breathing doesn't really sound like either of the two. I know you weren't connecting your point to the article, I'm merely pointing this out.
 
2013-03-03 10:03:34 PM

FarkinSneakyBastage: Can I please have the freedom to choose how and when I die and not rot to death in one of these depressing shiatholes they call a retirement community? That'd be great, thanks


Take up smoking.
 
2013-03-03 10:03:35 PM

Relatively Obscure: None of that being relevant to why this particular person did what they did.


If the reporting is accurate - the only relevant issue is that the 911 dispatcher should never have told the nurse to start CPR on a person who was still breathing.

If the reporting isn't accurate and the patient wasn't breathing, the nurse still shouldn't have performed CPR, because it rarely works on healthy young people, let alone nursing home patients.
 
2013-03-03 10:03:36 PM

Fell In Love With a Chair: djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather. CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.

THIIIIISSSSSS
That was the first farking thing I thought when I read this article. Why in fark's name would you do CPR ON SOMEONE WHOSE HEART IS BEATING AND THEY ARE STILL BREATHING?
You DO NOT do chest compressions on someone whose heart is still beating!
You DO NOT do rescue breathing on someone who is still farking breathing on their own!

The funny part is, I haven't had a CPR course EVER and I farking know this!


Actually you can.  Slightly bruised and alive is better than dead.  Every time. Right now, at least where I am it's if there's no breathing you don't even bother checking for a pulse you just go for the compressions. The problem is people like YOU scaring off passer-bys through indecision.  Even if you're having trouble telling whether they're breathing or not go for it.  It's not going to make dead any worse.

Yeah, CPR has a 2% survival rate if the person is found unconscious.  2% is better than 0%.  JUST DO IT.
 
2013-03-03 10:04:20 PM
I hope that nurse dies slowly, in full view of people unwilling to help her.
 
2013-03-03 10:04:29 PM
I'm guessing that the "nurse" in the facility really isn't a nurse.
 
2013-03-03 10:05:02 PM

PsychoPhil: But the issue here is CPR wasn't appropriate, and likely wouldn't have done squat, anyway. I mean, what next, you yell at the tow truck driver for not jump starting your car when it has a flat tire?


I fail to see how it wasn't appropriate.  "She was old" is not a good enough answer.
 
2013-03-03 10:05:44 PM

JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.


2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.
 
2013-03-03 10:05:58 PM
I'm surprised everyone is jumping to the liability thing.  By the way the management stressed that they are an independent living facility and the daughter, who is a nurse, said she was satisfied with the care her mother received... I would say its more likely this residence was chosen because she did not, in fact, want to be surrounded by nurses etc all the time.  Its likely the "nurse" isnt an actual nurse at all.
 
2013-03-03 10:06:02 PM

RandomRandom: If the reporting is accurate - the only relevant issue is that the 911 dispatcher should never have told the nurse to start CPR on a person who was still breathing.


Some institutions clearly indicate that CPR should be started if the person has difficulty breathing.

RandomRandom: If the reporting isn't accurate and the patient wasn't breathing, the nurse still shouldn't have performed CPR, because it rarely works on healthy young people, let alone nursing home patients.


I don't understand how 'rarely works' is a good reason, unless it works far less than doing nothing.
 
2013-03-03 10:06:11 PM
Obamacare
 
2013-03-03 10:06:14 PM
Do you know how often CPR is "successful"?
 
2013-03-03 10:06:34 PM
I got dibs on her chocolate pudding.
 
2013-03-03 10:07:15 PM

ByOwlLight: PsychoPhil: But the issue here is CPR wasn't appropriate, and likely wouldn't have done squat, anyway. I mean, what next, you yell at the tow truck driver for not jump starting your car when it has a flat tire?

I fail to see how it wasn't appropriate.  "She was old" is not a good enough answer.



Have you missed the numerous sources already cited that question the use of CPR on a breathing individual? Barely breathing, yes, but not gasping, etc. Is that not enough for you to possibly question that the on-scene person made possibly the right call?
 
2013-03-03 10:07:50 PM
NotoriousFire:
From your article, "not breathing normally" is defined as "ie, not breathing or only gasping." Barely breathing doesn't really sound like either of the two. I know you weren't connecting your point to the article, I'm merely pointing this out.

Obviously, it's a judgment call what's normal breathing. My point was that chest compressions can be appropriate even if the victim's heart is still beating.
 
2013-03-03 10:09:02 PM
Between the transcript and the whole demanding CPR be performed on someone who was still breathing, I'm gonna go with: the dispatcher is a bit of a spaz.
 
2013-03-03 10:09:39 PM

NotoriousFire: Have you missed the numerous sources already cited that question the use of CPR on a breathing individual? Barely breathing, yes, but not gasping, etc. Is that not enough for you to possibly question that the on-scene person made possibly the right call?


It doesn't appear anywhere that the on-scene nurse was doing that kind of an assessment at all.  If she wasn't breathing at all, it sounds like her response would have been "Yeah, we don't do that."

It may have been the right call in the end, but it wasn't like the nurse came to that conclusion.  She just said she's not helping because her boss said not to.

But, this being a news article, I'm sure there's plenty missing.
 
2013-03-03 10:09:46 PM

RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.


That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?
 
2013-03-03 10:10:35 PM

Spaghetti Eatin' Goombah: Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

I'm guessing further information will show that the 87 year old resident had other issues that would have made it a moot point anyways.  It's not like simply doing CPR saves everyone.

I found a guy lying next to my neighbor's house (it was the pest control guy).  No pulse, no breathing, no heartbeat, ashen gray in color.  911 dispatcher talked me through CPR (had never done it before, but sort of new the basics) which I performed on the guy until the EMTs arrived.

Dude died.


Dude was dead when you found him.
 
2013-03-03 10:10:42 PM

quizzical: Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

A nurse in a medical facility should already have that training.


FTA: After the nurse repeatedly refused, Halverson asked her to find a passerby or anyone who would be willing to help.  Halverson said she would talk someone through performing CPR.

octopied: Perhaps the patients there have DNR orders.

If you don't know what that is, it's for people who are viewed as so close to death that they have orders for  no CPR to be performed, as they want to die "naturally".


She did not.

djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.


See: agonal respiration

foxyshadis: But it was too much trouble for the reporter to ask if the 911 operator had a damn clue what they were talking about


FTA: Bakersfield Fire Battalion Chief Anthony Galagazza said Halverson followed protocol and that dispatchers give CPR instructions over the phone numerous times a year.
 
2013-03-03 10:10:45 PM

JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.


This.
 
2013-03-03 10:11:27 PM

Bonanza Jellybean: Between the transcript and the whole demanding CPR be performed on someone who was still breathing


NIH recommends rescue breathing/CPR for people with difficulty breathing.
 
2013-03-03 10:11:35 PM

NotoriousFire: Have you missed the numerous sources already cited that question the use of CPR on a breathing individual? Barely breathing, yes, but not gasping, etc. Is that not enough for you to possibly question that the on-scene person made possibly the right call?


As other people have pointed out, some places recommend you start chest compressions if the person is passed out and cannot be roused.  That's the training I received when I got certed.

From the sound of things, the nurse in question did not make the call to not perform CPR because the woman didn't need it, she made the call because the facility has a policy of not performing CPR.  Those are two totally different beasts.  If the nurse had said "She's still breathing, I don't think CPR is the right call at this time" it would have been a totally different ballgame and I would have sided with her.  But she didn't.  She said she wouldn't do it because of the policy.
 
2013-03-03 10:12:06 PM

djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.


Yeah, surprised nobody picked up on that. You do CPR, good chance you are going to break something. Not a big deal if it's a non-breathing individual, no pulse, in which case you can only try and keep some oxygen going to the brain, but if they're breathing and pulse beating, you don't do it. Same as you do NOT do the Heimlich maneuver on a person who can talk. You just take them from being someone with a bit of airway obstruction to someone with airway obstruction PLUS broken ribs.
 
2013-03-03 10:12:17 PM
Oh, also, is it just me or is this whole thread all kinds of whacked out?
 
2013-03-03 10:13:28 PM

Relatively Obscure: NotoriousFire: Have you missed the numerous sources already cited that question the use of CPR on a breathing individual? Barely breathing, yes, but not gasping, etc. Is that not enough for you to possibly question that the on-scene person made possibly the right call?

It doesn't appear anywhere that the on-scene nurse was doing that kind of an assessment at all.  If she wasn't breathing at all, it sounds like her response would have been "Yeah, we don't do that."

It may have been the right call in the end, but it wasn't like the nurse came to that conclusion.  She just said she's not helping because her boss said not to.

But, this being a news article, I'm sure there's plenty missing.



True, good points all around. Just to continue the discussion, perhaps the nurse fell back on that excuse simply because it was the easiest way to tell the fire dispatcher to pound sand. If the two of them (the nurse and dispatcher) got into a verbal fight over whose medical knowledge was better, that'd probably get real ugly for the "nurse." Saying it was "the rules" likely was much simplier for the nurse to defend.

/For all we know, the nursing home already paid off the family, hence why they aren't complaining.
 
2013-03-03 10:14:08 PM

ten foiled hats: Oh, also, is it just me or is this whole thread all kinds of whacked out?


I believe that it's on the Internet, so the odds of it being "all kinds of whacked out" are approximately 4,362.76%.
 
2013-03-03 10:15:01 PM

chookbillion: Spaghetti Eatin' Goombah: Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

I'm guessing further information will show that the 87 year old resident had other issues that would have made it a moot point anyways.  It's not like simply doing CPR saves everyone.

I found a guy lying next to my neighbor's house (it was the pest control guy).  No pulse, no breathing, no heartbeat, ashen gray in color.  911 dispatcher talked me through CPR (had never done it before, but sort of new the basics) which I performed on the guy until the EMTs arrived.

Dude died.

Dude was dead when you found him.


Yeah, pretty much thought the same thing when I found him.  Was kinda hoping something "magical" might happen, but never did.  Guy was 58.
 
2013-03-03 10:16:11 PM

NotoriousFire: True, good points all around. Just to continue the discussion, perhaps the nurse fell back on that excuse simply because it was the easiest way to tell the fire dispatcher to pound sand. If the two of them (the nurse and dispatcher) got into a verbal fight over whose medical knowledge was better, that'd probably get real ugly for the "nurse." Saying it was "the rules" likely was much simplier for the nurse to defend.


Could be, sure.  I can see that as a possibility, at least.  Doesn't seem like the best route to take, but I suppose it could happen.

NotoriousFire: /For all we know, the nursing home already paid off the family, hence why they aren't complaining.


Or, they could just be glad she's dead :P


Anyway, gotta go do some work.  Will probably check in later.
 
2013-03-03 10:16:38 PM

Fell In Love With a Chair: djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather. CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.

THIIIIISSSSSS
That was the first farking thing I thought when I read this article. Why in fark's name would you do CPR ON SOMEONE WHOSE HEART IS BEATING AND THEY ARE STILL BREATHING?
You DO NOT do chest compressions on someone whose heart is still beating!
You DO NOT do rescue breathing on someone who is still farking breathing on their own!

The funny part is, I haven't had a CPR course EVER and I farking know this!


That's odd, I've done CPR on a person who was breathing and had a heart beat. But I guess you would know better than those of us in emergency services
 
2013-03-03 10:16:45 PM

cynicalbastard: djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.

Yeah, surprised nobody picked up on that. You do CPR, good chance you are going to break something. Not a big deal if it's a non-breathing individual, no pulse, in which case you can only try and keep some oxygen going to the brain, but if they're breathing and pulse beating, you don't do it. Same as you do NOT do the Heimlich maneuver on a person who can talk. You just take them from being someone with a bit of airway obstruction to someone with airway obstruction PLUS broken ribs.


This is not true at all.  As a random passerby, being able to tell if somebody has a pulse and is breathing can be really crazy difficult, and usually not worth the time.  If somebody has collapsed, isn't responsive whatsoever, performing CPR is recommended.

Medical professionals are a totally different story, since they have training for that shiat.

Obviously, you wouldn't perform CPR on somebody who is responsive in some way, just as you wouldn't perform the heimlich on somebody who can talk.
 
2013-03-03 10:16:49 PM

cynicalbastard: You do CPR, good chance you are going to break something.


But it's like everyone is saying - better alive and with extreme pain and broken bones for the short remainder of your life than being dead! Plus, the old woman could sue the bejesus out of the facility for performing it. Sounds like a great plan!
 
2013-03-03 10:17:12 PM
Does no one else think this death is (policy-wise) deliberate? Sure your kids say they're gonna pick out a great place. And they do, it has tennis courts, a pool, it's even got a picturesque view, because it's way out in the mountains, "won't be a whole lotta traffic to keep you up at night anymore ma" "You won't have to worry about the coloreds moving in down the street either" "they've got 10 nurses on staff at all times" And the policy of the facility is de facto DNR. Meaning that the little bastard that puts you in wants to get at your money before the retirement home sucks it all up.

I like the idea of having the option to check into a place like this, but I'd like to know that it was me making the decision for myself, not my asshole money grubbing kids.
 
2013-03-03 10:19:17 PM

James F. Campbell: FTA: Bayless' daughter told KGET that she was a nurse and was satisfied with her mother's care at Glenwood Gardens, the station reported.

IIIInteresting.


Yep. Sounds like there is more to this than the paper is reporting, either a large inheritance or a woman who was dying and had an informal DNR that the family was on board with.
 
GBB
2013-03-03 10:19:59 PM

AverageAmericanGuy: I'm going to sound cold here, but the woman was in her late 80s. Sometimes its just a person's time to go.

The operator sounds like a spaz, from the way she's portrayed in the article. "It's a human being" Yes, and human beings die all the time. You can't be Superman and save everyone all the time.


Yeah, this is pretty much what you get when you have 2 people both trying to follow the policies of their respective work places, and those policies are in conflict.
 
2013-03-03 10:20:13 PM
But what is a life when measured against a policy? I mean, let's be reasonable, people. It's a POLICY. Which word do you not understand?
 
2013-03-03 10:20:20 PM

Relatively Obscure: NotoriousFire: /For all we know, the nursing home already paid off the family, hence why they aren't complaining.

Or, they could just be glad she's dead :P



See, I just find that difficult to digest. I'd be glad to win the lottery, but if I found a way to win even more money (the lawsuit against the facility in this case), I'd be all over it to sweeten the deal. Considering where the old woman was, I doubt she was loaded with money. And with her being in the home, the family doesn't have to see her much if they don't want to. Thus, just difficult for me to believe that's completely the case.

For the record, likely in the contract between the facility and the woman/family, there's a clause about not performing CPR at certain times (or perhaps at all). Assuming the woman/family signed this contract (which they'd have to), then they knew what to expect. If this clause was in existence, and the facility did perform CPR, they'd be in breach of contract and sued. What would you do if you were that nurse and knew that?
 
2013-03-03 10:20:41 PM
Sounds like her death panel came up...positive. YEEEEAAAAHH..

//no actual politics intended, just a bad pun.
 
2013-03-03 10:21:02 PM

JMacPA: That's great and all, but is CPR going to make her any deader? What exactly are the negative aspects of an attempt?


It's torture, it breaks ribs, it doesn't work.

The vast majority of retired physicians in nursing home end-of-life situations do not sign releases for CPR.  They know it doesn't work and have no desire to be tortured by the practice in their last moments of life.

It's not evil or cold to deny CPR to the nursing home population.  Given that it doesn't work on them, absence of CPR is just more compassionate.
 
2013-03-03 10:21:28 PM
www.jackscanlan.com
 
2013-03-03 10:23:08 PM
Dispatchers in Kern County have to go through EMD training. It's not a matter of whether a dispatcher "thinks" someone needs CPR. Depending on the answers given to the questions the dispatchers are required to ask, they may or may not tell the person to start CPR. Look up "agonal breathing" yes they may be breathing, but its inadequate, and if you can't feel a pulse, you start compressions. So, don't question the actions of a very experienced dispatcher, question the nurse who has no ethics or morals.
 
2013-03-03 10:23:44 PM

RandomRandom: JMacPA: That's great and all, but is CPR going to make her any deader? What exactly are the negative aspects of an attempt?

It's torture, it breaks ribs, it doesn't work.

The vast majority of retired physicians in nursing home end-of-life situations do not sign releases for CPR.  They know it doesn't work and have no desire to be tortured by the practice in their last moments of life.

It's not evil or cold to deny CPR to the nursing home population.  Given that it doesn't work on them, absence of CPR is just more compassionate.



I have broken so many ribs in my time with CPR.  From infants to elderly I have never seen CPR work.  Cracked chest or not.  Anecdotal to be sure, but people outside of health care still seem to think it's magic.
 
2013-03-03 10:24:12 PM
I have nothing but contempt for these so called "nurses" in these facilities. My mom was in an assisted living facility after a heart attack and subsequent heart failure (she was young, 67, but had a problem with prescription drugs, so we thought she would kill herself without supervised meds). All was okay for a year until she called wanting me to take her to the ER. I called the head nurse and asked if she had been complaining of pain or not acting well. She told me she had been complaining of some pain in her stomach, but she checked her vitals and everything was fine. She then proceeded to tell me that she "always gets herself worked up on the weekends, maybe just out of boredom". The next morning, mom was complaining so much they had decided to take her to the ER. I got a call at work a couple hours later telling me she had died in the ER. Apparently she had an ischemic bowel that was causing sepsis.

I can't believe I listened to that nurse instead of taking her to the hospital the minute she called. I probably could have sued, but mom's heart was pretty bad so really anything could have happened at anytime. Maybe just not that soon.

/ I miss her
 
2013-03-03 10:24:40 PM
This story sucks, and not for the reasons most people think it does:

1) It's making national news for a policy mandated by a single state.  Every single state in the nation has a different law, no two are the same.
2) CPR on an 87 year old frail woman is cruel.
3) The daughter was ok with this
4) Death has a 100% success rate, deal with it.
5) If we start farking with the CPR and good Samaritan laws using litigation, more people risk getting hurt.  This is one case out of millions that went bad.  Those are pretty good odds.

That being said, if the woman didn't have a DNR, then the facility is likely liable, however who is going to sue the facility?  The daughter was clearly fine with everything
 
2013-03-03 10:25:23 PM

PsychoPhil: ByOwlLight:
Withholding care when you're technically a medical professional is a kind of a terrible thing to do.

But the issue here is CPR wasn't appropriate, and likely wouldn't have done squat, anyway.  I mean, what next, you yell at the tow truck driver for not jump starting your car when it has a flat tire?


No, the issue are

1. the home had a policy of not doing CPR under any circumstances, and
2.  the nurse followed the policy of her employer instead of the expectations of strangers.

Assumptions do not create obligations; contracts do.  The home formed a contract with the state when it got licensed.  It formed a contract with the customer.  The nurse formed a contract with her employer.  The assumptions of dispatchers, TV reporters, and Farkers are irrelevant.
 
2013-03-03 10:25:41 PM
Oh and the woman didn't have a medical condition requiring CPR, as was mentioned in this thread.
 
2013-03-03 10:26:25 PM

NotoriousFire: Considering where the old woman was, I doubt she was loaded with money.


Damn, looked at the wrong link earlier. Nevermind, she was likely loaded. Minimum $2.2k per month, and Medicare not accepted. Guess she did have some benjamins... Link
 
2013-03-03 10:27:35 PM

Relatively Obscure: ten foiled hats: Oh, also, is it just me or is this whole thread all kinds of whacked out?

I believe that it's on the Internet, so the odds of it being "all kinds of whacked out" are approximately 4,362.76%.


So, bet my ass it's not just me, then?

/if I lose, DNR
 
2013-03-03 10:28:06 PM

RandomRandom: JMacPA: That's great and all, but is CPR going to make her any deader? What exactly are the negative aspects of an attempt?

It's torture, it breaks ribs, it doesn't work.

The vast majority of retired physicians in nursing home end-of-life situations do not sign releases for CPR.  They know it doesn't work and have no desire to be tortured by the practice in their last moments of life.

It's not evil or cold to deny CPR to the nursing home population.  Given that it doesn't work on them, absence of CPR is just more compassionate.


This.

A procedure that has a sub-5% chance of reviving someone, combined with a near-100% chance of causing an extremely painful injury that would most likely kill an otherwise healthy elderly person is not the sort of thing nursing homes just up and do. Most of the time their medical professionals and lawyers team up to tell them NOT to do it because cardiac arrest is a much better way to die than cardiac arrest followed by some asshole grinding your ribs into corn flakes on the shattered edges of your sternum followed by dying anyway.

So when the nursing home says "Do not do CPR on this patient" then the right thing for the nurse to do is not do farking CPR. That's how people stay employed, out of jail and away from lifelong court-imposed poverty.
 
2013-03-03 10:28:24 PM

JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?


I think that even on a healthy person things like broken ribs and a cracked sternum are fairly normal outcomes from doing chest compressions. Add an old lady, which probably has some form of osteoporosis, and I would imagine the trauma from chest compressions can be rather severe. To the point that it may indeed prove more dangerous than doing nothing. I would imagine, taking their frailty into account, the best thing the nurse could possibly due was put an oxygen mask on the lady.
 
2013-03-03 10:31:06 PM

RandomRandom: CPR doesn't work very well, not well at all.

Well, it does sometimes work - but does very little lasting good. IIRC, one month after having received CPR, less than 8% of of CPR recipients are alive, most of those are in a persistent vegetative state.


CSB
I was present when a guy -- maybe 60's, 70's, seemingly perfectly healthy -- keeled over. Another onlooker performed CPR until the medics came, and the guy survived. However, he was pretty much a vegetable, and I'm told the family hated the guy who performed CPR for doing it.
 
2013-03-03 10:31:20 PM

Acravius: Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.


good Samaritan laws do not apply to healthcare professionals, they apply to untrained civilians doing their best
 
2013-03-03 10:32:35 PM
Folks calling for help on the phone can get irrational. I had a lady call me once, at a federal parks site, about an injured seagull at a provincial beach 50-odd miles away. I gave her the numbers for provincial wildlife and she wailed "I tried them- there's nobody answering till Monday!" Then silence. Followed by "Omigod, there's some big black birds landing near it- I think they're going to eat it!" "Probably ravens, ma'am. They're very scared of people, if you moved near they'd leave very quickly." "Oh, my- but they're huge and I've got a heart condition- isn't there anything you can do?"
I was so tempted to start singing "The Circle of Life" it wasn't funny.
 
2013-03-03 10:33:16 PM

WhyteRaven74: The nurse needs to lose her license, and the facility needs some serious sanctions if not being shut down


Because they disappointed you?  Show me laws that they broke, then we'll talk.
 
2013-03-03 10:36:31 PM
I was in the waiting room of Mercy hospital here in Oklahoma City. A guy pulled up by the doors, opened the car door and made it about half way to the doors of ER and passed out. He was laying maybe 25 feet from the doors. The people working in the ER called 911. They would not go outside and get him. Me and two other guys walked out and picked him up and carried him into the ER and he was treated. I asked a nurse WTF? She told me that they normally have ambulance crew onsite, but if they are out on a run the policy in this situation is to call 911, they are not allowed to walk out of the doors to help anyone.

/Dude lived, low blood sugar.
 
2013-03-03 10:38:47 PM

wedun: FarkinSneakyBastage: Can I please have the freedom to choose how and when I die and not rot to death in one of these depressing shiatholes they call a retirement community? That'd be great, thanks

try smoking crack, fast cars, hookers, cocaine.


All of those increase your odds of ending up in a nursing home against your wishes.  Live prudently, be realistic about your health, and keep a pistol handy.
 
2013-03-03 10:38:54 PM

The One True TheDavid: I remember when the world's population hit 3 billion, 4 billion people ago; I was entering puberty then.


Wow, you got busy fast!
 
2013-03-03 10:40:03 PM
My grandfather was 86, still grading papers part-time for the University of Toronto (he was a Silver Medallist in Maths in his younger years) when one night he told his wife that he was stopping early, wasn't feeling too good. An hour later he was dead.
That's the way anyone should go, in their own home. Nursing homes scare the crap out of me.
 
2013-03-03 10:40:31 PM

ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.


Correction: she has a piece of paper with a title on it. In reality, she's barely a human being. MOST nurses I know wouldn't think of losing their job over saving the life of a patient.

On the other hand, CPR on an 87 year old outside the hospital...never a gods outcome, oftentimes worse than death, because they revive you so you can spend there months in the ICU and die anyway. I'd give the nyse a pass if this is what she was thinking about, although if the patient didn't have a DNR order, it's her duty to do so. Ironically enough though, if she did that, she'd have to still choose rules over patient's best interest.
 
2013-03-03 10:40:52 PM

NotoriousFire: Relatively Obscure: NotoriousFire: /For all we know, the nursing home already paid off the family, hence why they aren't complaining.

Or, they could just be glad she's dead :P


See, I just find that difficult to digest.


I was just kiddin', anyway.

Lehk: good Samaritan laws do not apply to healthcare professionals, they apply to untrained civilians doing their best


No.  In many states, this is the exact opposite of true.
 
2013-03-03 10:43:39 PM

AverageAmericanGuy: I'm going to sound cold here, but the woman was in her late 80s. Sometimes its just a person's time to go.

The operator sounds like a spaz, from the way she's portrayed in the article. "It's a human being" Yes, and human beings die all the time. You can't be Superman and save everyone all the time.


This.
I hope if I'm 87 in that situation they have the common decency to just let me be.

/ Maybe just a bit of morphine, thank you.
 
2013-03-03 10:46:30 PM
I would not be at all surprised if this "nurse" is actually no more than a CNA (certified nursing assistant).  Nursing homes use mostly CNAs, with a scant handful of LPNs / LVNs, and hardly any actual RNs.

Also, nursing homes suck.  I was stuck in one for three weeks once, and it was pure hell.  How bad was it?  Watching a Lawrence Welk rerun on a Saturday night was a high point.
 
2013-03-03 10:47:21 PM

NightOwl2255: I was in the waiting room of Mercy hospital here in Oklahoma City. A guy pulled up by the doors, opened the car door and made it about half way to the doors of ER and passed out. He was laying maybe 25 feet from the doors. The people working in the ER called 911. They would not go outside and get him. Me and two other guys walked out and picked him up and carried him into the ER and he was treated. I asked a nurse WTF? She told me that they normally have ambulance crew onsite, but if they are out on a run the policy in this situation is to call 911, they are not allowed to walk out of the doors to help anyone.

/Dude lived, low blood sugar.


Several good reasons for that:

- The hospital's insurance policy does not cover any care given outside of the building. Even if the patient is brought inside, the care given by the hospital started outside (cf. "the care given by the paramedic before the patient was handed over to the hospital inside the hospital building") so the insurance company isn't responsible for when something goes wrong.
- A nurse is not a paramedic. They don't have advanced life support equipment, training, insurance and most importantly, the help of a second paramedic.
- The ER nurse is responsible for everyone in the ER. If he turns his back to go outside and play paramedic, and someone inside has a grievous change of condition, that's his ass. Even if there was someone else there. Even if every RN, RPN, HCA and agency jackoff with stolen scrubs and a forged green card were crammed into the ER. The insurance company and the lawyers will say the level of care was diminished because someone who was required to be there farked off to someone else's job after specifically being told not to.
 
2013-03-03 10:47:47 PM
At least she died doing what she loved.
 
2013-03-03 10:50:34 PM

Korzine: JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?

I think that even on a healthy person things like broken ribs and a cracked sternum are fairly normal outcomes from doing chest compressions. Add an old lady, which probably has some form of osteoporosis, and I would imagine the trauma from chest compressions can be rather severe. To the point that it may indeed prove more dangerous than doing nothing. I would imagine, taking their frailty into account, the best thing the nurse could possibly due was put an oxygen mask on the lady.


She's dead. Soooo, no.
 
2013-03-03 10:54:00 PM

Xanadone: I would not be at all surprised if this "nurse" is actually no more than a CNA (certified nursing assistant).  Nursing homes use mostly CNAs, with a scant handful of LPNs / LVNs, and hardly any actual RNs.

Also, nursing homes suck.  I was stuck in one for three weeks once, and it was pure hell.  How bad was it?  Watching a Lawrence Welk rerun on a Saturday night was a high point.


What a bug you've got up your ass. What's wrong? They take your rings? They take your Rolex?
 
2013-03-03 10:54:38 PM

rga184: ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.

Correction: she has a piece of paper with a title on it. In reality, she's barely a human being. MOST nurses I know wouldn't think of losing their job over saving the life of a patient.


Then most nurses you know are older ones who are in it mainly for the warm fuzzies.  Nurses I've known wouldn't even give a handy for less than $20.  Of course, I always insist on the young, cute, underpaid ones who are supporting three babbies.
 
2013-03-03 10:55:00 PM

Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.


What happened to "one-one-thousand-two-one-thousand-three-one-thousand-four-one-thousan d-five-one-thousand-BREATHE" ?
 
2013-03-03 10:57:14 PM
It's been replaced by Mississippis.
 
2013-03-03 10:57:32 PM

ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.


An old lady, one of many, or your kids?

Pick one.
 
2013-03-03 10:58:02 PM

SpdrJay: Well if she didn't wanna die she shouldn't have gotten old!



img811.imageshack.us

Shanna, they bought their tickets, they knew what they were getting into. I say, let 'em crash.
 
2013-03-03 11:02:00 PM
The nurse signed the oath. Let her wait on tables the rest of her life.
 
2013-03-03 11:02:15 PM
My not so CSB...
My father was in a senior care facility, very bad diabetes, half of his heart basically destroyed, no circulation to his lower extremeties, and advanced alzheimers.
My mother, my sister and I came together as a family and issued a DNR so as not to prolong his suffering, he was 70.
At the facility he arrested one one evening and was taken by ambulance to the hospital, where he was promptly put on a ventilator, in clear defiance of the family ordered DNR.
Upon receiving news of said event from my frantic sister and mother, I promptly left work, drove 200 miles back home to the hospital, where I was met by my entire family in tears..
After ripping the nursing staff a new asshole, I ordered him to be removed from the ventilator, and doped to the gills..after comfirmation from my mother it was ordered.
We got the oh so great honor of watching my father gasp for breath for 2 hours , before he finally let go
 
2013-03-03 11:02:51 PM

Pointy Tail of Satan: The nurse signed the oath. Let her wait on tables the rest of her life.


What oath?
 
2013-03-03 11:04:08 PM
lh4.ggpht.com

doglover: An old lady, one of many, or your kids?


Godwin'd, beyotch!

/I only keed.
 
2013-03-03 11:04:17 PM

BarkingUnicorn: wedun: FarkinSneakyBastage: Can I please have the freedom to choose how and when I die and not rot to death in one of these depressing shiatholes they call a retirement community? That'd be great, thanks

try smoking crack, fast cars, hookers, cocaine.

All of those increase your odds of ending up in a nursing home against your wishes.  Live prudently, be realistic about your health, and keep a pistol handy.


My plan is cigarettes, alcohol, and the diet of a prediabetic teenager until I get too old and decrepit to make it on my own. Then I'll take out an ad on Craigslist.

Wanted: Thrill seeker or psychopath willing to end old man's life. Murder fantasies and extreme sports considered. Must bring own weapons. I have only done this once before.
 
2013-03-03 11:05:05 PM
Patient was breathing, CPR should not have been performed, 911 dispatchers are not medical personnel, non story.

And yeah, from my meager training, CPR on the elderly is not always the best idea, even on a healthy person if you do CPR right youre likely to break a rib or two. One thing i explicitly remember from training is to make sure youre doing compressions high enough on the patient, or youre likely to break the xiphoid process and cause internal bleeding. I remember that so well because the instructor kept saying regarding the possible internal hemorrhaging that it would "bleed like stink" and that was really funny for some reason.

CPR is not the panacea you see on television.
 
2013-03-03 11:06:02 PM

Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.


Ummm..i thought the new CPR rules are NO breathes...just compressions?
 
2013-03-03 11:06:06 PM

Cyno01: 911 dispatchers are not medical personnel, non story.


That's not true everywhere.  That's not true where I live.
 
2013-03-03 11:06:49 PM

Keyserroll: Ummm..i thought the new CPR rules are NO breathes...just compressions?


AHA's rules are, I think.  Not everyone's.
 
2013-03-03 11:07:32 PM

Cyno01: Patient was breathing, CPR should not have been performed, 911 dispatchers are not medical personnel, non story.

And yeah, from my meager training, CPR on the elderly is not always the best idea, even on a healthy person if you do CPR right youre likely to break a rib or two. One thing i explicitly remember from training is to make sure youre doing compressions high enough on the patient, or youre likely to break the xiphoid process and cause internal bleeding. I remember that so well because the instructor kept saying regarding the possible internal hemorrhaging that it would "bleed like stink" and that was really funny for some reason.

CPR is not the panacea you see on television.


To this day I remember my first code / cpr.  Brutal.  Crunch, crunch, crunch.  Ribs were snapping like twigs.  Broke me in as to what I should expect though.  Patient died.
 
2013-03-03 11:07:42 PM

Relatively Obscure: [lh4.ggpht.com image 188x270]
doglover: An old lady, one of many, or your kids?

Godwin'd, beyotch!

/I only keed.


Rommel?
 
2013-03-03 11:08:46 PM

BafflerMeal: Pointy Tail of Satan: The nurse signed the oath. Let her wait on tables the rest of her life.

What oath?


The "Nightingale Oath" that nurses recite at their graduations.  Has nothing to do with Florence Nightingale.  It has no more to do with certification or licensing than the Pledge of Allegiance does.
 
2013-03-03 11:10:08 PM

doglover: Relatively Obscure: [lh4.ggpht.com image 188x270]
doglover: An old lady, one of many, or your kids?

Godwin'd, beyotch!

/I only keed.

Rommel?


Don't think so.  Just a generic Nazi search.  Even more of a butt-chin than Rommel's I think.
 
2013-03-03 11:11:05 PM

JMacPA: Korzine: JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?

I think that even on a healthy person things like broken ribs and a cracked sternum are fairly normal outcomes from doing chest compressions. Add an old lady, which probably has some form of osteoporosis, and I would imagine the trauma from chest compressions can be rather severe. To the point that it may indeed prove more dangerous than doing nothing. I would imagine, taking their frailty into account, the best thing the nurse could possibly due was put an oxygen mask on the lady.

She's dead. Soooo, no.


Only in this specific case where we already know the outcome. What if they began chest compressions, shattered her ribs and sternum, only to find out she fainted because of low blood pressure (not sure this is 100% appropriate comparison, but it's the best I can think of off hand) or some such. Then we'd all be reading a story on how the nursing home was brutalizing patients with unnecessary medical procedures. There really is no win for the nursing home. Do or don't the end outrage will exist depending only on the outcome. Since the outrage outcome will eventually be the same no matter what they do, they simply choose the path of least liability.
 
2013-03-03 11:11:12 PM
I realize the woman was old, but that 911 call was some cold shiat.
 
2013-03-03 11:12:01 PM

BarkingUnicorn: BafflerMeal: Pointy Tail of Satan: The nurse signed the oath. Let her wait on tables the rest of her life.

What oath?

The "Nightingale Oath" that nurses recite at their graduations.  Has nothing to do with Florence Nightingale.  It has no more to do with certification or licensing than the Pledge of Allegiance does.



Ah yeah, that.  I remember all that now.  I white washed a lot of that night in my head.
 
2013-03-03 11:14:46 PM
No modified lemon party?

Live, dang you!
 
2013-03-03 11:15:26 PM
I learned CPR back in the 7th grade as a unit in health class. I think we all got certified, but
it was so long ago (decades) I can't remember.

At any rate, I only had to use it once. It was probably 12 years ago or so. I was home with my
son and we were out on the balcony of our apartment. The woman downstairs comes screaming
out of her apartment looking for someone - anyone - to help her. Her husband had collapsed
and wasn't breathing.

A couple of people just eyed her sideways and carried on. I hesitated for a moment (I'm still a
bit ashamed that I even hesitated) then grabbed my 4 year old and went downstairs. The
husband was collapsed on the floor of the bedroom. The woman's older son was there and
all of the 7th grade stuff came rushing back. I told the son how to do the compressions and I
did the breaths

Sadly, it was ineffective. I felt the man's life leave him before the paramedic (yes, as in one) got
there. Since he didn't have anyone with him, the paramedic had me stay and do compressions
while he bagged him.

Turns out the husband had had a stroke. I felt awful that I hadn't been able to help but when I
went downstairs a couple of days later to see how the woman was doing, the son told me that
they were just glad that *someone* tried to help.

I had to do the heimlich on my dad once too. Fortunately I met with more success that time.
 
2013-03-03 11:15:27 PM

IanMoone: So, if I was the family, I would sue the 911 dispatcher for telling someone to start CPR when someone is still breathing.

Good Samaritan Laws mean NOTHING if you are trained (or should have been trained) and do it wrong.  Heck even California knows this where a survivor sued the person who took her out of a burning car because her actions caused her injuries. (not the car crash, and nevermind that she probably would have suffered a fiery death had she remained in the car)


Countersue to set the survivor back on fire and finish the job.
 
2013-03-03 11:15:52 PM

The Evil That Lies In The Hearts Of Men: James F. Campbell: FTA: Bayless' daughter told KGET that she was a nurse and was satisfied with her mother's care at Glenwood Gardens, the station reported.

IIIInteresting.

Yep. Sounds like there is more to this than the paper is reporting, either a large inheritance or a woman who was dying and had an informal DNR that the family was on board with.


I'm also thinking Out of Court settlement. When there's a 911 recording of a facility's screw-up from beginning to end, they probably don't want this going to trial.
 
2013-03-03 11:22:49 PM

ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.


Bingo. Hard time come to terms with that. But it's very true
 
2013-03-03 11:23:38 PM

Cyno01: Patient was breathing, CPR should not have been performed, 911 dispatchers are not medical personnel, non story.


Says who? The derpity derp "nurse" who was more concerned about her personal stress level?
 
2013-03-03 11:24:17 PM

JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?


Here's as good of a place to jump in as any.  If she's the typical little old ladies, those ribs are FRAGILE.  Like, bag of potato chips fragile.  Since the purpose of chest compressions in CPR is to circulate blood, if the patient's heart is still running, it's much better to let it do its job. 

CPR on a living patient is a good way to kill them.  The lady was breathing.  CPR is the wrong treatment.  Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.
 
2013-03-03 11:28:08 PM

DoctorCal: No modified lemon party?

Live, dang you!


Not safe for Featured Partner Fark
 
2013-03-03 11:29:12 PM

djh0101010: JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?

Here's as good of a place to jump in as any.  If she's the typical little old ladies, those ribs are FRAGILE.  Like, bag of potato chips fragile.  Since the purpose of chest compressions in CPR is to circulate blood, if the patient's heart is still running, it's much better to let it do its job. 

CPR on a living patient is a good way to kill them.  The lady was breathing.  CPR is the wrong treatment.  Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.


Yep.  CPR is done on folks who are clinically dead.  They may not be biologically dead yet, but clinically they are (excluding the bit about state laws regarding who says 'call it' for legal purposes)

I have never lost a patient through CPR.  The use of CPR indicates they were dead when I started.  With that framework understood, I've never 'gained' a patient either.  They've all been dead when I started, and dead when I was done.
 
2013-03-03 11:32:05 PM

NutWrench: The Evil That Lies In The Hearts Of Men: James F. Campbell: FTA: Bayless' daughter told KGET that she was a nurse and was satisfied with her mother's care at Glenwood Gardens, the station reported.

IIIInteresting.

Yep. Sounds like there is more to this than the paper is reporting, either a large inheritance or a woman who was dying and had an informal DNR that the family was on board with.

I'm also thinking Out of Court settlement. When there's a 911 recording of a facility's screw-up from beginning to end, they probably don't want this going to trial.


I could be wrong on this, but it seems to me that if it's their policy, as in they admit it freely, then wouldn't they have made sure that it's legal?  I can't see them making an official policy that gives people grounds to squeeze them for settlements.

In fact I bet it's the opposite, that they have this policy specifically because it's the least likely approach to cost them settlement money down the line.
 
2013-03-03 11:33:14 PM

Fell In Love With a Chair: djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather. CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.

THIIIIISSSSSS
That was the first farking thing I thought when I read this article. Why in fark's name would you do CPR ON SOMEONE WHOSE HEART IS BEATING AND THEY ARE STILL BREATHING?
You DO NOT do chest compressions on someone whose heart is still beating!
You DO NOT do rescue breathing on someone who is still farking breathing on their own!

The funny part is, I haven't had a CPR course EVER and I farking know this!


yeah.. you should probably take one, as you are dead wrong.
http://firstaid.about.com/od/cprbasics/f/09_Gasping_CPR.htm">http:// firstaid.about.com/od/cprbasics/f/09_Gasping_CPR.htm
 
2013-03-03 11:35:56 PM
Peter von Nostrand:

That's odd, I've done CPR on a person who was breathing and had a heart beat. But I guess you would know better than those of us in emergency services

What do you mean by "heart beat"? Electrical activity or a pulse?
 
2013-03-03 11:36:52 PM

djh0101010: JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?

Here's as good of a place to jump in as any.  If she's the typical little old ladies, those ribs are FRAGILE.  Like, bag of potato chips fragile.  Since the purpose of chest compressions in CPR is to circulate blood, if the patient's heart is still running, it's much better to let it do its job. 

CPR on a living patient is a good way to kill them.  The lady was breathing.  CPR is the wrong treatment.  Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.


i am sorry, but where the hell did you get trained??  CPR is exactly what is performed on a choking casualty, and doesn't kill them.  i agree that CPR on an elderly patient will probably not have a positive outcome, but the lazy biatch didn't even try.  Most likely she was going through agonal respirations, not proper breaths.  i posted this already, and it seems pretty self explanatory even in laymans' terms...
http://firstaid.about.com/od/cprbasics/f/09_Gasping_CPR.htm">http:// firstaid.about.com/od/cprbasics/f/09_Gasping_CPR.htm
 
2013-03-03 11:37:33 PM

gwendolyyyn: djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.

I was thinking that exact same thing...it said she was still breathing. Barely, but even so.


I don't know if it was the right choice, but I'm inclined to believe the trained nurse over the news here. If she didn't preform CPR, there was probably a good reason.
 
2013-03-03 11:44:56 PM

Lawnchair: AirForceVet: Why bother calling 911 in the first place?

Guess I'll scratch that senior center off my list of retirement homes.

I could go for a place with that much restraint, if I got that old (exceedingly unlikely).  Besides being disindicated for a breathing person, basically no 87-year-old is going to survive the year of rehab from breaking every rib in her body, which would be the outcome from any CPR procedure that's worth the bother.

Why call 911?  Well, she's dying, and if she didn't write a DNR, it's easier for the hospital to deal with that.


All that may be true, but absent a written DNR order, it's not the NURSE'S decision to make. Your patient is going to have a bunch of broken ribs? Sorry, if CPR is indicated, you do CPR. They have a flailed chest from a steering wheel impact? You start CPR anyway. She's old and dying and you don't want the bother? Too bad, if she needs CPR and you don't want the pants sued off you, you initiate CPR.

And if you're on a recorded 911 line and the dispatcher is giving you contraindicated advice--like the lady is still breathing and CPR is not advised at this time--you say "I don't think CPR is advised, so we're not initiating it at this time." You DON"T say "I'm feeling stressed and she's yelling at me" like a whiny biatch. You don't make it sound like you're a callous whore who just called 911 to pick up the body, even if it's true.
 
2013-03-03 11:45:06 PM

ignacio: I don't know if it was the right choice, but I'm inclined to believe the trained nurse over the news here. If she didn't preform CPR, there was probably a good reason.


Her boss would be mad and she likes paychecks.
 
2013-03-03 11:45:09 PM
djh0101010:
Here's as good of a place to jump in as any.  If she's the typical little old ladies, those ribs are FRAGILE.  Like, bag of potato chips fragile.  Since the purpose of chest compressions in CPR is to circulate blood, if the patient's heart is still running, it's much better to let it do its job.

CPR on a living patient is a good way to kill them.  The lady was breathing.  CPR is the wrong treatment.  Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.


You're not the first to point out that she was already breathing, but I agree that it doesn't make sense to revive a breathing person.  When I was a kid the first thing ever said about CPR was 'When you find a person NOT BREATHING...........'.  Also, I do question if the 911 dispatcher was trained in anything besides being a glorified phone operator.  Most are, and it is an important job, but to second guess a trained professional just seems like a silly overreaction.  I listen to Flint's dispatchers and they are not always professional, well sometimes the cops aren't either.  I noticed an officer hitting on the dispatch over the radio, I don't care but it happened.  Usually they just pass calls onto the officers and look up background information for the officers.

/on a side note, a few months ago, I had mentioned how Flint officers could get a lot of criminals off the street by doing some traffic stops.  It worked, they have been and almost every car they stop has no license and/or outstanding warrants.  Surprise!
 
2013-03-03 11:45:12 PM

digitalrain: Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.

What happened to "one-one-thousand-two-one-thousand-three-one-thousand-four-one-thousan d-five-one-thousand-BREATHE" ?


it takes a minimum of 30 compressions to circulate blood through the body once.  sing staying alive under your breath and you will have the right speed.  1.6 compressions per second.  compression only cpr is fine for non-drowned adult casualties, but not in situations where they were already oxygen deprived.  aim high in the center of the chest, compress at least two inches, and allow the chest full recoil.

and yeah.  i teach it for a living.  i also teach health care provider levels, which is teaching nurses cpr.  i am horrified by this whole concept that a nurse would abrogate her duty like this.
 
2013-03-03 11:47:46 PM

AJisaff: CPR on a living patient is a good way to kill them. The lady was breathing. CPR is the wrong treatment. Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.

i am sorry, but where the hell did you get trained?? CPR is exactly what is performed on a choking casualty, and doesn't kill them. i agree that CPR on an elderly patient will probably not have a positive outcome, but the lazy biatch didn't even try. Most likely she was going through agonal respirations, not proper breaths. i posted this already, and it seems pretty self explanatory even in laymans' terms...


You seem to be confusing the Heimlich Maneuver with cardiac compressions.  Totally different mechanism, different action, different part of the body, and for a different reason.  If you're doing CPR on a choking patient, you missed the "airway" part and jumped all the way up to "circulation".
 
2013-03-03 11:48:51 PM

djh0101010: JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?

Here's as good of a place to jump in as any.  If she's the typical little old ladies, those ribs are FRAGILE.  Like, bag of potato chips fragile.  Since the purpose of chest compressions in CPR is to circulate blood, if the patient's heart is still running, it's much better to let it do its job. 

CPR on a living patient is a good way to kill them.  The lady was breathing.  CPR is the wrong treatment.  Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.


You can still have agonal breathing but not a BP that's compatible with life. My best guess would be PEA, so no palpable pulse. In that case you would start CPR.

The dispatchers usually have a flowchart they follow.
 
2013-03-03 11:53:03 PM

WhoGAS: Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.

You don't do breaths any more.


Only true some places, and even then only in layperson CPR. The nurse is at least certified in BLS, so she'd be doing breaths if she was doing CPR
 
2013-03-03 11:53:42 PM
Gyrfalcon:
All that may be true, but absent a written DNR order, it's not the NURSE'S decision to make. Your patient is going to have a bunch of broken ribs? Sorry, if CPR is indicated, you do CPR. They have a flailed chest from a steering wheel impact? You start CPR anyway. She's old and dying and you don't want the bother? Too bad, if she needs CPR and you don't want the pants sued off you, you initiate CPR.

And if you're on a recorded 911 line and the dispatcher is giving you contraindicated advice--like the lady is still breathing and CPR is not advised at this time--you say "I don't think CPR is advised, so we're not initiating it at this time." You DON"T say "I'm feeling stressed and she's yelling at me" like a whiny biatch. You don't make it sound like you're a callous whore who just called 911 to pick up the body, even if it's true.


See, because of that I don't think this so-called nurse was even properly assessing the situation. The patient probably wasn't breathing but meh, I'm stressed and being yelled at, my feelings are hurt.
 
2013-03-03 11:55:36 PM
I'm waiting to see what BronyMedic says.

But regardless of what he says, I waws thinking of having Do Not Resuscitate tattooed on my chest; now I think it should be "Let me die, fool!" tattooed all over my face.

At 37 I had to quit smoking because 1) I was having trouble trouble breathing and 2) this hot chick would let me move in but she was allergic to cigarette smoke (and she is). So I took to drink instead. (And once I became a crazy drunk after 9 years we broke up: that I'd rather drink than screw is not a reflection on her, I swear.)

It's not length of life but the quality of it: if I somehow make it to 60 (10 more years) I'll take up meth and Russian Roulette. The only reason I'd bother sticking around that long is my dog loves me and based on his breed & size he's got maybe 10 more years. Y'all might scoff but I never had a real reason to live before.

But still: if there's ever any indication that "this dude might live but he'll be farked up" then SMOTHER ME WITH A PILLOW!! What good am I if I can't walk my dog till he's tired and then carry him home?
 
2013-03-03 11:56:00 PM

Cyno01: Patient was breathing, CPR should not have been performed, 911 dispatchers are not medical personnel, non story.

And yeah, from my meager training, CPR on the elderly is not always the best idea, even on a healthy person if you do CPR right youre likely to break a rib or two. One thing i explicitly remember from training is to make sure youre doing compressions high enough on the patient, or youre likely to break the xiphoid process and cause internal bleeding. I remember that so well because the instructor kept saying regarding the possible internal hemorrhaging that it would "bleed like stink" and that was really funny for some reason.

CPR is not the panacea you see on television.


What about the magical defibberallator machine? That ALWAYS works, whether it's heart attack or poison or drowning or dyspepsia or whatever.
 
2013-03-03 11:56:25 PM

ArcadianRefugee: ZeroCorpse: People don't become doctors or nurses, or join the medical profession at all these day because they want to help people and save lives. These days, they do it because they want lots of money.

It's a disgrace that we even use the words "nurse" and "doctor" to describe these greedy animals. They bring dishonor to the words.

Pfft. To the people of the Gamma Forests, the word "doctor" means "mighty warrior".


*nerd-squeal*

/whovian
 
2013-03-03 11:57:10 PM
Not commenting on whether the nurse should have performed CPR (which I believe she should have) but on some of the suggestions and opinions stated which are truly baffling...

I have seen the statistic of 2% of people recovering fully after CPR is performed....and the American Heart Association states that 92,000 people were saved by CPR last year....so if both statistics are correct, or even close to correct, that means between 1500-2000 people were not only saved but were able to fully recover from whatever caused CPR to be necessary....

That's a lot of people surviving for CPR to be called "cruel, torturous, and ineffective"

My 2 cents
 
2013-03-03 11:57:56 PM

djh0101010: AJisaff: CPR on a living patient is a good way to kill them. The lady was breathing. CPR is the wrong treatment. Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.

i am sorry, but where the hell did you get trained?? CPR is exactly what is performed on a choking casualty, and doesn't kill them. i agree that CPR on an elderly patient will probably not have a positive outcome, but the lazy biatch didn't even try. Most likely she was going through agonal respirations, not proper breaths. i posted this already, and it seems pretty self explanatory even in laymans' terms...

You seem to be confusing the Heimlich Maneuver with cardiac compressions.  Totally different mechanism, different action, different part of the body, and for a different reason.  If you're doing CPR on a choking patient, you missed the "airway" part and jumped all the way up to "circulation".


um.. no, actually... if a choking patient becomes unconscious, we go to chest compressions.  and the heimlich manoever on it's own has been outdated for about two years now.  we do 5 back blows to relieve the laryngospasm, then 5 abdominal thrusts, until it is cleared, or they become unconscious...  at which point you start chest compressions, check the airway, attempt vents, and clear obstructions if found.
comressions and vents ARE CPR.
 
2013-03-03 11:58:57 PM
The most effective method is to perform CPR for a while, then have someone pull you off the patient as you scream and cry.  After a few seconds the patient will spontaneously take a huge breath, will be mostly recovered within an hour or two.

Also, why don't most nurses carry those Make Heart Go Now syringes with them at all times?  Just slam those suckers directly nto the heart and, bam, alive and kicking.
 
2013-03-03 11:59:12 PM

BuckTurgidson: Cyno01: Patient was breathing, CPR should not have been performed, 911 dispatchers are not medical personnel, non story.

And yeah, from my meager training, CPR on the elderly is not always the best idea, even on a healthy person if you do CPR right youre likely to break a rib or two. One thing i explicitly remember from training is to make sure youre doing compressions high enough on the patient, or youre likely to break the xiphoid process and cause internal bleeding. I remember that so well because the instructor kept saying regarding the possible internal hemorrhaging that it would "bleed like stink" and that was really funny for some reason.

CPR is not the panacea you see on television.

What about the magical defibberallator machine? That ALWAYS works, whether it's heart attack or poison or drowning or dyspepsia or whatever.


And it gives you an orgasm every time.
 
2013-03-04 12:02:48 AM

AJisaff: djh0101010: AJisaff: CPR on a living patient is a good way to kill them. The lady was breathing. CPR is the wrong treatment. Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.

i am sorry, but where the hell did you get trained?? CPR is exactly what is performed on a choking casualty, and doesn't kill them. i agree that CPR on an elderly patient will probably not have a positive outcome, but the lazy biatch didn't even try. Most likely she was going through agonal respirations, not proper breaths. i posted this already, and it seems pretty self explanatory even in laymans' terms...

You seem to be confusing the Heimlich Maneuver with cardiac compressions.  Totally different mechanism, different action, different part of the body, and for a different reason.  If you're doing CPR on a choking patient, you missed the "airway" part and jumped all the way up to "circulation".

um.. no, actually... if a choking patient becomes unconscious, we go to chest compressions.  and the heimlich manoever on it's own has been outdated for about two years now.  we do 5 back blows to relieve the laryngospasm, then 5 abdominal thrusts, until it is cleared, or they become unconscious...  at which point you start chest compressions, check the airway, attempt vents, and clear obstructions if found.
comressions and vents ARE CPR.


Breaths, thrusts, and back until something else is needed.  I sure as hell hope you guys are not doing compressions on someone with a pulse.  Unconscious != pulseless.
 
2013-03-04 12:05:17 AM
Only in Minnesota and Vermont are you required to perform cpr if you're certified. If she was breathing then she needed her mouth cleared and a jaw thrust procedure to open the airway.
 
2013-03-04 12:06:28 AM
RULES ARE RULES! WAARGAARRBLE
 
2013-03-04 12:06:59 AM
I just listened to the recording, that dispatcher really had no clue what was going on.

I've been to homes like this.  You have the residents(elderly) and workers there, that's pretty much it.  If the workers can't do it(CPR) you sure as hell aren't going to get that 90 year old guy eating lunch to do it.  Gimme a break!

If there by chance was a family member having lunch there with her grandma, imagine the reaction if the nurse hands the phone over to her saying "Here, they're going to talk you through doing CPR on this woman".   Haha, no.
 
2013-03-04 12:07:55 AM

BafflerMeal: AJisaff: djh0101010: AJisaff: CPR on a living patient is a good way to kill them. The lady was breathing. CPR is the wrong treatment. Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.

i am sorry, but where the hell did you get trained?? CPR is exactly what is performed on a choking casualty, and doesn't kill them. i agree that CPR on an elderly patient will probably not have a positive outcome, but the lazy biatch didn't even try. Most likely she was going through agonal respirations, not proper breaths. i posted this already, and it seems pretty self explanatory even in laymans' terms...

You seem to be confusing the Heimlich Maneuver with cardiac compressions.  Totally different mechanism, different action, different part of the body, and for a different reason.  If you're doing CPR on a choking patient, you missed the "airway" part and jumped all the way up to "circulation".

um.. no, actually... if a choking patient becomes unconscious, we go to chest compressions.  and the heimlich manoever on it's own has been outdated for about two years now.  we do 5 back blows to relieve the laryngospasm, then 5 abdominal thrusts, until it is cleared, or they become unconscious...  at which point you start chest compressions, check the airway, attempt vents, and clear obstructions if found.
comressions and vents ARE CPR.

Breaths, thrusts, and back until something else is needed.  I sure as hell hope you guys are not doing compressions on someone with a pulse.  Unconscious != pulseless.


No no, didn't you see all the "medics" up there saying you should be doing CPR for choking victims (and/or 87 year old ladies)? Don't be a fool, CPR is appropriate for everyone, and even laypeople should give it a shot.
 
2013-03-04 12:08:34 AM

ignacio: I don't know if it was the right choice, but I'm inclined to believe the trained nurse over the news here.


I'd just like to point out that we're currently arguing over whether it's the nurse, the journalist, or the 911 dispatcher who is an utter failure at their basic job functions. What the hell kind of society do we live in where this isn't an insane argument? I mean, just think about it for a moment: we really do live in a world where we don't find it unremarkable that any person could suck at their job so badly, even the people whose job it is to tell us that others suck at their jobs.
 
2013-03-04 12:09:07 AM

Birnone: If there by chance was a family member having lunch there with her grandma, imagine the reaction if the nurse hands the phone over to her saying "Here, they're going to talk you through doing CPR on this woman". Haha, no.


Because THAT was "Plan A" in this whole thing.
 
2013-03-04 12:12:12 AM

flamingboard: RULES ARE RULES! WAARGAARRBLE


Given the comments here, I half expect someone to hunt the nurse down and light her up.
 
2013-03-04 12:12:25 AM

James F. Campbell: FTA: Bayless' daughter told KGET that she was a nurse and was satisfied with her mother's care at Glenwood Gardens, the station reported.

IIIInteresting.


I read that part, too. If the daughter doesn't have an issue with what happened, then my outrage meter dispersed. I also have a feeling that there is some other dynamic to this whole situation that will complicate a blind outrage. Maybe the woman had some communicable disease. Maybe she had vomited and/or some other bodily fluid was all over her mouth and it would've created a hazard situation to perform assisted breathing exercises.

As also stated upthread, the woman was breathing, just badly. She had a pulse. Performing CPR would not be appropriate.. CPR nowadays is about chest compressions. You do not do the breathing part of it. It sounds to me like the nurse knew that, made an education decision that CPR wouldn't help and called 911 to get the woman the appropriate help. If that is true, I do not see where the rage should be.

/on Ambien so I may make no sense
 
2013-03-04 12:14:51 AM

silverjets: I'm guessing that the "nurse" in the facility really isn't a nurse.


I came to point this out. My mother in law just moved into 'assisted' living and spent two weeks in a full nursing home. They both have one nurse on duty (RN).
Patients and family refer to the rest of the staff as nurses, but I think they are 'just' called Care Staff.
 
2013-03-04 12:15:14 AM

octopied: Perhaps the patients there have DNR orders.

If you don't know what that is, it's for people who are viewed as so close to death that they have orders for  no CPR to be performed, as they want to die "naturally".


Perhaps that was covered in the article.

If you don't know what that is, it's the information contained on the webpage that is linked to the left of the headline, and often contains details that are pertinent to understanding the headline.
 
2013-03-04 12:15:25 AM
Wow, lots of folks just gleefully missing the point...perform CPR, don't perform CPR, whatever. The appalling part of the story is the way the nurse wanted to pass the buck and "not make that call". Listen dipshiat if you did not want to have to make calls in life or death situations THEN DON'T BECOME A NURSE!
 
2013-03-04 12:17:00 AM

BafflerMeal: AJisaff: djh0101010: AJisaff: CPR on a living patient is a good way to kill them. The lady was breathing. CPR is the wrong treatment. Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.

i am sorry, but where the hell did you get trained?? CPR is exactly what is performed on a choking casualty, and doesn't kill them. i agree that CPR on an elderly patient will probably not have a positive outcome, but the lazy biatch didn't even try. Most likely she was going through agonal respirations, not proper breaths. i posted this already, and it seems pretty self explanatory even in laymans' terms...

You seem to be confusing the Heimlich Maneuver with cardiac compressions.  Totally different mechanism, different action, different part of the body, and for a different reason.  If you're doing CPR on a choking patient, you missed the "airway" part and jumped all the way up to "circulation".

um.. no, actually... if a choking patient becomes unconscious, we go to chest compressions.  and the heimlich manoever on it's own has been outdated for about two years now.  we do 5 back blows to relieve the laryngospasm, then 5 abdominal thrusts, until it is cleared, or they become unconscious...  at which point you start chest compressions, check the airway, attempt vents, and clear obstructions if found.
comressions and vents ARE CPR.

Breaths, thrusts, and back until something else is needed.  I sure as hell hope you guys are not doing compressions on someone with a pulse.


 Unconscious != pulseless.???


hm.  i have been teaching this for 7 years now and the protocols have not changed in that regard, anyway.  chest compressions are called for in the event of a choking collapse, both to attempt to remove the object, and circulate blood.

maybe this article will make it clearer.
http://www.royonrescue.com/2013/01/question-answered-regarding-aggres i ve-chest-compressions-and-unconscious-choking-patient/">http://www.ro yonrescue.com/2013/01/question-answered-regarding-aggresi ve-chest-compressions-and-unconscious-choking-patient/
 
2013-03-04 12:19:49 AM
The nurse in question may not actually be any kind of nurse at all.  She may be a CNA or what they call a DCS (direct care staff) which have no credentials beyond in-facility training and first aid/cpr.  The home I worked at for disabled children was completely staffed by DCS with a nurse that oversaw several homes and stopped by maybe once a week to look paperwork over.  But you could reach her by phone if medical issues arose...

Of course, we also had a strict policy of performing CPR immediately on any patient that stopped breathing or experienced agonal breathing, and we did not allow DNR orders to be filed.  If the parents wanted DNR orders, they were to file them at the hospital.
 
2013-03-04 12:20:36 AM

Owangotang: Wow, lots of folks just gleefully missing the point...perform CPR, don't perform CPR, whatever. The appalling part of the story is the way the nurse wanted to pass the buck and "not make that call". Listen dipshiat if you did not want to have to make calls in life or death situations THEN DON'T BECOME A NURSE!


I disagree.  If I'm a nurse and take a job dispensing meds or whatever to seniors at a place that specifically does not allow me to do CPR on them, then I can say I didn't sign up for that(to make that call).

If she had a job where CPR might be a thing she'd need to do, then yes I think she should have done it.  But this is not that kind of job.
 
2013-03-04 12:21:31 AM

herdgirl72: Unbelievable. I don't care what my workplace policy is. If that lady was Full Code and not DNR, I'm a nurse, i should do CPR. I'd rather lose my job than my license.


As a camera operator doing legal video I had an old guy give out on me.
Everyone had left, the lawyers and the court reporter his wife were all gone.
I'm coiling cable and I went for the mic and realized he was blue.
Vigorously called the nurses station and it was pretty much a "Meh, he's a DNR so don't worry, we'll be right there"
I dragged the rest of the kit out the door and packed up in the parking lot.

It seemed painless and it seemed right.  He knew he wasn't getting out or getting better.  He just wanted justice to provide for his wife.  Keeping him going wasn't the best policy.
 
2013-03-04 12:22:55 AM
My father spent the last 6 months of his life in two separate nursing homes - one which showed little interest at all as he suffered from an accidental Fentanyl overdose, and another that showed little interest as he became disoriented from a near fatal UTI.  (Repeated infections did later help claim his life.)  I can't imagine the horrors people go through who DON'T have family visiting them every day.
 
2013-03-04 12:32:17 AM

Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.


Paramedics get certified, and have special tools they can use too, but anyone can perform CPR. You don't need a certification.

Birnone: I'm guessing further information will show that the 87 year old resident had other issues that would have made it a moot point anyways. It's not like simply doing CPR saves everyone.


So, why bother then? Is that your point?
 
2013-03-04 12:36:35 AM

AJisaff: BafflerMeal: AJisaff: djh0101010: AJisaff: CPR on a living patient is a good way to kill them. The lady was breathing. CPR is the wrong treatment. Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.

i am sorry, but where the hell did you get trained?? CPR is exactly what is performed on a choking casualty, and doesn't kill them. i agree that CPR on an elderly patient will probably not have a positive outcome, but the lazy biatch didn't even try. Most likely she was going through agonal respirations, not proper breaths. i posted this already, and it seems pretty self explanatory even in laymans' terms...

You seem to be confusing the Heimlich Maneuver with cardiac compressions.  Totally different mechanism, different action, different part of the body, and for a different reason.  If you're doing CPR on a choking patient, you missed the "airway" part and jumped all the way up to "circulation".

um.. no, actually... if a choking patient becomes unconscious, we go to chest compressions.  and the heimlich manoever on it's own has been outdated for about two years now.  we do 5 back blows to relieve the laryngospasm, then 5 abdominal thrusts, until it is cleared, or they become unconscious...  at which point you start chest compressions, check the airway, attempt vents, and clear obstructions if found.
comressions and vents ARE CPR.

Breaths, thrusts, and back until something else is needed.  I sure as hell hope you guys are not doing compressions on someone with a pulse.


 Unconscious != pulseless.???

hm.  i have been teaching this for 7 years now and the protocols have not changed in that regard, anyway.  chest compressions are called for in the event of a choking collapse, both to attempt to remove the object, and circulate blood.

maybe this article will make it clearer.
http://www.royonrescue.com/2013/01/question-answered-regarding-aggres i ve-chest-compressions-and-unconscious-choking-patient/">htt ...



Ah.  I see.  My involvement in the thread made me alter a few facts in my memory.  You're right regarding after a choking or presumed choking event.  In my head I responding to something that wasn't there.  I was thinking about the breathing and pulse != cpr argument.
 
2013-03-04 12:37:13 AM

Forecaster18: My father spent the last 6 months of his life in two separate nursing homes - one which showed little interest at all as he suffered from an accidental Fentanyl overdose, and another that showed little interest as he became disoriented from a near fatal UTI.  (Repeated infections did later help claim his life.)  I can't imagine the horrors people go through who DON'T have family visiting them every day.


My grandmother had some pains, and she didn't know why. It was kidney stones, but the doctor didn't do any testing for it. His words "she's old, pain's a part of that." We fired him that day. Got another doctor the next day, he treated her and she felt so much better. Not getting the treatment you want, fire the bums! If I had a parent or grandparent in the place in this article they would be out ASAP.
 
2013-03-04 12:38:49 AM

AverageAmericanGuy: I'm going to sound cold here, but the woman was in her late 80s. Sometimes its just a person's time to go.

The operator sounds like a spaz, from the way she's portrayed in the article. "It's a human being" Yes, and human beings die all the time. You can't be Superman and save everyone all the time.


So then, why even bother? That is your point?
 
2013-03-04 12:38:56 AM

The One True TheDavid: I'm waiting to see what BronyMedic says.


Me too. But my layperson thoughts on it (I have CPR certification but it's long expired) were ...I could see not doing chest compressions on someone in distress but still has a heartbeat who is elderly because you're going to pop a shiatload of ribs and potentially kill them. Assisted breathing however...I'd have done it. Especially since she did NOT have a DNR.

DNRs should be respected, though just through anecdotal accounts, it seems that the tendency is for it to be ignored and 'heroic' measures taken more often than someone is just left alone.

To my knowledge (and I could easily easily be wrong here) there's times where breathing alone is called for. I would think this would be one. Drowning is another. Other than that AFAIK, chest compress is most important (to the tune of Stayin' Alive).

And yeah, CPR usually fails. I don't know of anyone who's done it in an emergency situation where the person has survived (outside of a hospital or being an EMT). Everyone I know who has, the person died. Still...I'd rather try to help.

But when I took the class we were told repeatedly that chest compressions if done right, were gonna at a bare min. crack ribs. In someone injured, it could tear up their liver, puncture their lungs, etc. This shiat was hammered home in a 'be sure it's needed before you do it' way. In that you'd best be damned farking sure there's no heartbeat or respiration before you start cracking up their ribs, especially if they're old. We were also told (because the instructor was awesome) that odds were not good and if the person didn't make it...well, that was sadly the odds. Not to blame ourselves, better to help and try than do nothing. 5% chance is still a chance.

Anyhoo, looking forward to Brony and others who certainly know more than me on this shiat. :D

/has never done it except on a doll
/would like to keep it that way ideally
 
2013-03-04 12:39:24 AM

Birnone: Owangotang: Wow, lots of folks just gleefully missing the point...perform CPR, don't perform CPR, whatever. The appalling part of the story is the way the nurse wanted to pass the buck and "not make that call". Listen dipshiat if you did not want to have to make calls in life or death situations THEN DON'T BECOME A NURSE!

I disagree.  If I'm a nurse and take a job dispensing meds or whatever to seniors at a place that specifically does not allow me to do CPR on them, then I can say I didn't sign up for that(to make that call).

If she had a job where CPR might be a thing she'd need to do, then yes I think she should have done it.  But this is not that kind of job.


Re-read the statement by the director of the facility, he does not say that performing CPR is not allowed. He simply says that the policy is to call for emergency medical assistance and then stay with the individual. That means it was the nurse's call, whether she "signed up for" that or not. Being a nurse is a job where CPR just might be a thing you have to do, that is simple common sense.
 
2013-03-04 12:39:54 AM

James F. Campbell: FTA: Bayless' daughter told KGET that she was a nurse and was satisfied with her mother's care at Glenwood Gardens, the station reported.

IIIInteresting.


More moolah for her to inherit...
 
2013-03-04 12:45:23 AM

herdgirl72: Unbelievable. I don't care what my workplace policy is. If that lady was Full Code and not DNR, I'm a nurse, i should do CPR. I'd rather lose my job than my license.


I'm just some guy and if I saw this I'd like to think I'd jump in and at least try. I've taken a CPR class. If it didn't work, I don't think I'd stick around to answer questions, though.
 
2013-03-04 12:46:34 AM

Abacus9: Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

Paramedics get certified, and have special tools they can use too, but anyone can perform CPR. You don't need a certification.

Birnone: I'm guessing further information will show that the 87 year old resident had other issues that would have made it a moot point anyways. It's not like simply doing CPR saves everyone.

So, why bother then? Is that your point?


No, my point was just that outrage over the nurse not 'saving' her is misplaced if she couldn't be saved in the first place.

My evidence that she couldn't be saved in the first place is that she was 87 and needed CPR, two things that when taken together would indicate to me that this person is farked.   What evidence does anyone have that this woman could be saved?
 
2013-03-04 12:47:08 AM

Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

I'm guessing further information will show that the 87 year old resident had other issues that would have made it a moot point anyways.  It's not like simply doing CPR saves everyone.


They made CPR idiot proof. Anyone that can follow the command to "put your hands in the middle of the chest and push hard and fast" can do CPR
 
2013-03-04 12:49:11 AM
I did CPR on a guy and he lived. He was quite blue, but he had a pulse. I breathed into his mouth until the ambulance arrived. He returned to pink and breathing right as they showed up. The EMTs seemed almost kinda pissed off. Not sure why. Anyway, breaths only, no compressions.

I think the people who teach CPR have never used it to save a life so they have no idea what they're talking about. You can't hurt anyone by breathing in their mouth.
 
2013-03-04 12:49:43 AM

jakepowers: Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

I'm guessing further information will show that the 87 year old resident had other issues that would have made it a moot point anyways.  It's not like simply doing CPR saves everyone.

They made CPR idiot proof. Anyone that can follow the command to "put your hands in the middle of the chest and push hard and fast" can do CPR


Most people don't know how hard to push, nor how fast.
 
2013-03-04 12:50:34 AM

Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.


Actually, they don't recommend the breaths anymore. It's more important to get the heart going again than to waste time forcing useless CO2 into the lungs. Paramedics have a device they can use though that will force ambient air into the lungs, and if certified, are supposed to use it. Also, shocks won't do any good if the heart is completely stopped. For that you want epinephrine. Then maybe a shock.
 
2013-03-04 12:50:51 AM

Anastacya: As also stated upthread, the woman was breathing, just badly. She had a pulse. Performing CPR would not be appropriate..


I know it's been pointed out several times, but agonal respirations happen quite frequently with cardiac arrest, especially when the person is in v-fib.  If she was gasping and had no palpable pulse, then CPR is absolutely indicated.

The larger issue is the stupid policy of the facility to not perform CPR.  Yes, it probably would not have made a difference in the case of this 87 year old lady, but what if the 40 year old cook collapses in cardiac arrest?  These places are full of dumb liability driven policies, such as calling 911 whenever a resident falls, even if there are no injuries and the resident doesn't want to go to the hospital.
 
2013-03-04 12:51:21 AM

mccallcl: I did CPR on a guy and he lived. He was quite blue, but he had a pulse. I breathed into his mouth until the ambulance arrived. He returned to pink and breathing right as they showed up. The EMTs seemed almost kinda pissed off. Not sure why. Anyway, breaths only, no compressions.

I think the people who teach CPR have never used it to save a life so they have no idea what they're talking about. You can't hurt anyone by breathing in their mouth.


Comedy gold right here....
 
2013-03-04 12:52:05 AM

Yogimus: I am sure a breating 84 year old is much better off without a nurse slamming on her chest.  Besides, CPR works less than 1% of the time.


Citation needed.
 
2013-03-04 12:53:38 AM
lh4.googleusercontent.com
 
2013-03-04 12:55:41 AM

AJisaff: digitalrain: Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.

What happened to "one-one-thousand-two-one-thousand-three-one-thousand-four-one-thousan d-five-one-thousand-BREATHE" ?

it takes a minimum of 30 compressions to circulate blood through the body once.  sing staying alive under your breath and you will have the right speed.  1.6 compressions per second.  compression only cpr is fine for non-drowned adult casualties, but not in situations where they were already oxygen deprived.  aim high in the center of the chest, compress at least two inches, and allow the chest full recoil.

and yeah.  i teach it for a living.  i also teach health care provider levels, which is teaching nurses cpr.  i am horrified by this whole concept that a nurse would abrogate her duty like this.


Thanks for updating my CPR knowledge (seriously - thanks!)
 
2013-03-04 12:57:24 AM
Private healthcare + liability insurance = this situation.

Frankly, I'm willing to give the "nurse" the benefit of the doubt. In a highly stressful situtation with a person badgering you on the phone to do something you know is against your works policy to do, most people would have done the same. If she's the sole breadwinner in her family and has dependants to support, I can't imagine her making any other decision.

It sucks, but at some point you need to put the welfare of yourself and your family ahead of other people. It's simply put - not her fault, but the fault of her employers for not covering such a measure (or perhaps more so, the fault of us all for continuing to rely upon private health care providers in this country).

Of course, the irony of this situation is that she will likely be fired ANYWAY because there is no downside to the business for doing so, and only upsides (stopping the negative publicity).
 
2013-03-04 01:02:52 AM

Owangotang: Wow, lots of folks just gleefully missing the point...perform CPR, don't perform CPR, whatever. The appalling part of the story is the way the nurse wanted to pass the buck and "not make that call". Listen dipshiat if you did not want to have to make calls in life or death situations THEN DON'T BECOME A NURSE!


Well, that's the whole point. Whether the dispatcher was right or wrong or the lady was old or feeble or whatever--if the old woman didn't have a written DNR, then when you're told to do CPR, you do it, and that's that. And if you refuse, then you just became liable for that person's death, EVEN IF she would have died anyway, and even if her daughter has "no complaint" with her care at the nursing home or whatever.

Nursing homes have what's called a "duty of care" to their patients which is greater than the normal duty of care owed to people in hotels or whatever. The duty a nurse owes to a patient to ensure her safety and survival is quite high, and just calling 911 if a patient is in distress won't cut it. I have this feeling that the circling buzzards, er, personal injury lawyers have already contacted the daughter and apprised her of just this fact, and she may not be so satisfied with the nursing home's quality of care after a good night's sleep.
 
2013-03-04 01:05:19 AM
I'm pretty sure CPR has never worked.
 
2013-03-04 01:08:55 AM
Acravius:
CPR isn't really for reviving the corpse, its keeping the corpses organs alive long enough for the body to get to improved treatment facilities so that there is a greater capacity for the victim to be revived successfully and with less overall damage.

The manager of the home might have worked as an EMT at some point and feel bad for them.  If an emergency responder arrives and you're doing CPR they have to continue the attempt until delivery to a doctor who can declare it moot.  Even if the body spent a day in the water and you're an insane grief stricken mother.

/Probably not the reason
//known a few EMTs.  They'll tell horrible crash stories that still give them nightmares.  Assisted breathing a corpse, though, even they turn green.
 
2013-03-04 01:10:15 AM

Birnone: Abacus9: Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

Paramedics get certified, and have special tools they can use too, but anyone can perform CPR. You don't need a certification.

Birnone: I'm guessing further information will show that the 87 year old resident had other issues that would have made it a moot point anyways. It's not like simply doing CPR saves everyone.

So, why bother then? Is that your point?

No, my point was just that outrage over the nurse not 'saving' her is misplaced if she couldn't be saved in the first place.

My evidence that she couldn't be saved in the first place is that she was 87 and needed CPR, two things that when taken together would indicate to me that this person is farked.   What evidence does anyone have that this woman could be saved?


They could have tried. We don't need evidence that it might have worked to just try it, knowing there is a 100% chance she will die without it.
 
2013-03-04 01:11:54 AM

Gyrfalcon: Whether the dispatcher was right or wrong or the lady was old or feeble or whatever--if the old woman didn't have a written DNR, then when you're told to do CPR, you do it, and that's that. And if you refuse, then you just became liable for that person's death, EVEN IF she would have died anyway, and even if her daughter has "no complaint" with her care at the nursing home or whatever.


The dispatcher has no legal authority between the health care provider and the patient other than to provide their service.  Their service does not include creating a subservient legal relationship with someone they are talking to.

As stated up thread, nurse practice acts provide the legal framework of what a nurse can do.  Facilities provide the framework of what a nurse will / should do.  If it was not policy for the nurse at that facility, it would violate the work agreement and that can not only get one fired, but also get marks against one's license (up to losing one's license).

There are scant real details here, but as a take away, nurses, doctors, etc... have rules at every facility they are agents of.  One does not get a license and just 'wing it'.
 
2013-03-04 01:13:19 AM

mccallcl: I did CPR on a guy and he lived. He was quite blue, but he had a pulse. I breathed into his mouth until the ambulance arrived. He returned to pink and breathing right as they showed up. The EMTs seemed almost kinda pissed off. Not sure why. Anyway, breaths only, no compressions.

I think the people who teach CPR have never used it to save a life so they have no idea what they're talking about. You can't hurt anyone by breathing in their mouth.


Sounds like what you did was artificial respiration, not CPR.
 
2013-03-04 01:17:35 AM

Lady Indica: To my knowledge (and I could easily easily be wrong here) there's times where breathing alone is called for. I would think this would be one. Drowning is another. Other than that AFAIK, chest compress is most important (to the tune of Stayin' Alive).


Oddly, "Another One Bites The Dust" also works (roughly the same beats per minute)...
 
2013-03-04 01:17:49 AM
Thanks to the litigious nature of people, this form of policy is not unusual. It all started back in the 60's, when a physician stopped at a car wreck and worked to keep the victim alive until rescue came. (Remember. Back then no cell phones. Landlines had to be used.) Working without equipment, he basically did battlefield care and made an error or two which could not be avoided.

He saved the man's life. After recovering, the guy got a lawyer, who sued the physician for causing him irreparable injuries and .... won.

This opened the door for the major landslide of medical lawsuits that started in the 70's. It also would result in so many people not wanting to get involved that 'Good Samaritan' laws would have to be enacted in many States by the mid 80's.

Medical lawsuits exploded during the 80's, to include institutions, suppliers, designers and laboratories. This resulted in a dramatic increase in health care expenses.

Employers became nearly obsessive about lawsuits. Common sense took a back seat to money. Criminals were finding ways to sue their victims if their victims fought back -- which changed the way many stores handled theft.

In actuality, it was the criminals lawyers who were finding ways to sue the victims.

When working in psychiatrics, I ran afoul of this situation myself. The clinic I worked in had a policy of not getting involved with patients beyond talking who called in at night in distress. This was after one suicidal woman had called in threatening suicide -- a thing she had done many times before -- was fluffed off and went out and hung herself. (I would have thought that would have altered the policy.)

I had a suicide call. The lady had overdosed and went quiet on the phone and was unresponsive. Protocol stated I was to not get involved. She had called in to the patients phone (a pay phone in the day room). So, to keep it brief, I called the cops, gave them the patient's phone number, they ran a trace, got her address, sent out rescue, found her unconscious and took her to the hospital. After pumping her stomach, a few hours later, she was Baker Acted to the clinic I worked in.

I damn near got fired. I was pulled off my shift and placed on the morning shift, under observation and on probation.

However, I'd have done it again.

These days, human life is devalued. You can be sued for stepping in to rescue a person. You can be fired from your job. Everyone is afraid of the Lawyers because they have the ability to make right seem to be wrong and even going to court to defend yourself can be a hideously expensive process. That's why companies will often settle out of court, even if they were in the clear. The court battle to prove it would be more costly than a settlement.

Sometimes, you have to make a judgment call. You have to determine what is more valuable: your job or a human life.
 
2013-03-04 01:19:47 AM

ByOwlLight: WhoGAS: Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.

You don't do breaths any more.

Yes, you do.  30 to 2 is the new standard.  The emphasis is on compressions, now, but breaths haven't been completely cut out, unless you don't feel comfortable doing them.


I took my CPR course when I was 14 in the 80's and they taught us 2 breaths, 15 compressions.

Never been recertified or whatever.  Maybe I should.
 
2013-03-04 01:23:52 AM

chookbillion: Spaghetti Eatin' Goombah: Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

I'm guessing further information will show that the 87 year old resident had other issues that would have made it a moot point anyways.  It's not like simply doing CPR saves everyone.

I found a guy lying next to my neighbor's house (it was the pest control guy).  No pulse, no breathing, no heartbeat, ashen gray in color.  911 dispatcher talked me through CPR (had never done it before, but sort of new the basics) which I performed on the guy until the EMTs arrived.

Dude died.

Dude was dead when you found him.


Yeah, probably but still, good on ya man, for trying.  Many people wouldn't have.
 
2013-03-04 01:24:09 AM

tripleseven: ByOwlLight: WhoGAS: Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.

You don't do breaths any more.

Yes, you do.  30 to 2 is the new standard.  The emphasis is on compressions, now, but breaths haven't been completely cut out, unless you don't feel comfortable doing them.

I took my CPR course when I was 14 in the 80's and they taught us 2 breaths, 15 compressions.

Never been recertified or whatever.  Maybe I should.


Not a bad thought.  I would say that a first-aid course is probably more useful.
 
2013-03-04 01:24:33 AM

Don't Troll Me Bro!: Seems like a stupid policy.  Are they worried that their staff will do it wrong?  Is it a liability thing?  I'd have to imagine they could should hire people that are qualified to do things like this, especially being a senior living center and all.

Also: The elderly woman was identified by KGET-TV as 87-year-old Lorraine Bayless. She died Tuesday at Mercy Hospital Southwest, KGET reported.

It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.  If this had been a child, or a healthy person that should have some time left on the clock, I'd be pretty disgusted.


You're a despicable human being.
 
2013-03-04 01:25:49 AM

Colin O'Scopy: Don't Troll Me Bro!: Seems like a stupid policy.  Are they worried that their staff will do it wrong?  Is it a liability thing?  I'd have to imagine they could should hire people that are qualified to do things like this, especially being a senior living center and all.

Also: The elderly woman was identified by KGET-TV as 87-year-old Lorraine Bayless. She died Tuesday at Mercy Hospital Southwest, KGET reported.

It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.  If this had been a child, or a healthy person that should have some time left on the clock, I'd be pretty disgusted.

You're a despicable human being.


4.bp.blogspot.com
 
2013-03-04 01:26:13 AM
Iblame the lawyers.
 
2013-03-04 01:28:25 AM

ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.


Welcome to America. I'm sure the free market will sort it out eventually.
 
2013-03-04 01:33:05 AM

ZeroCorpse: People don't become doctors or nurses, or join the medical profession at all these day because they want to help people and save lives. These days, they do it because they want lots of money.

It's a disgrace that we even use the words "nurse" and "doctor" to describe these greedy animals. They bring dishonor to the words.


Gee thanks! Got any racism to go with your broad brush?

Also, many nurses don't make a whole lot of money.
 
2013-03-04 01:42:27 AM

PsychoPhil: CPR is surprisingly not very effective:
"So, if an average adult keels over in the street, is found unresponsive and pulseless by a bystander, and is administered CPR while a 911 call is made, the odds that such a person will emerge from the eventualities of the resuscitation effort healthy and with a normally functioning brain are about 2%. "


Important point:  *FOUND UNRESPONSIVE*.  The odds are better if the person is observed going down.
 
2013-03-04 01:46:02 AM

Rik01: Sometimes, you have to make a judgment call. You have to determine what is more valuable: your job or a human life.


I'd  put it another way.  Which would make you feel better:  having a job, or having a memory of saving someone's life?

Hint:  nobody ever bought me a drink for having a job.
 
2013-03-04 01:48:22 AM

Colin O'Scopy: Don't Troll Me Bro!: Seems like a stupid policy.  Are they worried that their staff will do it wrong?  Is it a liability thing?  I'd have to imagine they could should hire people that are qualified to do things like this, especially being a senior living center and all.

Also: The elderly woman was identified by KGET-TV as 87-year-old Lorraine Bayless. She died Tuesday at Mercy Hospital Southwest, KGET reported.

It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.  If this had been a child, or a healthy person that should have some time left on the clock, I'd be pretty disgusted.

You're a despicable human being.


Hey, the old lady's daughter seems cool with it.  What's your beef?
 
2013-03-04 01:50:09 AM
this sounds like a situation for 15L O2 non rebreather,

if breathing stops apply BVM and monitor for change in pulse.

if heart stops begin cpr

worked as ambulance dispatcher for a couple years.

the most common reply to our crews arriving on scene to a nursing home was "not my patient"

I'll die alone in the woods before wasting away in one of those hell holes
 
2013-03-04 01:50:39 AM

Medic Zero: ZeroCorpse: People don't become doctors or nurses, or join the medical profession at all these day because they want to help people and save lives. These days, they do it because they want lots of money.

It's a disgrace that we even use the words "nurse" and "doctor" to describe these greedy animals. They bring dishonor to the words.

Gee thanks! Got any racism to go with your broad brush?

Also, many nurses don't make a whole lot of money.


Man, no one bit on it and then you did.
Let the trolls be.
 
2013-03-04 01:52:58 AM

The One True TheDavid: If we're ever going to bring the population down this kind of "heartless callousness" is exactly what we need.

Of course we could teach and encourage birth control in schools starting in 6th grade and make sure abortion is safe, legal and easily obtainable on demand for every pregnant female. Oh, and "doctor assisted suicide," "death with dignity" and/or "voluntary euthanasia" might help too.

But failing those common-sensical measures, yeah, let's stand idly by while somebody's granny keels over. Maybe we can herd everybody over 50 into death camps (starting of course with me after friday). "Boots on the ground" anywhere Islam runs rampant would help too. We might also use subliminal programming to encourage people to gun down strangers at shopping malls, theaters and (even better) elementary schools. After all if we're not going to limit births we should encourage deaths, right? "Viva la muerte!"

I remember when the world's population hit 3 billion, 4 billion people ago; I was entering puberty then. Now I'm almost 50 and you breeders STILL haven't learned restraint. God must love stupid people, He increases them exponentially. After all when we've picked this planet clean we can just move the rich & famous to another planet a few hundred light-years away and start the cycle all over again. AMIRITE?!?!?!!?

/ Drunk and cynical. And constipated.


I would like to subscribe to your newsletter.

/ Favorited.
 
2013-03-04 01:54:03 AM
"She died Tuesday at Mercy Hospital Southwest."

Words no longer mean things.

Please buy a can opener and a Glock.

And rotsa ruck.
 
2013-03-04 01:58:45 AM

djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.


This.

CPR breaks ribs.  If a heart is beating, CPR will stop it.

CPR should only be done if the victim has no pulse.  If the victim is not breathing and has a pulse, then make sure the airway is not constricted and begin artificial respiration.
 
2013-03-04 02:08:53 AM

Yogimus: I am sure a breating 84 year old is much better off without a nurse slamming on her chest.  Besides, CPR works less than 1% of the time.


Not true.
 
2013-03-04 02:10:39 AM
Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?
 
2013-03-04 02:20:35 AM

Loucifer: I'm pretty sure CPR has never worked.


In fact, it just might be the greatest threat to human life that mankind has ever known...

...you know, based on the thread to this point.
 
2013-03-04 02:28:28 AM
For many seniors, especially those without family, the payment (trade-off) to the nursing home, is all their assets, including their home. The nursing home loses money for every day that the 'guest' lives.
 
2013-03-04 02:29:53 AM

Flakeloaf: NightOwl2255: I was in the waiting room of Mercy hospital here in Oklahoma City. A guy pulled up by the doors, opened the car door and made it about half way to the doors of ER and passed out. He was laying maybe 25 feet from the doors. The people working in the ER called 911. They would not go outside and get him. Me and two other guys walked out and picked him up and carried him into the ER and he was treated. I asked a nurse WTF? She told me that they normally have ambulance crew onsite, but if they are out on a run the policy in this situation is to call 911, they are not allowed to walk out of the doors to help anyone.

/Dude lived, low blood sugar.

Several good reasons for that:

- The hospital's insurance policy does not cover any care given outside of the building. Even if the patient is brought inside, the care given by the hospital started outside (cf. "the care given by the paramedic before the patient was handed over to the hospital inside the hospital building") so the insurance company isn't responsible for when something goes wrong.
- A nurse is not a paramedic. They don't have advanced life support equipment, training, insurance and most importantly, the help of a second paramedic.
- The ER nurse is responsible for everyone in the ER. If he turns his back to go outside and play paramedic, and someone inside has a grievous change of condition, that's his ass. Even if there was someone else there. Even if every RN, RPN, HCA and agency jackoff with stolen scrubs and a forged green card were crammed into the ER. The insurance company and the lawyers will say the level of care was diminished because someone who was required to be there farked off to someone else's job after specifically being told not to.


Short version: it really is a liability issue, at least here in OKC.
 
2013-03-04 02:30:45 AM

Gulper Eel: If I'm reading this bit on the California good samaritan law correctly, it looks to me that the nursing home could've been sued to the eyeballs - not for trying the CPR, but if something else went wrong somewhere along the line.


Looks like a bill to correct that insanity has been enacted.  http://www.johnbenoit.com/pdfs/Benoits_Good_Samaritan_law_signed.pdf
 
2013-03-04 02:32:49 AM

nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?


Yes, I would.  An 87 year-old who survives such an incident is very unlikely to enjoy her remaining days.

Much of the dying's suffering is caused by their survivors.
 
2013-03-04 02:36:39 AM

BarkingUnicorn: nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?

Yes, I would.  An 87 year-old who survives such an incident is very unlikely to enjoy her remaining days.

Much of the dying's suffering is caused by their survivors.


You say that now, but your not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.
 
2013-03-04 02:38:05 AM

rga184: ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.

Correction: she has a piece of paper with a title on it. In reality, she's barely a human being. MOST nurses I know wouldn't think of losing their job over saving the life of a patient.

On the other hand, CPR on an 87 year old outside the hospital...never a gods outcome, oftentimes worse than death, because they revive you so you can spend there months in the ICU and die anyway. I'd give the nyse a pass if this is what she was thinking about, although if the patient didn't have a DNR order, it's her duty to do so. Ironically enough though, if she did that, she'd have to still choose rules over patient's best interest.


My 90 year old grandmother went through something sorta similar. After getting out of the hospital she hung on for another few months and during that time dementia really kicked in. I'm sure being completely paranoid and combative is what she would've wanted though.
 
2013-03-04 02:42:22 AM

nmemkha: BarkingUnicorn: nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?

Yes, I would.  An 87 year-old who survives such an incident is very unlikely to enjoy her remaining days.

Much of the dying's suffering is caused by their survivors.

You say that now, but your not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.


Yes, it is easy now.  My mother died in 1995, as I watched.  It was the best thing that could have happened to her, and I'd have been a poor son had I clung to her.
 
2013-03-04 02:52:04 AM

djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.


Could have been agonal breathing, in which case you would be correct to begin CPR.
 
2013-03-04 02:52:59 AM

BarkingUnicorn: nmemkha: BarkingUnicorn: nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?

Yes, I would.  An 87 year-old who survives such an incident is very unlikely to enjoy her remaining days.

Much of the dying's suffering is caused by their survivors.

You say that now, but your not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.

Yes, it is easy now.  My mother died in 1995, as I watched.  It was the best thing that could have happened to her, and I'd have been a poor son had I clung to her.


I see your point, and I think it's each person's decision to make. This lady didn't have a DNR.

/sorry about your mom
 
2013-03-04 02:53:13 AM

BarkingUnicorn: nmemkha: BarkingUnicorn: nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?

Yes, I would.  An 87 year-old who survives such an incident is very unlikely to enjoy her remaining days.

Much of the dying's suffering is caused by their survivors.

You say that now, but your not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.

Yes, it is easy now.  My mother died in 1995, as I watched.  It was the best thing that could have happened to her, and I'd have been a poor son had I clung to her.


...and then, some families are a bit to eager to be done with the person that has become an inconvenience.

It cuts both ways. Which is why I intend to check myself out, before that decision has to fall to anybody else...

/Brave words, for somebody not on their death bed.
 
2013-03-04 02:56:28 AM
Stupid nurse. She should have a made a deal with Mephisto and sacrificed her marriage to save the old woman! It's the only way!
 
2013-03-04 03:01:03 AM
Thus the coming norm in our ever increasing litigous society.  No good deed goes unpunished these days
 
2013-03-04 03:05:43 AM

Gdalescrboz: Thus the coming norm in our ever increasing litigous society.  No good deed goes unpunished these days


As I stated earlier, it was a money thing, and nothing else.
Not every person with a nursing degree, is Florence Nightingale.
I don't think anybody has ever been successfully sued for having their attempt at emergency CPR not work.
 
2013-03-04 03:08:02 AM
Medic Zero ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired. Welcome to America. I'm sure the free market will sort it out eventually.

Wait, what? It's gov't intrusion in to daily events like this that has actually caused it.  Maybe if our justice system wasn't so quick to award families $10million for "pain and suffering" caused by someone trying to help out their fellow man we wouldnt see companies instituting policies like this.
 
2013-03-04 03:12:32 AM

Gdalescrboz: Medic Zero ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired. Welcome to America. I'm sure the free market will sort it out eventually.

Wait, what? It's gov't intrusion in to daily events like this that has actually caused it.  Maybe if our justice system wasn't so quick to award families $10million for "pain and suffering" caused by someone trying to help out their fellow man we wouldnt see companies instituting policies like this.


It has very little to do with that.
Fact is, the nursing home loses money for every day that patient stays alive.
I used to work at one.
"Free market capitalists", are the REAL "death panels".
 
2013-03-04 03:13:47 AM
Yeah. CPR has a lifesaving potential of about 5%. That's because it's mostly applied to very old people in hospital-like situations who are about to die anyway.
 
2013-03-04 03:17:13 AM

Guess_Who: Obamacare


I was about to leave this post depressed.

This gave me life.
 
2013-03-04 03:18:09 AM
What moron is coming up with these percentages regarding CPR?
 
2013-03-04 03:20:51 AM

herdgirl72: Unbelievable. I don't care what my workplace policy is. If that lady was Full Code and not DNR, I'm a nurse, i should do CPR. I'd rather lose my job than my license.


Perfect.
 
2013-03-04 03:28:04 AM

Abacus9: BarkingUnicorn: nmemkha: BarkingUnicorn: nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?

Yes, I would.  An 87 year-old who survives such an incident is very unlikely to enjoy her remaining days.

Much of the dying's suffering is caused by their survivors.

You say that now, but your not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.

Yes, it is easy now.  My mother died in 1995, as I watched.  It was the best thing that could have happened to her, and I'd have been a poor son had I clung to her.

I see your point, and I think it's each person's decision to make. This lady didn't have a DNR.

/sorry about your mom


Thank you.

Whatever contract this lady had with the facility did not oblige it to do more than was done, as far as we know.  Since this "call 911 only" policy seems to be of great importance to the operators who drummed it into employees, I assume it was communicated to customers who agreed to it.  The fact that the daughter is not screaming for someone's head reinforces my surmise; but perhaps she just wasn't in the mood to make trouble immediately after her mother's death.

Under common law, a property owner has a duty to rescue invitees - people who are on his property with his permission.  (He can watch trespassers DIAF with impunity.) However, a contract could nullify that duty or limit it to calling 911.

It's a fact that most people don't have to lift a finger to save your life.
 
2013-03-04 03:30:56 AM
You think the nurse who stood by and watched an elderly patient die is horrible? When you find stories about how children of 8 or 9 years of age have successfully used CPR to save people's lives, you will realise that the nurse is even more horrible than you think she is:

http://www.syracuse.com/news/index.ssf/2012/05/volney_boy_8_uses_cpr _t o_save.html

http://articles.cnn.com/2011-04-19/us/arizona.boy.saves.sister_1_che st -compressions-cpr-resuscitation?_s=PM:US

To think a child can have the knowledge and courage to do what a trained nurse wouldn't do- it just leaves me with a double handed facepalm in shock at how callous people can be.
 
2013-03-04 03:31:25 AM
 
2013-03-04 03:36:46 AM

Bumblefark: BarkingUnicorn: nmemkha: BarkingUnicorn: nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?

Yes, I would.  An 87 year-old who survives such an incident is very unlikely to enjoy her remaining days.

Much of the dying's suffering is caused by their survivors.

You say that now, but your not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.

Yes, it is easy now.  My mother died in 1995, as I watched.  It was the best thing that could have happened to her, and I'd have been a poor son had I clung to her.

...and then, some families are a bit to eager to be done with the person that has become an inconvenience.

It cuts both ways. Which is why I intend to check myself out, before that decision has to fall to anybody else...

/Brave words, for somebody not on their death bed.


"Life is pleasant. Death is peaceful. It's the transition that's difficult." Isaac  Asimov.
 
2013-03-04 03:59:11 AM

BarkingUnicorn: Whatever contract this lady had with the facility did not oblige it to do more than was done, as far as we know. Since this "call 911 only" policy seems to be of great importance to the operators who drummed it into employees, I assume it was communicated to customers who agreed to it.


True, I just think it's a stupid policy. She should have had a choice in the matter (maybe she did, I don't know). I know you don't even need to be certified to perform CPR, it's not considered a medical procedure, but a first aid thing. Of course, a paramedic or doctor would be certified to do even more. I know that CPR wouldn't have been the thing to do while she was still breathing, but wasn't she dead by the time the ambulance got there? Her heart stopped at some point, and that's when it could have been administered.

Also, I know that it normally can break ribs and all, but I'm pretty sure there is a gentler procedure for small children and the elderly.
 
2013-03-04 04:04:52 AM

AverageAmericanGuy: I'm going to sound cold here, but the woman was in her late 80s. Sometimes its just a person's time to go.

The operator sounds like a spaz, from the way she's portrayed in the article. "It's a human being" Yes, and human beings die all the time. You can't be Superman and save everyone all the time.


Thread is TL;DR, but this is exactly my sentiment.

There's far too much hysteria focused on 'saving' someone's life, when that person is already, most certainly, just about to die naturally.

My grandfather was kept vegetative for his last 10 years  because his wife, then daughters were sentimental enough not to let the guy die in dignity.

He led his men out of a Japanese torture camp, taking a high ranking officer's ceremonial sword as trophy, ffs. having his diaper changed twice a day by some ex-convict orderly was horrifying for me, never mind him.

I hope they rot in hell for such egotism.
 
2013-03-04 04:09:00 AM

NotoriousFire: ByOwlLight: PsychoPhil: But the issue here is CPR wasn't appropriate, and likely wouldn't have done squat, anyway. I mean, what next, you yell at the tow truck driver for not jump starting your car when it has a flat tire?

I fail to see how it wasn't appropriate.  "She was old" is not a good enough answer.


Have you missed the numerous sources already cited that question the use of CPR on a breathing individual? Barely breathing, yes, but not gasping, etc. Is that not enough for you to possibly question that the on-scene person made possibly the right call?


Well yeah, they've watched House. They KNOW these things.

/has DNR as of recently
//lemme go in peace
/if it's long term drug the ever living fark out of me - I love drugs
 
2013-03-04 04:10:27 AM

Abacus9: BarkingUnicorn:

Also, I know that it normally can break ribs and all, but I'm pretty sure there is a gentler procedure for small children and the elderly.


Not really - it's pretty much the same. If you have an infant and a two rescuer situation, you can switch to two thumb squeeze, but you're still compressing 1/3 of the chest depth in any situation.

The times I've done it I'm pretty sure I've broken ribs on every one. It's hard to miss that crunchy feeling. Sorta gives you the creeps. It does make it a lot easier to compress after that, though.

I've got ACLS, PALS and BLS certifications as the putative king of security at work, although none of us have ever coded thank FSM, we've got a Zoll but no rescue drugs other than a tank of O2 and a bag mask. I have done it three times 'in the wild', one lived, but he ROSC'd about round 2 and woke up a few minutes later.
 
2013-03-04 04:15:03 AM
Ugh, the nursing home hate is strong in you farkers. I never bite, but this is my one sore spot, and now I got all riled up.

YES, there are a lot of shiathole nursing homes that are old people warehouses. YES, there are plenty of staff that work in them and don't deserve to. However, don't paint them all with the same brush. I've worked in dementia care for almost ten years, and it's not something I ever plan on giving up. We don't make tons of money and pretty much the entire world looks down on us, but it's the greatest thing I've ever experienced. I feel honored to be let in to these people's home to share their most fragile moments.

Despite the crappy experiences that many people have had, there really are LTC facilities where the staff is caring, well-educated, and capable of not being cruel morons. There are facilities that are clean and well managed and lack asinine rules, with a lot of various diversions to keep the natives happy.

I love my career as a nursing home nurse and find it to be a deeply rewarding experience. Whenever I lose someone, it rips a piece of my heart away. I can imagine the stress the person in the article (not sure if real nurse or if the reporter decided on that title for LOLs), because I've been there before, although I like to think I've handled it in a more professional manner.

The most precious moments are when they remember my name.
 
2013-03-04 04:22:50 AM
My granddad is at a nursing home right now. If he died from something that could have been prevented but the nursing staff wasn't willing to do anything about I would not sue them.
I would brain them with a hammer.
My granddad deserves better.
 
2013-03-04 04:26:01 AM

Medic Zero: ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.

Welcome to America. I'm sure the free market will sort it out eventually.


Because in the non-free market there aren't any rules and procedures that must be followed to a T? The same government that won't let you cut a tree blocking your driveway until an environmental review has been completed is the same type of regulation that a nurse in an old folks home might be under from her evil free market people.

I watched people from NASA install the wrong parts on non-flight critical systems because independent thinking will get you written up and sometimes fired. The check-list is there for a reason, and so is your brain. The answer is the woman should have helped as a human and if she'd been fired the outrage would have been against her employer.
 
2013-03-04 04:32:43 AM

BarkingUnicorn: nmemkha: BarkingUnicorn: nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?

Yes, I would.  An 87 year-old who survives such an incident is very unlikely to enjoy her remaining days.

Much of the dying's suffering is caused by their survivors.

You say that now, but your not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.

Yes, it is easy now.  My mother died in 1995, as I watched.  It was the best thing that could have happened to her, and I'd have been a poor son had I clung to her.


Did she die alone and sacred on the floor of some two-bit care facility as people just stood and gawked at her?

Would you have been pissed if she had?
 
2013-03-04 04:38:33 AM

pedobearapproved: Forecaster18: My father spent the last 6 months of his life in two separate nursing homes - one which showed little interest at all as he suffered from an accidental Fentanyl overdose, and another that showed little interest as he became disoriented from a near fatal UTI.  (Repeated infections did later help claim his life.)  I can't imagine the horrors people go through who DON'T have family visiting them every day.

My grandmother had some pains, and she didn't know why. It was kidney stones, but the doctor didn't do any testing for it. His words "she's old, pain's a part of that." We fired him that day. Got another doctor the next day, he treated her and she felt so much better. Not getting the treatment you want, fire the bums! If I had a parent or grandparent in the place in this article they would be out ASAP.


We fired the first place after he fell and broke his ankle.  The second place was one of the best rated in the state (shudder) and was the only place for counties around equipped to handle his needs, perform physical therapy (a losing prospect, turns out), and both had space and would work with medicare/private insurance.

Elder care is an embarrassment in this nation.  My dad struggled with huge health problems his entire life, so much so that it is a minor miracle he didn't die before they could even have me.  My mom supported the family and Dad did everything he could to the point of exhaustion to help however he could.  They did everything right, scrimped and saved, put two kids through college, and my mom damn near lost her retirement to get Dad onto medicaid when medicare was about to run out.  If he had died 12 hours later, the conversion of her account would have gone through and more than halved her retirement income - the only other option the lawyer gave (knowing it wouldn't be taken) is divorce.  I'm an atheist, and if I consider anything about this nation sinful, it's for-profit healthcare.
 
2013-03-04 04:48:37 AM
CPR has its merits, and some people do survive. However most "code saves" come from correcting fatal dysrhythmias (ventricular tachycardia/fibrillation). In those instances the underlying problem is an electrical disturbance of the heart. Early application of electricity by either an AED or a manual defibrillator leads to a correction of the rhythm disturbance and the restoration of normal heart function. Those instances are where you hear about people walking out of the hospital (even better outcomes with induced hypothermia). In these cases CPR serves to essentially buy the brain time. These saves are people who are normallyactive at baseline and by all means are viable, especially when even witnessed.However those cases are the rarity. Also the only ones that are viewed as viable in the national rankings for cardiac arrest save rates. The other arrests don't typically have an easily reversible causes and is a gradual progressive process (sepsis, anemia, respiratory conditions, neurological event, overdoses) and once they progress to cardiac arrest (normally PEA/asystole) even with aggressive resuscitation they'll never recover neurologically beyond potato. Most nursing home patients meet this criteria. DNRs and hospice are a great thing. /paramedic//27% of our viable arrests walk out in my city
 
2013-03-04 04:52:07 AM

Lehk: as a nurse is there not a duty of care? She will be lucky if she does not go to jail


As a nurse, the nurse in the article followed policy. You are making a moral judgement based on your feelings....not facts.
 
2013-03-04 04:52:43 AM

djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.


Incorrect.
 
2013-03-04 04:56:10 AM
My grandpop had dementia. He was terrified of nursing homes. He did NOT want to go into one. Ever. My uncles took care of him at his home (and did a wonderful job). My mom offered to take him (we live across the country). He and I were extremely close. I'd have happily taken him in as well. I have a really really wonderful Irish Catholic family and all the siblings did their part in helping out, some more than others as they were able (some had more time, others more money).

Near the end, he had to be in hospital/nursing care twice. The first time due to a back injury before the dementia got too terrible. My mother held the medical proxy, which I helped to arrange (just with family politics) because she's the least religiously batshiat of my relatives. I spent YEARS talking to them about end of life choices. I did not want to see my beloved grandpop suffering in a nursing home as his father had. (My Great-grandfather lived to 103, the home he was in was really good...but it's a nursing home). Due to bad religious advice, they were told by the church in no uncertain terms they HAD to do everything possible medically for him and not 'let him go'. So they did...he lived to 103.

Grandpop got a MRSA infection and the decision was made to make him comfy, no fluids no food, just pain meds. He lasted a week. He was not uncomfortable during that week...but it was agony on us. I couldn't go see him (he wouldn't have been aware of my presence, and if there was no benefit for *him* I couldn't do it). I also couldn't attend the funeral. It hurt too much. Still does.

It was so so so farking hard knowing he was DYING in that hospital, even though I was the first in the family to pretty much promote this. Part of me wanted to believe he'd somehow pull out of it. My relatives still struggle with it, my aunt especially, because people in our family are very long lived. He was 93, she felt he could have had another decade sans MRSA.

But what kind of decade?

I'm an atheist. So I don't believe there's anything else. He's gone, and I will miss him as long as I draw breath. My grandpop was a believer and wasn't afraid of death. He looked upon it as the next great adventure.

It's never an easy decision. I sincerely doubt there's many making such decisions out of any form of malice. Yes, it was HARD for relatives to take care of him. YES at times they were farking sick of it. But they loved him utterly. I know of no one who has five GOOD kids like my grandfather did.

I'm very grateful for the medical staff that made him comfy, took good care of him, and that the decision to allow him to die with peace and dignity could be made.

And frankly I don't give a fark what anyone else thinks. But my fist would prolly hit your face if someone was stupid enough to say they were 'selfish' or 'didn't want to take care of an old man' to my face.

Ok, it def. would.
 
2013-03-04 05:01:15 AM

ZeroCorpse: People don't become doctors or nurses, or join the medical profession at all these day because they want to help people and save lives. These days, they do it because they want lots of money.

It's a disgrace that we even use the words "nurse" and "doctor" to describe these greedy animals. They bring dishonor to the words.


Diaf

Nurses are UNDER paid for their level of expertise....and considering a bsn takes 5.5 years...NOT 4 to obtain.

Plus, we have arseholes like u threatening to sue us constantly bc u dont agree with how/what we are doing, or because we refuse to act like your personal servant while u are in the hospital bc your kid has a snotty nose.

Go fark yourself.
/pissing your nurse off is at LEAST an order of magnitude less wise than pissing off your waiter
// think about it.
 
2013-03-04 05:04:00 AM
This is par for the course.
Group homes and nursing homes have zero ability to do CPR.
They also don't do lift assists or attempt to do any life saving attempts.

Not sure why this is national news.
 
2013-03-04 05:05:45 AM
That's utterly disgraceful behaviour. Most countries have laws that cover a duty of care. If you call 911 and they tell you to start doing CPR NOW and you refuse, you should be held accountable under law. Death is a foreseeable consequence of refusing to perform CPR and this nurse and whoever else was there should be prosecuted. And as a nurse she should hang her head in shame. She has failed in her profession and should be thrown out on her ass.
 
2013-03-04 05:10:55 AM

drxym: That's utterly disgraceful behaviour. Most countries have laws that cover a duty of care. If you call 911 and they tell you to start doing CPR NOW and you refuse, you should be held accountable under law. Death is a foreseeable consequence of refusing to perform CPR and this nurse and whoever else was there should be prosecuted. And as a nurse she should hang her head in shame. She has failed in her profession and should be thrown out on her ass.


Because a licensed nurse has no obligation to accept any "order" of a medical nature from some random UNlicensed 911 dispatcher.

The sad fact: the nurse complied with the standard of care for the facility she was in.
 
2013-03-04 05:14:25 AM

The more you eat the more you fart: Because a licensed nurse has no obligation to accept any "order" of a medical nature from some random UNlicensed 911 dispatcher.

The sad fact: the nurse complied with the standard of care for the facility she was in.


Dispatchers are nationally certified, and often licensed at the state level to work in 911 centers. In addition, they work under standing medical orders through the Priority Dispatch system.

The fact of the matter is that CPR is considered a basic "standard of care", and requires no verbal or medical orders to perform. The only reason NOT to perform CPR is if the woman had a sign of death like decomp, had injuries obviously incompatible with life, or had a signed medical order known as a Do Not Resuscitate Order.

/Tennessee EMD #495. Kept it even after getting my Paramedic to say I had one of the original ones.
 
2013-03-04 05:23:50 AM

drxym: That's utterly disgraceful behaviour. Most countries have laws that cover a duty of care. If you call 911 and they tell you to start doing CPR NOW and you refuse, you should be held accountable under law. Death is a foreseeable consequence of refusing to perform CPR and this nurse and whoever else was there should be prosecuted. And as a nurse she should hang her head in shame. She has failed in her profession and should be thrown out on her ass.


Well, there is also no mention if there was a DNR/DNI on file.
Doesn't matter either way, but sadly there are cases of people gettign sued for doing CPR.....go figure....
 
2013-03-04 05:28:00 AM

BatmanX: drxym: That's utterly disgraceful behaviour. Most countries have laws that cover a duty of care. If you call 911 and they tell you to start doing CPR NOW and you refuse, you should be held accountable under law. Death is a foreseeable consequence of refusing to perform CPR and this nurse and whoever else was there should be prosecuted. And as a nurse she should hang her head in shame. She has failed in her profession and should be thrown out on her ass.

Well, there is also no mention if there was a DNR/DNI on file.
Doesn't matter either way, but sadly there are cases of people gettign sued for doing CPR.....go figure....


Per the AHA 2010 BLS instructor book, no person has ever been successfully sued for providing CPR on a patient who needed it.

They have for failing to provide it.
 
2013-03-04 05:29:13 AM
This wasn't the case of someone who "knew better" refusing to perform CPR on a person who was still, albeit barely, breathing.  This was someone who very clearly was in CYA mode.  You can hear it clearly in the recording.  No argument.  Nothing.  Just, "Sorry, I don't wanna do that."  Very pathetic and sad.  Fark your job and fark you, you stupid biatch!
 
2013-03-04 05:32:03 AM

hardinparamedic: The more you eat the more you fart: Because a licensed nurse has no obligation to accept any "order" of a medical nature from some random UNlicensed 911 dispatcher.

The sad fact: the nurse complied with the standard of care for the facility she was in.

Dispatchers are nationally certified, and often licensed at the state level to work in 911 centers. In addition, they work under standing medical orders through the Priority Dispatch system.

The fact of the matter is that CPR is considered a basic "standard of care", and requires no verbal or medical orders to perform. The only reason NOT to perform CPR is if the woman had a sign of death like decomp, had injuries obviously incompatible with life, or had a signed medical order known as a Do Not Resuscitate Order.

/Tennessee EMD #495. Kept it even after getting my Paramedic to say I had one of the original ones.


Or the nurse, a licensed medical professional who has faaar more working knowledge than a dispatcher, decided that it was inappropriate, or the facility's policy met the standard of care.

Regardless, no nurse is gonna get in trouble for refusing an "order" given by someone less qualified than her to make medical decisions.
 
2013-03-04 05:34:44 AM

erewhon: Abacus9: BarkingUnicorn:

Also, I know that it normally can break ribs and all, but I'm pretty sure there is a gentler procedure for small children and the elderly.

Not really - it's pretty much the same. If you have an infant and a two rescuer situation, you can switch to two thumb squeeze, but you're still compressing 1/3 of the chest depth in any situation.

The times I've done it I'm pretty sure I've broken ribs on every one. It's hard to miss that crunchy feeling. Sorta gives you the creeps. It does make it a lot easier to compress after that, though.

I've got ACLS, PALS and BLS certifications as the putative king of security at work, although none of us have ever coded thank FSM, we've got a Zoll but no rescue drugs other than a tank of O2 and a bag mask. I have done it three times 'in the wild', one lived, but he ROSC'd about round 2 and woke up a few minutes later.


Hmmm... I take your word for it. I've heard though that once the heart stops, they're already dead, so you can't really harm them any further. Although I guess that depends on the case and their wishes. Sounds like a rough thing for the patient, but also for the paramedic to have to do.
 
2013-03-04 05:36:54 AM

hardinparamedic: BatmanX: drxym: That's utterly disgraceful behaviour. Most countries have laws that cover a duty of care. If you call 911 and they tell you to start doing CPR NOW and you refuse, you should be held accountable under law. Death is a foreseeable consequence of refusing to perform CPR and this nurse and whoever else was there should be prosecuted. And as a nurse she should hang her head in shame. She has failed in her profession and should be thrown out on her ass.

Well, there is also no mention if there was a DNR/DNI on file.
Doesn't matter either way, but sadly there are cases of people gettign sued for doing CPR.....go figure....

Per the AHA 2010 BLS instructor book, no person has ever been successfully sued for providing CPR on a patient who needed it.

They have for failing to provide it.


Incorrect. I know three nurses who were sued for performing cpr on a patient with a dnr.

Only...they were unaware of the dnr thanks to hipaa law...they saw it happen, gave cpr, then were later told they SHOULD have checked first.

And ppl wonder why the nurse in this article played CYA....
 
2013-03-04 05:38:43 AM

The more you eat the more you fart: hardinparamedic: The more you eat the more you fart: Because a licensed nurse has no obligation to accept any "order" of a medical nature from some random UNlicensed 911 dispatcher.

The sad fact: the nurse complied with the standard of care for the facility she was in.

Dispatchers are nationally certified, and often licensed at the state level to work in 911 centers. In addition, they work under standing medical orders through the Priority Dispatch system.

The fact of the matter is that CPR is considered a basic "standard of care", and requires no verbal or medical orders to perform. The only reason NOT to perform CPR is if the woman had a sign of death like decomp, had injuries obviously incompatible with life, or had a signed medical order known as a Do Not Resuscitate Order.

/Tennessee EMD #495. Kept it even after getting my Paramedic to say I had one of the original ones.

Or the nurse, a licensed medical professional who has faaar more working knowledge than a dispatcher, decided that it was inappropriate, or the facility's policy met the standard of care.

Regardless, no nurse is gonna get in trouble for refusing an "order" given by someone less qualified than her to make medical decisions.


This was not a medical decision.  This was purely a case of not wanting to take responsibility for anything.  Must have been fun watching the lady gasp for breath while standing there.  This "nurse" needs a farkin' falcon punch for the "I'm feeling stressed..." line.  OMFG!  Quit your job you useless piece of shiat!
 
2013-03-04 05:44:26 AM
No cpr = heartless BIATCH.

Cpr= did she have a dnr? How do you know? Why did you do it with such force that you fractured her ribs? (a common side effect of cpr). Did you check her medical records to determine what her final wishes were?

In my experience, you answer far more questions if you DO cpr than if you dont. The person is already dead..you cant make them MORE dead by not doing cpr....but you CAN bring a braindead person back with it..then be drug thru court case after court case for 5+ years bc you "should have known better" than to try.
 
2013-03-04 05:45:31 AM

vrax: The more you eat the more you fart: hardinparamedic: The more you eat the more you fart: Because a licensed nurse has no obligation to accept any "order" of a medical nature from some random UNlicensed 911 dispatcher.

The sad fact: the nurse complied with the standard of care for the facility she was in.

Dispatchers are nationally certified, and often licensed at the state level to work in 911 centers. In addition, they work under standing medical orders through the Priority Dispatch system.

The fact of the matter is that CPR is considered a basic "standard of care", and requires no verbal or medical orders to perform. The only reason NOT to perform CPR is if the woman had a sign of death like decomp, had injuries obviously incompatible with life, or had a signed medical order known as a Do Not Resuscitate Order.

/Tennessee EMD #495. Kept it even after getting my Paramedic to say I had one of the original ones.

Or the nurse, a licensed medical professional who has faaar more working knowledge than a dispatcher, decided that it was inappropriate, or the facility's policy met the standard of care.

Regardless, no nurse is gonna get in trouble for refusing an "order" given by someone less qualified than her to make medical decisions.

This was not a medical decision.  This was purely a case of not wanting to take responsibility for anything.  Must have been fun watching the lady gasp for breath while standing there.  This "nurse" needs a farkin' falcon punch for the "I'm feeling stressed..." line.  OMFG!  Quit your job you useless piece of shiat!


Walk a mile...
 
2013-03-04 05:46:33 AM
Headed out on a call. Ill reply to your posts when I get back The more
 
2013-03-04 05:52:47 AM

The more you eat the more you fart: No cpr = heartless BIATCH.

Cpr= did she have a dnr? How do you know? Why did you do it with such force that you fractured her ribs? (a common side effect of cpr). Did you check her medical records to determine what her final wishes were?

In my experience, you answer far more questions if you DO cpr than if you dont. The person is already dead..you cant make them MORE dead by not doing cpr....but you CAN bring a braindead person back with it..then be drug thru court case after court case for 5+ years bc you "should have known better" than to try.


Sometimes doing the right thing is hard.  I couldn't live with myself knowing that I had actively refused to do anything.  I truly don't know anyone who could.  IMHO, this person is in the wrong profession.  She doesn't care about people or life, it's clearly just a paycheck.  If she wants to pretend to help people and draw a paycheck she should go work in AT&T phone support or something.  Though, that might stress her out.  Boo hoo!
 
2013-03-04 05:54:42 AM
My guess is that once EMS arrived on scene, they began resuscitation attempts through CPR in addition to using a high volume of oxygen and a defibrillator (this is my best guess).  After all, the lady "died" at the hospital.

As for the dispatcher, she was using nationally used protocols called the Medical Priority Dispatch System. This system uses a program called ProQA. It asks the same basic questions you hear in the 911 recording. The ProQA system grades you on your performance and compliance with procedures that fall under the medical direction of a physician. If the call taker is non-compliant with doing EXACTLY what MPDS calls for, she too could lose her job and could also be held liable in the death of the patient.

You may think she's being pushy and over the top but she's doing exactly what she's supposed to do.

/I'm not an EMD but 911 is my number
 
2013-03-04 05:55:38 AM

The more you eat the more you fart: vrax: The more you eat the more you fart: hardinparamedic: The more you eat the more you fart: Because a licensed nurse has no obligation to accept any "order" of a medical nature from some random UNlicensed 911 dispatcher.

The sad fact: the nurse complied with the standard of care for the facility she was in.

Dispatchers are nationally certified, and often licensed at the state level to work in 911 centers. In addition, they work under standing medical orders through the Priority Dispatch system.

The fact of the matter is that CPR is considered a basic "standard of care", and requires no verbal or medical orders to perform. The only reason NOT to perform CPR is if the woman had a sign of death like decomp, had injuries obviously incompatible with life, or had a signed medical order known as a Do Not Resuscitate Order.

/Tennessee EMD #495. Kept it even after getting my Paramedic to say I had one of the original ones.

Or the nurse, a licensed medical professional who has faaar more working knowledge than a dispatcher, decided that it was inappropriate, or the facility's policy met the standard of care.

Regardless, no nurse is gonna get in trouble for refusing an "order" given by someone less qualified than her to make medical decisions.

This was not a medical decision.  This was purely a case of not wanting to take responsibility for anything.  Must have been fun watching the lady gasp for breath while standing there.  This "nurse" needs a farkin' falcon punch for the "I'm feeling stressed..." line.  OMFG!  Quit your job you useless piece of shiat!

Walk a mile...


I would, but I might get hurt or something.  Why take the chance?  Better to do nothing.
 
2013-03-04 05:58:50 AM

The more you eat the more you fart: hardinparamedic: BatmanX: drxym: That's utterly disgraceful behaviour. Most countries have laws that cover a duty of care. If you call 911 and they tell you to start doing CPR NOW and you refuse, you should be held accountable under law. Death is a foreseeable consequence of refusing to perform CPR and this nurse and whoever else was there should be prosecuted. And as a nurse she should hang her head in shame. She has failed in her profession and should be thrown out on her ass.

Well, there is also no mention if there was a DNR/DNI on file.
Doesn't matter either way, but sadly there are cases of people gettign sued for doing CPR.....go figure....

Per the AHA 2010 BLS instructor book, no person has ever been successfully sued for providing CPR on a patient who needed it.

They have for failing to provide it.

Incorrect. I know three nurses who were sued for performing cpr on a patient with a dnr.

Only...they were unaware of the dnr thanks to hipaa law...they saw it happen, gave cpr, then were later told they SHOULD have checked first.

And ppl wonder why the nurse in this article played CYA....


Were they PERSONALLY sued, or was the facility sued for not making sure that the staff had proper awareness of the patient's requests and rights?
HUGE difference there.

Not that I'm not sympathetic or shiatting on the ppl you know...but it's a big big difference. The lawsuits I've seen regarding such have always been against the facility (though doctors and nurses are often named, they're not liable personally, just professionally. Doctors have malpractice insurance and generally the facility is liable for any *lawful* behavior of their staff. As long as they weren't acting outside the scope of their job or outside of 'standard of care' etc. Personal liability comes when they do something outside the scope, like sticking their dick into a patient.
 
2013-03-04 05:59:41 AM

pedobearapproved: Medic Zero: ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.

Welcome to America. I'm sure the free market will sort it out eventually.

Because in the non-free market there aren't any rules and procedures that must be followed to a T? The same government that won't let you cut a tree blocking your driveway until an environmental review has been completed is the same type of regulation that a nurse in an old folks home might be under from her evil free market people.

I watched people from NASA install the wrong parts on non-flight critical systems because independent thinking will get you written up and sometimes fired. The check-list is there for a reason, and so is your brain. The answer is the woman should have helped as a human and if she'd been fired the outrage would have been against her employer.


Oh yeah, this in spades.

I've already related the sorry tale of my paramedic friend who got a write-up and 10-day suspension for saving a guy's life at Disneyland because he went way way waaaayy outside the chain of command and commandeered an AED and an ambulance crew he--gasp!--wasn't "signed off on" to use (and told the nurse off, btw, because he was a grade-A asshole). The issue becomes whether you as a human being can live with yourself saying "Yes, it's sad that the person died, but I was only following orders."

There are times to follow orders, of course, and times not to; and blindly obeying the workplace regulations may sometimes be necessary. But if you really can go to bed at night comfortably assuring yourself you've done the right thing by allowing someone to die when you could have saved them BUT IT WAS POLICY NOT TO, then people need to stop blaming the Germans for letting the Holocaust happen.
 
2013-03-04 06:07:37 AM
So, a trained medical professional tells a phone jockey that she knows what is better for the patient, and the local media blows it out of proportion because, like the phone jockey, they think CPR is a magic wand.

Well, I know a whole bunch of farkers in this thread I never want to pass out next to, in case they decide to start CPR on my breathing unconscious self.
 
GBB
2013-03-04 06:20:46 AM

Gyrfalcon: There are times to follow orders, of course, and times not to; and blindly obeying the workplace regulations may sometimes be necessary. But if you really can go to bed at night comfortably assuring yourself you've done the right thing by allowing someone to die when you could have saved them BUT IT WAS POLICY NOT TO, then people need to stop blaming the Germans for letting the Holocaust happen.


I have a more condensed version of this I tell my trainees:

The difference between a bad dispatcher and a good dispatcher: knowing and following policies and procedures.
The difference between a good dispatcher and a great dispatcher: knowing when to ignore policies and procedures and actually help someone.
When a bad dispatcher screws up: more training.
When a great dispatcher screws up: under the bus.
How to keep your job: don't get caught screwing up trying to be a great dispatcher or fake being a bad dispatcher.

/ok, maybe not that condensed.
 
2013-03-04 06:21:17 AM

The more you eat the more you fart: In my experience


The more you eat the more you fart: The person is already dead..you cant make them MORE dead by not doing cpr....but you CAN bring a braindead person back with it.


Well, I'd certainly trust your experience completely. :\
 
2013-03-04 06:21:53 AM

Gyrfalcon: pedobearapproved: Medic Zero: ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.

Welcome to America. I'm sure the free market will sort it out eventually.

Because in the non-free market there aren't any rules and procedures that must be followed to a T? The same government that won't let you cut a tree blocking your driveway until an environmental review has been completed is the same type of regulation that a nurse in an old folks home might be under from her evil free market people.

I watched people from NASA install the wrong parts on non-flight critical systems because independent thinking will get you written up and sometimes fired. The check-list is there for a reason, and so is your brain. The answer is the woman should have helped as a human and if she'd been fired the outrage would have been against her employer.

Oh yeah, this in spades.

I've already related the sorry tale of my paramedic friend who got a write-up and 10-day suspension for saving a guy's life at Disneyland because he went way way waaaayy outside the chain of command and commandeered an AED and an ambulance crew he--gasp!--wasn't "signed off on" to use (and told the nurse off, btw, because he was a grade-A asshole). The issue becomes whether you as a human being can live with yourself saying "Yes, it's sad that the person died, but I was only following orders."

There are times to follow orders, of course, and times not to; and blindly obeying the workplace regulations may sometimes be necessary. But if you really can go to bed at night comfortably assuring yourself you've done the right thing by allowing someone to die when you could have saved them BUT IT WAS POLICY NOT TO, then people need to stop blaming the Germans for letting the Holocaust happen.


And the nurse shouldnt worry about being fired, sued, etc right?

Because she can at least say she tried....while standing in the food stamp line trying to feed her kids bc she was fired then turned over to the State Board for failing to follow the company's policy on the standard of care.


Thats what i think MOST of you just are NOT understanding. This nurse KNEW that no matter what she did, she was farked...so she chose the path that had the least chance of her ending up fired and unable to provide for herself and her family.

/one of the FEW professions where LITERALLY everyone is out to get you
 
2013-03-04 06:22:42 AM

starsrift: Well, I know a whole bunch of farkers in this thread I never want to pass out next to, in case they decide to start CPR on my breathing unconscious self.


I don't think you need to worry.  You're obviously already brain dead.
 
2013-03-04 06:23:15 AM

GBB: Gyrfalcon: There are times to follow orders, of course, and times not to; and blindly obeying the workplace regulations may sometimes be necessary. But if you really can go to bed at night comfortably assuring yourself you've done the right thing by allowing someone to die when you could have saved them BUT IT WAS POLICY NOT TO, then people need to stop blaming the Germans for letting the Holocaust happen.

I have a more condensed version of this I tell my trainees:

The difference between a bad dispatcher and a good dispatcher: knowing and following policies and procedures.
The difference between a good dispatcher and a great dispatcher: knowing when to ignore policies and procedures and actually help someone.
When a bad dispatcher screws up: more training.
When a great dispatcher screws up: under the bus.
How to keep your job: don't get caught screwing up trying to be a great dispatcher or fake being a bad dispatcher.

/ok, maybe not that condensed.


Pretty accurate I'd say
 
2013-03-04 06:25:02 AM

Relatively Obscure: The more you eat the more you fart: In my experience

The more you eat the more you fart: The person is already dead..you cant make them MORE dead by not doing cpr....but you CAN bring a braindead person back with it.

Well, I'd certainly trust your experience completely. :\


Diaf.

My experience has literally saved hundreds of lives, farkwad.

Dont talk about things you have no.actual knowledge about.
 
2013-03-04 06:39:21 AM

octopied: Perhaps the patients there have DNR orders.

If you don't know what that is, it's for people who are viewed as so close to death that they have orders for  no CPR to be performed, as they want to die "naturally".


Perhaps you could rtfa and see that she didn't have a dnr, which at her age is no accident, she wanted to be saved.
 
2013-03-04 06:41:52 AM
So, putting gramma in an apartment downtown is better than this place.  At least downtown someone might help.
I hope this place goes out of business quick.
 
2013-03-04 06:46:22 AM

The Envoy: starsrift: Well, I know a whole bunch of farkers in this thread I never want to pass out next to, in case they decide to start CPR on my breathing unconscious self.

I don't think you need to worry.  You're obviously already brain dead.


Like to explain why, or are you just picking a name at random to troll?
 
2013-03-04 06:52:32 AM
Abacus9:
Hmmm... I take your word for it. I've heard though that once the heart stops, they're already dead, so you can't really harm them any further. Although I guess that depends on the case and their wishes. Sounds like a rough thing for the patient, but also for the paramedic to have to do.

I guess you get used to it, I really never expected to have to use the training. But so far, three arrests and a Heimlich under my belt. The Heimlich was the most gratifying in that I popped that chunk of food about 4 feet when I hit the right spot, and the guy was immediately better. The CPR episodes were more like and 15 and 16 and (crack) oh my god and 18 and 19 (crack) jesus palomino and 21 and...

Of course, when the guys got there and relieved me it was "well, he was dead anyway" but still, it's sort of stressful to do to someone you aren't mad at.

The really odd thing was the bystanders, you get the wildest suggestions. "Here, stick this candy in his mouth!" Well, no, I'm pretty sure this isn't hypoglycemia...
 
2013-03-04 06:54:21 AM

starsrift: Like to explain why, or are you just picking a name at random to troll?


 Probably because you have no clue what the FARK you're talking about.

starsrift: So, a trained medical professional tells a phone jockey that she knows what is better for the patient, and the local media blows it out of proportion because, like the phone jockey, they think CPR is a magic wand.


 Dispatchers  ARE trained medical professionals if they are giving pre-arrival instructions, like CPR. The Priority Dispatch system is not allowed, by the corporation's own words as well as the laws of most states, to be used by someone who is not, at the very least, a Certified Emergency Medical Dispatcher, and many dispatchers are at least trained to the EMT-Basic level in a 911 system. (It's actually very common to see EMTs and Paramedics in dispatch centers who have sustained field-career ending injuries.) In addition, this is not a "phone jockey thinking CPR is a magic wand", it's a dispatcher following the EMD protocol system. You see, dispatchers are NOT allowed to give medical advice outside of the protocol sets. In reality, what lead him to instruct the nurse on administering CPR was the Priority EMD system identified, based on the information the nurse HERSELF gave the dispatcher, that the patient was likely in cardiac arrest.  That system of protocols is signed off on by the 911 system's  Medical Director, and the entire EMD protocol set is evidence based and has been backed successfully in court multiple times.

starsrift: Well, I know a whole bunch of farkers in this thread I never want to pass out next to, in case they decide to start CPR on my breathing unconscious self.


Well, good news. If you pass out, according to the 2010 AHA Heartsaver BLS guidelines, someone will start hands-only CPR on you if you have signs of ineffective respirations, and poor circulation.

Laypeople aren't taught to check for pulses.

Also, you keep using that word "breathing". Define Agonal Respiration. Do you know how to recognize it?

The fact that this patient was in full cardiac arrest when the Paramedic team arrived tells me that it wasn't "effective' respiration.
 
2013-03-04 06:56:29 AM

octopied: Perhaps the patients there have DNR orders.


Want to know how I know you didn't RTFA?
 
2013-03-04 07:00:07 AM

The more you eat the more you fart: Incorrect. I know three nurses who were sued for performing cpr on a patient with a dnr.

Only...they were unaware of the dnr thanks to hipaa law...they saw it happen, gave cpr, then were later told they SHOULD have checked first.

And ppl wonder why the nurse in this article played CYA....


I'm calling shenanigans on you. First off, HIPAA does not prevent providers from knowing patient information who are involved in the direct care of that patient. Secondly, you're presenting a vague situation which turned into a legal case without knowing all the facts. Chances are they were not sued for performing CPR, but rather for performing heroic measures in violation of that patient's legal wishes. The proper thing to do is to perform CPR, and then once a DNR is in hand and known to be valid, to stop all resuscitative measures.

I've had to code people with a DNR before, because the family didn't have the paperwork to prove it, or because they wished the DNR ignored.

In addition to this, again, NO ONE has been successfully sued, according to the  American Heart Association for performing CPR when it was indicated. If you have an actual case where this has occured, please cite it. I would be very interested to bring this to the attention of my fellow AHA Instructors.
 
2013-03-04 07:06:41 AM
As a RN, I find this story absolutely appalling.  Any nurse working in a patient care facility is required to maintain BLS certification (Basic Life Support) which is nothing more than providing the basics; obtaining an airway, providing breaths and giving chest compressions; quite similar to the CPR given to non-healthcare workers but with a few minor differences and tweaks.  BLS for healthcare providers (at least in most states/institutions/healthcare settings) also includes training and certification with an AED (Automated External Defibrillator). They are commonplace in healthcare and non-healthcare settings alike (even airports, universities, coffee shops, car dealerships, etc have them readily available for use for instances such as this). I can't imagine that a nursing home with would be without one, in fact I believe that they are required to have at least one functional machine at all times. The AED has a picture of where to place the two pads, automatically checks the heart rhythm to see if the patient requires shocking, and if required, delivers the shocks automatically at the correct time and and sequence under BLS guidelines, it even tells you when to start/stop CPR!  This machine is so simple to operate that my 5 year old son could use it properly with a near zero percent chance of screwing it up!  I find it absurd that a nursing home could have a protocol to withhold basic life support from patients who request to be full code (wanting CPR performed).  Code status options are reviewed and decided by the patient upon admission to ANY nursing home, that information is relayed to all staff and is required to be carried out in the event of the patient requiring CPR.  If it is the patient's wish to be "full code" and have CPR administered, every attempt to resuscitate the patient should be carried out by all available staff regardless of the nursing home's protocol of which I'm sure would not hold up to the state's standards of practice.  It sickens me to the point of projectile vomiting that there were several licensed and trained healthcare providers whose job it was to carry out whatever life saving measures the patient requested during the admission process and that all of these "professionals" were quite comfortable not performing CPR, watching someone die, merely calling 911, when the patient needed them the most. The inadequate response rendered to this patient wasted precious minutes to intervene when seconds count.  While their actions (or should I say in-action) were required by the protocol of the nursing home; I imagine that should an investigation by the state board of nursing and/or senior services would be launched, numerous violations to the states nurse practice act will have been found violated.  Hopefully, action will be taken by the board to ensure that these people will never again be placed in a position of trust to care for patients and have their licenses revoked. They had duty to act, they breached that duty; they deviated from the appropriate standards of care for their patient, which potentially led to her death.  Had they acted in a prudent and timely manner, within their expected scope of practice as trained professionals, this may have led to saving someone's life.  Instead, multiple people failed to act in a prudent manner as professional nurses, failed to act within their scope of practice and led to a patient death that may have been avoidable.
 
2013-03-04 07:06:58 AM

starsrift: Like to explain why, or are you just picking a name at random to troll?


I see it's been covered for me.  But to clarify, my comment is based on you making a statement that has been discussed and shown to be wrong throughout TFT.  There are links and everything.
 
2013-03-04 07:08:19 AM

The more you eat the more you fart: And the nurse shouldnt worry about being fired, sued, etc right?


Depending on what state she's in, firing a nurse for performing CPR when indicated, and providing resuscitative measures would qualify as wrongful termination. In addition, at least she would be keeping her license when the state nursing board found out about this.

Chances are, if this nurse avoids a lawsuit on her and the facility for failure to act within the expected standard of care, she's going to lose her nursing license.

The more you eat the more you fart: Because she can at least say she tried....while standing in the food stamp line trying to feed her kids bc she was fired then turned over to the State Board for failing to follow the company's policy on the standard of care.


That "facility policy" will not protect her when she goes before the State Board and has to explain why she acted with willful negligence and with wanton disregard for her duty to act. A facility CANNOT mandate you cannot perform CPR when it is indicated. The only time, by law, CPR can be withheld by a medical professional without an MD order is if a DNR is in place and valid at the time of the cardiac arrest, AND the family is not telling you to disregard it.

The more you eat the more you fart: Thats what i think MOST of you just are NOT understanding. This nurse KNEW that no matter what she did, she was farked...so she chose the path that had the least chance of her ending up fired and unable to provide for herself and her family.

/one of the FEW professions where LITERALLY everyone is out to get you


No. She committed the basic definition of malpractice and negligence, and her failure to act is the most probable reason a peri-arrest situation degraded into a full code by the time EMS arrived on scene.

And nursing homes and assisted living facilities are not known for hiring the "cream of the crop" of nurses. Elder care is NOT something that most nurses go into willingly.
 
2013-03-04 07:09:53 AM

hardinparamedic: Well, good news. If you pass out, according to the 2010 AHA Heartsaver BLS guidelines, someone will start hands-only CPR on you if you have signs of ineffective respirations, and poor circulation.


...And according to the nurse at the scene, the patient was breathing. Agonal respiration? Well, maybe you're right and the woman was gasping her last in the middle of the dining area. But, like the 911 operator, neither you nor I were there. The nurse was.

The fact that this patient was in full cardiac arrest when the Paramedic team arrived tells me that it wasn't "effective' respiration.

Oh, was she in full cardiac arrest? I followed a couple of the other links in this thread, I never saw this mentioned. Link?
 
2013-03-04 07:15:10 AM

Lehk: Acravius: Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

good Samaritan laws do not apply to healthcare professionals, they apply to untrained civilians doing their best


It depends on which state you are in.  Here Good Samaritan Laws cover any medical professional trying their best in a situation in which they are out of their element.
 
2013-03-04 07:16:21 AM

starsrift: ...And according to the nurse at the scene, the patient was breathing. Agonal respiration? Well, maybe you're right and the woman was gasping her last in the middle of the dining area. But, like the 911 operator, neither you nor I were there. The nurse was.


I'm drinking in the irony of this comment.

"I wasn't there, but I'll make insulting and informed statements about 911 dispatchers, and I'll defend a nurse who refused to act according to the basic standard of care. But you weren't there, how dare you question them!"

You're defending an indefensible act.

starsrift: Oh, was she in full cardiac arrest? I followed a couple of the other links in this thread, I never saw this mentioned. Link?


You're being obtuse now. Clearly, she died of that EMS crew's transport.

An ambulance arrived several minutes after the call and took the woman to a hospital, where she was later pronounced dead.

Read more:  http://www.foxnews.com/us/2013/03/02/elderly-woman-dies-in-california - after-nurse-refuses-to-do-cpr/#ixzz2MZZ8w7lR
 
2013-03-04 07:18:00 AM
Ahem. "uninformed". Fsck you, autocorrect.

lyanna96: It depends on which state you are in.  Here Good Samaritan Laws cover any medical professional trying their best in a situation in which they are out of their element.


No good Samaritan laws protect medical providers while they are on the clock, as there is a legal and ethical duty to act, and an expectation for them to provide the basic standards of care of their respective license levels. Those that do protect them when they render aid off duty.
 
2013-03-04 07:26:39 AM

starsrift: Like to explain why, or are you just picking a name at random to troll?


I'd like to add - sorry for being a dick about it.  I could have just said that others have covered it and that didn't seem to be the case.  Someone's got a case of the Mondays.  It's not an excuse, so apologies again for being a dick for no good reason.
 
2013-03-04 07:28:03 AM

Fell In Love With a Chair: and even laypeople should give it a shot.


Yes, yes they should.  In it's currently taught form it's been stripped down to make it as un ambiguous as possible specifically so that lay people will just start doing it rather than hmmming and hawing over how many ribs they'll break.
 
2013-03-04 07:38:07 AM

starsrift: ...And according to the nurse at the scene, the patient was breathing. Agonal respiration? Well, maybe you're right and the woman was gasping her last in the middle of the dining area. But, like the 911 operator, neither you nor I were there. The nurse was.


I'd like to add, for anecdotal experience, that I have worked some pure incompetence-related events in nursing homes. The last one, the call came in as "altered mental status" and fall. The patient was rolled to the dining hall in the exact same position he had been dressed by the CNA in that morning, and then appeared to be asleep during the meal. The LPN told the CNA that was normal for him, and that they had called the family in to discuss making him a DNR that day. The CNA couldn't get him to eat, and rolled him back to his room. Family comes in, find Pop not breathing, and has the nurse call 911. First Responding Fire crews start CPR, when we roll up, his jaw is already starting to rigor and stiffen, and he's cold as the room he's in.

MD at the pronouncing hospital thinks he's been dead for at least four to six hours.
 
2013-03-04 07:44:24 AM

hardinparamedic: You're being obtuse now. Clearly, she died of that EMS crew's transport.

An ambulance arrived several minutes after the call and took the woman to a hospital, where she was later pronounced dead (Link to FOXnews).


Ahhh. Didn't see that one, both TFA and and the local story didn't mention she was DOA as that sentence suggests, only that she "later died".


The Envoy: I'd like to add - sorry...


Not at all, we're all dicks on the internet.
 
2013-03-04 07:45:31 AM
Thank God for nurses, oh, wait.....
um, code of ethics, damn...
basic humanity?,
nope.

see you in hell

Nurse Ratched ha
 
2013-03-04 07:47:07 AM

starsrift: Ahhh. Didn't see that one, both TFA and and the local story didn't mention she was DOA as that sentence suggests, only that she "later died".


I'm not trying to be an asshole to you, either. Sorry if it comes off as such. I'm getting off a 24 hour shift, so mondays and all.

The problem is, and it's been pointed out over the course of the thread, that the nurse didn't just tell the dispatcher that she disagreed with him, and that she felt he was breathing adequately, if not in distress, but rather that she absolutely refused, and she's on tape as saying her facility policies will not let them perform CPR.

The facility is going to stand behind her now because they have to circle the wagons with that statement being public knowledge. By now, I'm willing to bet the State Nursing Board, as well as the Long-Term Care facility licensing board have begun an investigation into the matter.
 
2013-03-04 07:54:59 AM

hardinparamedic: starsrift: Ahhh. Didn't see that one, both TFA and and the local story didn't mention she was DOA as that sentence suggests, only that she "later died".

I'm not trying to be an asshole to you, either. Sorry if it comes off as such. I'm getting off a 24 hour shift, so mondays and all.


Not at all. I don't disrespect dispatchers, and certainly not EMT's, but I am - generally speaking - more inclined to trust a nurse in situ than a non-practicing certified person who isn't there. Even when senior's homes have a reputation for bad staff. :/
 
2013-03-04 08:06:03 AM
The more you eat the more you fart:  /one of the FEW professions where LITERALLY everyone is out to get you

This.
Patients, families, strangers, other nurses, doctors., especially online couch medics... EVERYONE!!  Quick to wharrgarbl manufactured media outrage, slow to figure out what the facts actually are, too damn stubborn to admit it when they find out they were wrong.

I don't do my job for the money like someone above posted.  If I did, I'd pick a much easier job to do for the same money!  I couldn't go to one of those desk type of nursing jobs until my every joint and limb quit on me and then I'll do telephone nursing till the day I'm forcibly removed.

I'm really pissed that people are passing judgment on someone who was probably NOT a nurse on the phone but a CNA or less.   No one here knows what happened other than shallow breathing and died at the hospital, so how do you even know if she did right or wrong?  The family is happy that they did what they could do.

MDs, nurses, EMS, fire dept...  we do our best every day to save your farkin asses so you have the ability to tell us what greedy pieces of shiat you think we are.

You're welcome.

/I love my job
//fark all of you
 
2013-03-04 08:07:03 AM
The more you eat the more you fart:
Regardless, no nurse is gonna get in trouble for refusing an "order" given by someone less qualified than her to make medical decisions.

Remember the cruise ship that sank in Italy, some time ago? And remember how the Coast Guard was on the radio telling the Captain to return back on the ship?

I don't know what rank the CG on the radio had. But it's possible that it was lower than a Captain, and either way he wasn't there, in the middle of it. Yet, the CG on the radio had charge of the situation.

When you call 911, the dispatcher takes charge of the rescue. Just like when you call for Coast Guard's help, they take charge of the rescue. This continues until they expressly give up the command to someone else.
 
2013-03-04 08:27:39 AM

hardinparamedic: starsrift: Ahhh. Didn't see that one, both TFA and and the local story didn't mention she was DOA as that sentence suggests, only that she "later died".

I'm not trying to be an asshole to you, either. Sorry if it comes off as such. I'm getting off a 24 hour shift, so mondays and all.

The problem is, and it's been pointed out over the course of the thread, that the nurse didn't just tell the dispatcher that she disagreed with him, and that she felt he was breathing adequately, if not in distress, but rather that she absolutely refused, and she's on tape as saying her facility policies will not let them perform CPR.

The facility is going to stand behind her now because they have to circle the wagons with that statement being public knowledge. By now, I'm willing to bet the State Nursing Board, as well as the Long-Term Care facility licensing board have begun an investigation into the matter.


Meh. When we were trying to get mom into an assisted-living facility, no-CPR clauses were universal.

Also on the train that the "nurse" was probably an unlicensed caregiver. It's an assisted living facility. The only nurses on staff are probably the DON/ADON who fills out paperwork in an office and takes call from home.
 
2013-03-04 08:36:01 AM

ZeroCorpse: People don't become doctors or nurses, or join the medical profession at all these day because they want to help people and save lives. These days, they do it because they want lots of money.

It's a disgrace that we even use the words "nurse" and "doctor" to describe these greedy animals. They bring dishonor to the words.


Ummmm..... if you think nurses are getting rich I am going to assume you have never actually known one.
 
2013-03-04 08:36:04 AM

Abacus9: Lady Indica: To my knowledge (and I could easily easily be wrong here) there's times where breathing alone is called for. I would think this would be one. Drowning is another. Other than that AFAIK, chest compress is most important (to the tune of Stayin' Alive).

Oddly, "Another One Bites The Dust" also works (roughly the same beats per minute)...


But its not nearly as optimistic...
 
2013-03-04 08:37:39 AM

Medic Zero: ZeroCorpse: People don't become doctors or nurses, or join the medical profession at all these day because they want to help people and save lives. These days, they do it because they want lots of money.

It's a disgrace that we even use the words "nurse" and "doctor" to describe these greedy animals. They bring dishonor to the words.

Gee thanks! Got any racism to go with your broad brush?


Sure! White nurses are more squeamish than non-white nurses. Whitey's afraid of cooties.

Feel better, now?
 
2013-03-04 08:39:51 AM

SpectroBoy: ZeroCorpse: People don't become doctors or nurses, or join the medical profession at all these day because they want to help people and save lives. These days, they do it because they want lots of money.

It's a disgrace that we even use the words "nurse" and "doctor" to describe these greedy animals. They bring dishonor to the words.

Ummmm..... if you think nurses are getting rich I am going to assume you have never actually known one.


There's a difference between "rich" and "lots of money."  Nurses make more than the average retail or service industry worker and most of them chose the career because of that fact.

Yes, it's a generality, but it's becoming more and more true as the years go on. Medicine isn't a calling anymore; It's a career path.
 
2013-03-04 08:41:13 AM
That is so farked up.

Nope, not gonna break the rules. I would rather watch this old woman gasp for air and die like a fish on the beach. Rules are rules.

Fortunately this biatch's life is about to become as miserable as she deserves.
 
2013-03-04 08:44:45 AM

lyanna96: The more you eat the more you fart:  /one of the FEW professions where LITERALLY everyone is out to get you

This.
Patients, families, strangers, other nurses, doctors., especially online couch medics... EVERYONE!!  Quick to wharrgarbl manufactured media outrage, slow to figure out what the facts actually are, too damn stubborn to admit it when they find out they were wrong.

I don't do my job for the money like someone above posted.  If I did, I'd pick a much easier job to do for the same money!  I couldn't go to one of those desk type of nursing jobs until my every joint and limb quit on me and then I'll do telephone nursing till the day I'm forcibly removed.

I'm really pissed that people are passing judgment on someone who was probably NOT a nurse on the phone but a CNA or less.   No one here knows what happened other than shallow breathing and died at the hospital, so how do you even know if she did right or wrong?  The family is happy that they did what they could do.

MDs, nurses, EMS, fire dept...  we do our best every day to save your farkin asses so you have the ability to tell us what greedy pieces of shiat you think we are.

You're welcome.

/I love my job
//fark all of you


Also people tarring RNs, RPNs, HCAs and PSWs with the same brush. They're all profoundly hard jobs that a lot of people just plain vanilla can not do, but here come these poor bastards with expertise and equipment in hand to make you slightly less miserable while your dignity is out of commission. They should not be able to walk down the street without a high-five free coffee blowjob and a doughnut but instead we treat them like the handle on the malpractice slot machine.
 
2013-03-04 08:49:05 AM

nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?


If my mother was 87, yes.  Even if she was 80.  If I make it to be that old I'll have DNR paperwork filled out as well.  All four of my grandparents made it to 80, and all of them filled out DNR orders at about that time.  My parents have expressed that they will do the same and that they don't want their family to go through years of watching them sit in bed, half coherent, pumped up with drugs, and spending any half-lucid time they have staring out the window wondering when someone will visit.  I don't believe in keeping people clinging to life just to keep them around, especially when there isn't much time left anyway and what little time there is will basically be spent in bed waiting to die.

And like I said in my post, if I'm someone that should still have some quality time on the clock I hope someone will try to keep me around.  If I'm 87 and living in a home, just let me go.  I had a great-aunt that didn't take that path.  She had a stroke and went full-code.  They managed to bring her back, then she spent the next several years being spoonfed, needing someone to move her every couple hours so she didn't get bedsores, shiatting and pissing in a bag, not knowing who any of us were, asking where her mother was, then if we told her that her mother had died (30 years ago) it was like she was just finding out for the first time, so we decided we'd just lie and say she was out getting groceries or something.  It was heartbreaking, especially for her kids.  I don't want to do that to my family, and I'd rather their good memories of me aren't tarnished and overwritten with years of that awful shiat.
 
2013-03-04 08:54:50 AM

Bumblefark: BarkingUnicorn: nmemkha: BarkingUnicorn: nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?

Yes, I would.  An 87 year-old who survives such an incident is very unlikely to enjoy her remaining days.

Much of the dying's suffering is caused by their survivors.

You say that now, but your not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.

Yes, it is easy now.  My mother died in 1995, as I watched.  It was the best thing that could have happened to her, and I'd have been a poor son had I clung to her.

...and then, some families are a bit to eager to be done with the person that has become an inconvenience.

It cuts both ways. Which is why I intend to check myself out, before that decision has to fall to anybody else...

/Brave words, for somebody not on their death bed.


Story time...not related to TFA but related to the notion of clinging to a dying parent for one's own sake
rather than the parent's:

My dad was diagnosed with stage 4 esophageal cancer that had metastized just before Christmas 2005.
I went to visit him a month or two later (he was living in TN, I'm in FL) and made him swear to me that he
would not give up or quit fighting. An understandable reaction on my part - I didn't want to lose my dad if
there was even another day left in him.

Flash forward another 5 months. My mother (she and my dad had been separated until he got sick) had
moved down to TN to be with my dad at his parents place. They have a home on a lake and being on
the water was my dad's favorite place to be. So hospice set him up in the living room overlooking the
water. So, I get the phone call that it could be any day now and I needed to get up there. I tell my dad
that I'm coming and to hang on. I hopped on a greyhound and made the trip.

He went downhill fast once I got there. He went from being able to carry on a short, breathy conversation
to not being able to talk at all inside of a couple of hours. I was sitting with him in the middle of the night
and it hit me how selfish I'd been, demanding that he hang on when he was obviously miserable and in
agony. He seemed to know that I had something I needed to tell him, because he woke up just then.

I told him that I know I had made him promise not to stop fighting but that I'd been wrong to demand that
of him and that sometimes there does come a point where you've fought long enough and hard enough
and that its ok to stop fighting and rest. I never said "give up" or anything like that. i just told him that i
know how hard he fought and how much he hurt. i told him that i loved him and that it was OK to rest.

The next day, surrounded by family and friends, with old Redskins games on the TV and great music on
the stereo, he passed away. One moment he was there and we were all going about our conversations
and the next moment everyone in the room looked up like a shadow had passed overhead. We looked
at my mom who was sitting next to my dad and knew that he'd gone.

My dad loved me unreservedly even though he didn't have to (he is my mom's second husband) and
even though I was a complete shiat to him as a kid at times. He is the one who made music such a
critical part of my life, who made sure that i'd never be stranded on the side of a dark road with a flat
tire just because I was a girl. He was mom AND dad to me when my mom was too sick to be functional.

God I miss my dad.
 
2013-03-04 09:17:00 AM

HectorSchwartz: octopied: Perhaps the patients there have DNR orders.

If you don't know what that is, it's for people who are viewed as so close to death that they have orders for  no CPR to be performed, as they want to die "naturally".

This.  They still call 911 because it's a helluva lot easier when they die in a hospital.  Most of those poor old farts have been circling the drain for years and are quite ready to go.

/ my mom has a DNR, for example.
/ I have pretty specific instructions in a living will, and all you you should think about it if you don't already have one...


Read the article much?
 
2013-03-04 09:20:54 AM

octopied: Perhaps the patients there have DNR orders.

If you don't know what that is, it's for people who are viewed as so close to death that they have orders for  no CPR to be performed, as they want to die "naturally".


You are misinformed. A DNR order has nothing to do with CPR. It specifies against using extraordinary means such as defibrillation and artificial ventilators.
 
2013-03-04 09:27:31 AM

RubberBabyBuggyBumpers: You are misinformed. A DNR order has nothing to do with CPR. It specifies against using extraordinary means such as defibrillation and artificial ventilators.


Wat.

No, a DNR has everything to do with CPR. Tennessee's POST (physicians orders for scope of treatment) has, as it's first selectable section: CPR or NO CPR. This leads to zany DNR combinations in my state, like "Give Resuscitation drugs" and "Intubate" but NO CPR.

You're thinking of advanced directives, or a living will.
 
2013-03-04 09:39:45 AM

RubberBabyBuggyBumpers: octopied: Perhaps the patients there have DNR orders.

If you don't know what that is, it's for people who are viewed as so close to death that they have orders for  no CPR to be performed, as they want to die "naturally".

You are misinformed. A DNR order has nothing to do with CPR. It specifies against using extraordinary means such as defibrillation and artificial ventilators.


Nope. "Do Not Resusitate" means just that. If a facility has a different definition for DNR, it needs to be spelled out. Most facilities have "care directives" in place that granny and/or the family agree to.
Usually 3 or 4 level directives ranging from 911 CPR  to comfort measures only.
 
2013-03-04 09:53:53 AM
http://dmanager.streamtheworld.com/media/default_audio_player.php?aud i o_file_id=102204171

Here is the full 911 call. I agree with the operator hearing the full call in context.
 
2013-03-04 10:01:21 AM
DNR means no compressions, no edison medicine. Period.
 
2013-03-04 10:04:06 AM
Everyone, except the medical personnel and family who have posted here, and have not been through anything like this "end of life situation", are talking through their hats.
Prepare for your own "end of life" situations by having open and concise conversations with your spouse, parent, or loved one before you are there.
The lady in the article, along with her daughter, were no doubt aware of the "care directives" in place at the facility when mom went in there, and would have agreed to it.
The media and armchair experts love this kind of shiat, especially when it sounds "callous" or uncaring from the facilities standpoint.
This happens everyday, everywhere.
You will be in this end of life position at some point in your life. Prepare for it.
 
2013-03-04 10:15:42 AM
Just for kicks I went and tried to look up that 3% claim.
Not that I didn't believe it, just that I figured there had to be more to it.


Type of ArrestSurvivalSourceWitnessed In-Hospital Cardiac Arrest48%22%Unwitnessed In-Hospital Cardiac Arrest21%1%Bystander Cardiocerebral Resuscitation40%6%Bystander Cardiopulmonary Resuscitation40%4%No Bystander CPR (Ambulance CPR)15%2%Defibrillation within 3-5 minutes74%30%As I figured, it's more complicated than even this graph.  Training plays a huge factor too.  Well anyway...
http://en.wikipedia.org/wiki/Cardiopulmonary_resuscitation
 
2013-03-04 10:16:01 AM

RandomRandom: Relatively Obscure: None of that being relevant to why this particular person did what they did.

If the reporting is accurate - the only relevant issue is that the 911 dispatcher should never have told the nurse to start CPR on a person who was still breathing.

If the reporting isn't accurate and the patient wasn't breathing, the nurse still shouldn't have performed CPR, because it rarely works on healthy young people, let alone nursing home patients.


No.

First. CPR is indicated with severely abnomal respirations, such as agonal breaths. Suppose she was breathing 4 times a minute. That's not good, and at the very least, her breathing should have been assisted.

Second. The patient certainly had the right to have a DNR if she chose. The article said she did not have a DNR. Believe it or not, you don't get to decide other people's healthcare. It isn't up to you, the ambulance staff or anyone other than than the patient to say "CPR is a low-percentage play, so let's forget it." The only one who gets to decide if she gets CPR is herself, and she does it in advance by having DNR paperwork ready.

Third. CPR doesn't "work" on anyone, as in it doesn't restart hearts. Recipients of CPR don't cough and sit up after a 20 tense seconds of it, Baywatch-style. It is a stop-gap effort to delay tissue death long enough to attempt other interventions, such as defibrilation and administration of cardiac drugs.

Lastly, the effectiveness of CPR goes through the roof under certain conditions. A witnessed arrest with early CPR and defibrilation gets circulation back 75% of the time and a survival rate of over 20%.
 
2013-03-04 10:16:13 AM
Dumski:
Prepare for your own "end of life" situations by having open and concise conversations with your spouse, parent, or loved one before you are there.


Does it have to be concise? Can I at least ask them how their day was first?
 
2013-03-04 10:16:22 AM
Bleh, sorry, that didn't copy over at all :-/
 
2013-03-04 10:43:19 AM

seniorgato: Just for kicks I went and tried to look up that 3% claim.
Not that I didn't believe it, just that I figured there had to be more to it.


Type of ArrestSurvivalSourceWitnessed In-Hospital Cardiac Arrest48%22%Unwitnessed In-Hospital Cardiac Arrest21%1%Bystander Cardiocerebral Resuscitation40%6%Bystander Cardiopulmonary Resuscitation40%4%No Bystander CPR (Ambulance CPR)15%2%Defibrillation within 3-5 minutes74%30%As I figured, it's more complicated than even this graph.  Training plays a huge factor too.  Well anyway...
http://en.wikipedia.org/wiki/Cardiopulmonary_resuscitation


It also depends on what area of the United States you're in, and millions of other factors. Google "2010 AHA Guidelines Circulation" and there's a 100+ page document which outlines the science behind the guidelines.

/sorry for sporatic typing. Posting between tubing kids for biannual surgical intubation competencies. -.-
 
2013-03-04 10:49:50 AM

hardinparamedic: seniorgato: Just for kicks I went and tried to look up that 3% claim.
Not that I didn't believe it, just that I figured there had to be more to it.


Type of ArrestSurvivalSourceWitnessed In-Hospital Cardiac Arrest48%22%Unwitnessed In-Hospital Cardiac Arrest21%1%Bystander Cardiocerebral Resuscitation40%6%Bystander Cardiopulmonary Resuscitation40%4%No Bystander CPR (Ambulance CPR)15%2%Defibrillation within 3-5 minutes74%30%As I figured, it's more complicated than even this graph.  Training plays a huge factor too.  Well anyway...
http://en.wikipedia.org/wiki/Cardiopulmonary_resuscitation

It also depends on what area of the United States you're in, and millions of other factors. Google "2010 AHA Guidelines Circulation" and there's a 100+ page document which outlines the science behind the guidelines.

/sorry for sporatic typing. Posting between tubing kids for biannual surgical intubation competencies. -.-


You really shouldn't be talking about tubing kids on a public forum, perv :-P
 
2013-03-04 10:53:18 AM
Thanks, Obama!!
 
2013-03-04 11:13:46 AM

Coming on a Bicycle: Yeah. CPR has a lifesaving potential of about 5%. That's because it's mostly applied to very old people in hospital-like situations who are about to die anyway.


CPR only has the possibility of saving your life if the problem that stopped your heart in the first place is fixable.  Usually it isn't.
 
2013-03-04 11:13:55 AM
nmemkha:

 [Y]our(sic) not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.


If letting my mother go was called for I'd have no problem with it. Why cave in her fragile ribs and maybe leave her brain damaged from lack of oxygen? She's miserable enough already.

That remind me, I've got to update my Final Directive to make it VERY clear they should "Just let me die damn you!"

How many languages should I have "Do Not Resuscitate" tattooed on my chest in? English, Spanish and Chinese sound obvious, but there should be no doubt.
 
2013-03-04 11:17:57 AM

WhoGAS: Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.

You don't do breaths any more.


and the rate of compressions is changing too.... but have not seen the newer guidelines in a while and cant remember what it is.
 
2013-03-04 11:26:57 AM

hardinparamedic: The more you eat the more you fart: Incorrect. I know three nurses who were sued for performing cpr on a patient with a dnr.

Only...they were unaware of the dnr thanks to hipaa law...they saw it happen, gave cpr, then were later told they SHOULD have checked first.

And ppl wonder why the nurse in this article played CYA....

I'm calling shenanigans on you. First off, HIPAA does not prevent providers from knowing patient information who are involved in the direct care of that patient. Secondly, you're presenting a vague situation which turned into a legal case without knowing all the facts. Chances are they were not sued for performing CPR, but rather for performing heroic measures in violation of that patient's legal wishes. The proper thing to do is to perform CPR, and then once a DNR is in hand and known to be valid, to stop all resuscitative measures.

I've had to code people with a DNR before, because the family didn't have the paperwork to prove it, or because they wished the DNR ignored.

In addition to this, again, NO ONE has been successfully sued, according to the  American Heart Association for performing CPR when it was indicated. If you have an actual case where this has occured, please cite it. I would be very interested to bring this to the attention of my fellow AHA Instructor.


Call your shenanigans.  HIPAA states that unless you are directly involved with the care of a particular patient, you are not allowed to look through their charts, etc.

If a nurse working the same facility sees a patient fall out, and starts CPR, unless that particular patient is a patients of his or hers, there is no way he or she would know.

So...shenanigans for YOU as well, for making assumptions about a situation that you know nothing about.  Very apparent that you are completely unfamiliar with what it is like working in a hospital or LTC facility.
 
2013-03-04 11:34:43 AM

hardinparamedic: starsrift: ...And according to the nurse at the scene, the patient was breathing. Agonal respiration? Well, maybe you're right and the woman was gasping her last in the middle of the dining area. But, like the 911 operator, neither you nor I were there. The nurse was.

I'm drinking in the irony of this comment.

"I wasn't there, but I'll make insulting and informed statements about 911 dispatchers, and I'll defend a nurse who refused to act according to the basic standard of care. But you weren't there, how dare you question them!"

You're defending an indefensible act.

starsrift: Oh, was she in full cardiac arrest? I followed a couple of the other links in this thread, I never saw this mentioned. Link?

You're being obtuse now. Clearly, she died of that EMS crew's transport.

An ambulance arrived several minutes after the call and took the woman to a hospital, where she was later pronounced dead.

Read more:  http://www.foxnews.com/us/2013/03/02/elderly-woman-dies-in-california - after-nurse-refuses-to-do-cpr/#ixzz2MZZ8w7lR


So she was still alive when she arrived at the hospital then...because they pronounced her dead LATER, after she arrived at the hospital and had been there.

So...like I was saying earlier...you dont know.  You weren't there, I wasn't there, the 911 dispatcher was not there.

Sounds like the nurse acted appropriately to me now...before I was questionable..but considering the patients was clearly alive during transport and even after arriving at the hospital.
 
2013-03-04 11:36:04 AM

Relatively Obscure: WhoGAS: You don't do breaths any more.

That isn't true everywhere.


Back when I took my CPR training that's what they told me too. It is better to keep the blood circulating with depleted oxygen than to stop CPR to try and put more oxygen in the lungs (which is a questionable attempt if the heart isn't beating well already). The blood still has oxygen in it, so just keep it moving.

/that was a few years ago
 
2013-03-04 11:39:32 AM

finnished: The more you eat the more you fart:
Regardless, no nurse is gonna get in trouble for refusing an "order" given by someone less qualified than her to make medical decisions.

Remember the cruise ship that sank in Italy, some time ago? And remember how the Coast Guard was on the radio telling the Captain to return back on the ship?

I don't know what rank the CG on the radio had. But it's possible that it was lower than a Captain, and either way he wasn't there, in the middle of it. Yet, the CG on the radio had charge of the situation.

When you call 911, the dispatcher takes charge of the rescue. Just like when you call for Coast Guard's help, they take charge of the rescue. This continues until they expressly give up the command to someone else.


Sorry...you are incorrect.
 
2013-03-04 11:41:18 AM

Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.


It's 5 compressions, then breath. 30 compressions then a breath would leave a person without a heart compression to pass the oxygen into the bloodstream and thus leaving the person dead from asphyxiation to the cells of the body that needed them or at the very least Hypoxia. Time to brush up on your CPR Training. This is why during training, that is exactly what they teach you, be it a baby or an elderly person or anyone in between. You have to think about what a person does while maintaining their own live support. Try not breathing 30 times at one sitting and see what happens. Doesn't feel very good nor does it feel natural or appropriate.
 
2013-03-04 11:55:06 AM

James F. Campbell: FTA: Bayless' daughter told KGET that she was a nurse and was satisfied with her mother's care at Glenwood Gardens, the station reported.

IIIInteresting.


/looks like someone got paid.
 
2013-03-04 12:02:08 PM
How disturbing.   In other places they have enacted laws where it is a crime to do nothing.
 
2013-03-04 12:09:23 PM

The more you eat the more you fart: Sorry...you are incorrect.


Actually, he's quite correct for out-of-hospital emergencies which turn into a Pre-Arrival Instruction Protocol, like Childbirth, Suspected MI or Cardiac Arrest. Those protocols are considered to be medical orders, given by a proxy acting under the physician. You're  more than welcome not to follow them, especially if you are a trained healthcare provider, but you are given no legal protection if you cannot justify why you did not to a reasonable man standard.

I.e. "I didn't give him asprin because he has a history of bleeding ulcers, I didn't give CPR because his head was cut off"

Priority Dispatch has it's own special card for interfacility transfers where an MD is directly involved in the patient's care that do not lead into the pre-arrival protocols.

Example: If you refuse to follow the instructions for childbirth, and that patient suffers a birth anoxic brain injury because of your actions, you're held responsible for that. Especially if you're a healthcare provider.

The more you eat the more you fart: Call your shenanigans.  HIPAA states that unless you are directly involved with the care of a particular patient, you are not allowed to look through their charts, etc.


And administering CPR is not being directly involved in a patient's care? And actually, there are very specific exceptions to that rule pertaining to emergency situations as well as QA/QI and auditing, as well as legally mandated release of PHI. At any rate, there are more jailhouse lawyers who don't know as much as they think about HIPAA.

I've had emergency runs where trained nurses have refused to allow the crew to know the allergies, medication history, or medical history of a nursing home patient because of HIPAA. All of which are legally allowed disclosures.

The more you eat the more you fart: So she was still alive when she arrived at the hospital then...because they pronounced her dead LATER, after she arrived at the hospital and had been there.


Actually, according to the story that is making rounds on the Nursing and Paramedic Facebook groups, she was pronounced AT the hospital. Not dying later.

You'll forgive me for believing them.

Also:

The nurse asked for paramedics to come and help the 87-year-old woman who had collapsed in the facility and was barely breathing.  The woman was later declared dead at Mercy Southwest Hospital.

An elderly woman being cared for at a California retirement facility died following the refusal of a nurse at the facility to perform CPR on the woman after she collapsed, authorities said.
 
Collapse with ineffective or questionable breathing leads into the Questionable Life Status - CPR protocol on Priority Dispatch.

The more you eat the more you fart: So...shenanigans for YOU as well, for making assumptions about a situation that you know nothing about.  Very apparent that you are completely unfamiliar with what it is like working in a hospital or LTC facility.


Considering I work in a regional pediatric level 1 Trauma Center for a Pediatric Flight Team, I'd think I know a little about HIPAA. I also spent two years working as a CNA in a LTC facility while going to EMT school.

I have horror stories of LTC centers I could set down all day and tell you.

LTC nurses are not the cream of the crop. They're not even the bottom of the barrel. They're there because they either can't get a job somewhere else, are getting job experience to go to a higher acuity level of care, or maybe 1 in 100 actually WANT to work in Elder Care.

CutBoard: It's 5 compressions, then breath. 30 compressions then a breath would leave a person without a heart compression to pass the oxygen into the bloodstream and thus leaving the person dead from asphyxiation to the cells of the body that needed them or at the very least Hypoxia. Time to brush up on your CPR Training. This is why during training, that is exactly what they teach you, be it a baby or an elderly person or anyone in between. You have to think about what a person does while maintaining their own live support. Try not breathing 30 times at one sitting and see what happens. Doesn't feel very good nor does it feel natural or appropriate.


Uh, What? I think it's time to brush up on YOUR CPR training, because you're completely incorrect.

3:1 Ratio is NRP for Neonates fresh out of the chute. It's not for adult and pediatric BLS providers. Adult is 30:2, Pedi 1 Man is 30:2, and 2 man Pedi is 15:2. The body does NOT need very much oxygen during a cardiac arrest, and hyper-oxygenation during cardiac arrest will actually cause MORE cellular damage. Ventilation and removal of CO2 is not even all that necessary in a primary cardiac arrest until approaching ROSC, when ETCO2 will peak. Even performing rescue breathing and NOT CPR, you're taught to breath 6-8 times a minute with oxygen according to AHA, and 10-12 without oxygen for adults in arrest.
 
2013-03-04 12:13:42 PM

The more you eat the more you fart: If a nurse working the same facility sees a patient fall out, and starts CPR, unless that particular patient is a patients of his or hers, there is no way he or she would know.


And I'm telling you you're not telling the full story of what happened by saying these three nurses were successfully sued for starting CPR on a patient when it was indicated, and when it was not known the patient had a DNR order.

If you want to post the civil case or the names of the people involved, I'll be happy to call a Legal Paramedic friend of mine and have him pull the case history and brief. Otherwise, as a Healthcare Provider (which I'm assuming you are, based on your language in this thread), it's  farking irresponsible to scare people from performing CPR when it's indicated by telling them they'll be sued for it.
 
2013-03-04 12:19:34 PM

Don't Troll Me Bro!: Seems like a stupid policy.  Are they worried that their staff will do it wrong?  Is it a liability thing?  I'd have to imagine they could should hire people that are qualified to do things like this, especially being a senior living center and all.

Also: The elderly woman was identified by KGET-TV as 87-year-old Lorraine Bayless. She died Tuesday at Mercy Hospital Southwest, KGET reported.

It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.  If this had been a child, or a healthy person that should have some time left on the clock, I'd be pretty disgusted.


As someone who recently lost their father (in the same age range)

FARK YOU you cock. He wanted to live just as much as you do, and yet that life got wasted on a piece of shiat like you. Life is not fair.

May you die a long, lingering death - attended by caring souls just like yourself.
 
2013-03-04 12:29:46 PM
A lot of people in this thread have not seen the aftermath of being "saved" by CPR. I hope you never have to.
 
2013-03-04 12:33:31 PM

The more you eat the more you fart: hardinparamedic: starsrift: ...And according to the nurse at the scene, the patient was breathing.

So she was still alive when she arrived at the hospital then...because they pronounced her dead LATER, after she arrived at the hospital and had been there.

So...like I was saying earlier...you dont know.  You weren't there, I wasn't there, the 911 dispatcher was not there.

Sounds like the nurse acted appropriately to me now...before I was questionable..but considering the patients was clearly alive during transport and even after arriving at the hospital.


Yes you are right. Here's my final thought.
 When the First Responder/EMT/Paramedics arrived, they would have assessed the patient (unless it was a "scoop and run" decision - usually done by less qualified responders), otherwise they would have stabilized her, then took her to hospital. Higher up the Paramedic qualification training would be a team that could intubated her, and then assist her breathing and do CPR , if they thought it was necessary.

The more likely scenario is this: Team arrives, assesses, treats as they feel is necessary (O2), speaks with facility staff and maybe the daughter. The decision was made that she was dying and that because she probably was essentially taking her last breaths at the scene, the crew took her to hospital where she passed away.
The other possibility is that she was breathing her last when team arrived, none of the team can pronounce her death so they take her to hospital where she is declared.
Either way her death was imminent, and staff, medical responders, family and finally the hospital ER make hard choices when it is necessary. The 911 operator, even though was not at the scene and didn't know the circumstances, was doing what she was trained to do. She cannot be faulted for responding the way she did. In the end, every person involved in this lady's care decided that CPR and ALS was not indicated, and it would appear from how I read it, was the right decision.

/Retired RN - Critical Care, Emergency, Med/Surg, Psychiatry, Manager. Dad died at home with family care. Mom died in care facility with appropriate DNR comfort measures only. I've worked and lived the scenario.
 
2013-03-04 12:36:27 PM

Dictatorial_Flair: A lot of people in this thread have not seen the aftermath of being "saved" by CPR. I hope you never have to.


I've had a person walk up to me, shake my hand, and tell me thank you for doing CPR on them two years after I did it.

I've seen a 17 year old athlete survive after two hours of CPR while being crashed to ECMO for myocarditis, neurologically intact.

I've also seen people live long enough to have their family say goodbye to them, and die in the surrounding of their loved ones rather than alone in the middle of the grocery store.

And I've seen people end up in the nursing home from it.

That's not going to stop me from doing my job, and doing it for people who need it. Because I don't get the choice to play God, and decide who's going to have a CPC outcome of 1 when they walk out of the hospital. I do what I do because I know it's the best chance that patient has to survive, and I act on the assumption that they would want to live until proven otherwise, or it's proven to be futile to resuscitate them.

No healthcare provider gets to make that choice, and even Doctors have to justify why. The thought that people wouldn't help another human being because it "might not work" is sickening, and contrary to the oath every healthcare provider - nurse, RT, MD, DO, Paramedic - takes when they enter their profession.

CPR doesn't work every time, for a myriad of reasons. Some reversible in the field, some not. It's not a magic bullet like TV portrays it, but it is the best, and only chance for survival in a patient who is in a non-perfusing rhythm.
 
2013-03-04 12:39:43 PM

Dumski: Either way her death was imminent, and staff, medical responders, family and finally the hospital ER make hard choices when it is necessary. The 911 operator, even though was not at the scene and didn't know the circumstances, was doing what she was trained to do. She cannot be faulted for responding the way she did. In the end, every person involved in this lady's care decided that CPR and ALS was not indicated, and it would appear from how I read it, was the right decision.


As much as I want to down on the nursing home nurse for this, you're absolutely right.

I think what's infuriating to me more given the situation and tape is that there is a "facility policy against doing CPR".
 
2013-03-04 01:04:39 PM
Fark lawyers
 
2013-03-04 01:14:24 PM
images.sodahead.com
 
2013-03-04 01:16:42 PM

ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.


I guess the ones who don't put keeping their job before matters of life and death aren't working there anymore.
 
2013-03-04 01:32:03 PM

FarkinSneakyBastage: Can I please have the freedom to choose how and when I die and not rot to death in one of these depressing shiatholes they call a retirement community? That'd be great, thanks


"Freedom to choose" implies a choice between two or more alternatives.  In order for people to be able to choose to die naturally, we need to have the option of choosing a "follow your damn oath and try to keep me alive" order instead of a "do not resuscitate" order if that is what some people prefer.  If everyone gets the DNR treatment whether they want it or not, that's not a choice.
 
2013-03-04 01:35:30 PM

The more you eat the more you fart: Diaf.

My experience has literally saved hundreds of lives, farkwad.

Dont talk about things you have no.actual knowledge about.


The more you eat the more you fart: but you CAN bring a braindead person back with it.


Take your own advice.
 
2013-03-04 01:47:16 PM

Don't Troll Me Bro!: Seems like a stupid policy.  Are they worried that their staff will do it wrong?  Is it a liability thing?  I'd have to imagine they could should hire people that are qualified to do things like this, especially being a senior living center and all.

Also: The elderly woman was identified by KGET-TV as 87-year-old Lorraine Bayless. She died Tuesday at Mercy Hospital Southwest, KGET reported.

It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.  If this had been a child, or a healthy person that should have some time left on the clock, I'd be pretty disgusted.


I'm pretty disgusted that you just arbitrarily decided 87 was old enough to let someone die.  You don't know that she may have made it only a few more years.  Shrugging your shoulders and walking away because the person is old is pretty heartless.
 
2013-03-04 01:50:58 PM

Relatively Obscure: The more you eat the more you fart: Diaf.

My experience has literally saved hundreds of lives, farkwad.

Dont talk about things you have no.actual knowledge about.

The more you eat the more you fart: but you CAN bring a braindead person back with it.

Take your own advice.


I can forgive him/her for not knowing about the Emergency and Imminent Harm rules that HIPAA has regarding the release of PHI to care team members, depending on what area of healthcare he/she works in. The Healthcare Industry has created a multitude of Jailhouse Lawyers thanks to the HIPAA and HITEC acts, and a poor job of educating providers.

And, to be fair, you CAN get a veggie back by doing CPR (or an organ donor), but that is NOT your call to make - you don't get to play the prediction game of who's gonna walk out with a CPC score of 1 a few days later. You act on the assumption that, unless stated in a DNR or Advance Directive, the patient would want you to do everything you could for them.

What I cannot forgive is this fear-mongering rumor spreading about someone being successfully sued for providing CPR to a patient who indicated it, without having any knowledge of a DNR. I find it odd that, doing a Google search, there is NO mention of this case. I also searched several trade and professional publications, such as Nursing World, Journal Of EMS, Journal of Prehospital Care, and the AHA's own Circulation publication, and there is no mention of a case of a nurse or group of nurses being sued for what he/she stated.

If he has more information on the case, I would actually welcome it since I teach BLS and Heartsaver, and would be very interested to know the details of the case.

The fact of the matter is thus: No DNR, Questionable DNR authenticity, or incomplete DNR = You get CPR. I'd rather defend to a jury that I did everything I could on the patient's behalf - and to the court of public opinion - more so than "Well, I just let him die because it seemed better." Regardless of my personal opinions on the matter.
 
2013-03-04 01:51:33 PM
Also, thanks  finnished for the month of TF!
 
2013-03-04 01:55:35 PM

The more you eat the more you fart: So...shenanigans for YOU as well, for making assumptions about a situation that you know nothing about. Very apparent that you are completely unfamiliar with what it is like working in a hospital or LTC facility.


Yeah, I don't always get along with hardinparamedic, aka BronyMedic.  Mostly about the role of my union in the EMS field.  But he's pretty damned knowledgeable about the healthcare industry as a whole and EMS specifically.  He's demonstrated this more than once.  I wouldn't go around accusing him of ignorance when it comes to stuff like this.

I think you're missing the word "successfully" in his declaration about no one being successfully sued for performing CPR when indicated.  I'm not prepared to call you a liar about your friend getting sued, but did he lose?  If he won the lawsuit, then he was not successfully sued.  I've been unsuccessfully sued because someone hit the parked ladder truck I was driving, it was a big waste of my time but didn't cost me anything else.
 
2013-03-04 02:00:38 PM

lizyrd: Yeah, I don't always get along with hardinparamedic, aka BronyMedic.  Mostly about the role of my union in the EMS field.  But he's pretty damned knowledgeable about the healthcare industry as a whole and EMS specifically.  He's demonstrated this more than once.  I wouldn't go around accusing him of ignorance when it comes to stuff like this.

I think you're missing the word "successfully" in his declaration about no one being successfully sued for performing CPR when indicated.  I'm not prepared to call you a liar about your friend getting sued, but did he lose?  If he won the lawsuit, then he was not successfully sued.  I've been unsuccessfully sued because someone hit the parked ladder truck I was driving, it was a big waste of my time but didn't cost me anything else.


Check your email. :)

I'm not trying to call him a liar. I just think that he has the facts of what he's saying incomplete, or there is something going on that he was not aware of.

It'd be pretty ground-breaking to see someone in healthcare successfully sued for providing the standard of care without malpractice or negligence for something like CPR. I don't think it would be something that would have been kept local either - it would have made national news, if not in trade publications, then in the mass media.
 
2013-03-04 02:02:17 PM
(Can't use any formatting here are work for some reason so I can't quote anything without doing it all manually...so...)

Good to know all the differences around the region.  Three years ago, the CPR classes taught here in Poway were just teaching and certifying with no breaths.
 
2013-03-04 02:04:11 PM

The One True TheDavid: nmemkha:

 [Y]our(sic) not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.

If letting my mother go was called for I'd have no problem with it. Why cave in her fragile ribs and maybe leave her brain damaged from lack of oxygen? She's miserable enough already.

That remind me, I've got to update my Final Directive to make it VERY clear they should "Just let me die damn you!"

How many languages should I have "Do Not Resuscitate" tattooed on my chest in? English, Spanish and Chinese sound obvious, but there should be no doubt.


I vote for cuniform and pictograms
 
2013-03-04 02:09:07 PM

WhoGAS: Good to know all the differences around the region.  Three years ago, the CPR classes taught here in Poway were just teaching and certifying with no breaths.


You have to understand too that it depends on what you take and what level. ACLS/PALS/NRP is going to teach a different way than BLS-HCP, which is going to teach it different than HeartSaver/First Aid, which is going to teach it different than American Red Cross or NSC CPR.

Hands-only CPR is good for Adult victims of Primary Cardiac-causes of arrest only, such as Sudden Cardiac Arrest and arrest related to arrhythmia. The reason is that it buys time for the heart to be defibrillated and  resume an organized rhythm by forcing perfusion of the myocardium (muscle) of the heart through coronary artery flow. In adults, that blood is already heavily saturated with oxygen in these patients, and the decreased metabolic demands will keep it that way for some time.

Since the above is the most common reason that adults arrest, it's why it's pushed so hard to lay people, who were not doing CPR because they had to do the kiss of life to a stranger.

It's absolutely useless for children/infants, and adults who have a cardiac arrest due to a respiratory or metabolic cause. In pediatrics, the primary causes of arrest are related to hypoxia, since they USUALLY have healthy hearts. Hands-only CPR is a death sentence for people who are hypoxic before the arrest, as they need ventilation and oxygenation during cardiac arrest. Professional CPR providers will recognize this, and it's why it's discouraged from being done at the Healthcare Provider level.
 
2013-03-04 02:10:10 PM

BafflerMeal: RandomRandom: JMacPA: That's great and all, but is CPR going to make her any deader? What exactly are the negative aspects of an attempt?

It's torture, it breaks ribs, it doesn't work.

The vast majority of retired physicians in nursing home end-of-life situations do not sign releases for CPR.  They know it doesn't work and have no desire to be tortured by the practice in their last moments of life.

It's not evil or cold to deny CPR to the nursing home population.  Given that it doesn't work on them, absence of CPR is just more compassionate.


I have broken so many ribs in my time with CPR.  From infants to elderly I have never seen CPR work.  Cracked chest or not.  Anecdotal to be sure, but people outside of health care still seem to think it's magic.


But you still do the CPR because it has a chance to work.

/or are you worried you might get fired if you don't?
 
2013-03-04 02:28:21 PM

hardinparamedic: Dictatorial_Flair: A lot of people in this thread have not seen the aftermath of being "saved" by CPR. I hope you never have to.

I've had a person walk up to me, shake my hand, and tell me thank you for doing CPR on them two years after I did it.

I've seen a 17 year old athlete survive after two hours of CPR while being crashed to ECMO for myocarditis, neurologically intact.

I've also seen people live long enough to have their family say goodbye to them, and die in the surrounding of their loved ones rather than alone in the middle of the grocery store.

And I've seen people end up in the nursing home from it.

That's not going to stop me from doing my job, and doing it for people who need it. Because I don't get the choice to play God, and decide who's going to have a CPC outcome of 1 when they walk out of the hospital. I do what I do because I know it's the best chance that patient has to survive, and I act on the assumption that they would want to live until proven otherwise, or it's proven to be futile to resuscitate them.

No healthcare provider gets to make that choice, and even Doctors have to justify why. The thought that people wouldn't help another human being because it "might not work" is sickening, and contrary to the oath every healthcare provider - nurse, RT, MD, DO, Paramedic - takes when they enter their profession.

CPR doesn't work every time, for a myriad of reasons. Some reversible in the field, some not. It's not a magic bullet like TV portrays it, but it is the best, and only chance for survival in a patient who is in a non-perfusing rhythm.


VERY well said and spoke from obvious experience!  I appreciate the work that you do and I'm sure the countless patients who have survived under your care against all odds when it "might not work" appreciate it as well!  Keep up the good work and sleep well knowing that you have done everything you could save lives...whether or not they survive is arbitrary....you're doing your job legally, ethically and morally.
 
2013-03-04 02:38:57 PM

hardinparamedic: Also, thanks  finnished for the month of TF!


You're doing a good job.
 
2013-03-04 02:40:22 PM

hardinparamedic: lizyrd: Yeah, I don't always get along with hardinparamedic, aka BronyMedic.  Mostly about the role of my union in the EMS field.  But he's pretty damned knowledgeable about the healthcare industry as a whole and EMS specifically.  He's demonstrated this more than once.  I wouldn't go around accusing him of ignorance when it comes to stuff like this.

I think you're missing the word "successfully" in his declaration about no one being successfully sued for performing CPR when indicated.  I'm not prepared to call you a liar about your friend getting sued, but did he lose?  If he won the lawsuit, then he was not successfully sued.  I've been unsuccessfully sued because someone hit the parked ladder truck I was driving, it was a big waste of my time but didn't cost me anything else.

Check your email. :)

I'm not trying to call him a liar. I just think that he has the facts of what he's saying incomplete, or there is something going on that he was not aware of.

It'd be pretty ground-breaking to see someone in healthcare successfully sued for providing the standard of care without malpractice or negligence for something like CPR. I don't think it would be something that would have been kept local either - it would have made national news, if not in trade publications, then in the mass media.


Thanks!

Almost as bad as the lawsuit fearmongering is the attitude that "it doesn't work, and she was old, so why bother?" Certainly, I may be DNR at that age and situation, but who am I to tell anyone else what quality of life is worth living compared to death?
 
2013-03-04 02:48:43 PM

lizyrd: Almost as bad as the lawsuit fearmongering is the attitude that "it doesn't work, and she was old, so why bother?" Certainly, I may be DNR at that age and situation, but who am I to tell anyone else what quality of life is worth living compared to death?


What I would really love is for some of the things that have been said in this thread along those lines to be repeated in a Court of Law, or Deposition in a lawsuit. Especially "She was old, what's the point"

I think you would actually see physical dollar signs form in the eyes of the Plaintiff's Attorney. Like, Old Fashioned Loony Toons Style.
 
2013-03-04 02:55:07 PM
hardinparamedic:

Hey. Just wanted to say I appreciate what you do, both here and out in the real world.
 
2013-03-04 03:02:42 PM

1. Put snakes on plane: hardinparamedic:

Hey. Just wanted to say I appreciate what you do, both here and out in the real world.


I really appreciate you saying this, but, there's a lot of people on FARK that deserve that. Not me.  Medic Zero, Lizyrd and many others also do the same job as I do, and they deserve it just as much. As much BS and crap as Lizyrd puts up with being a Fire/EMT, I'd say he deserves a lot more.

I may rib him because he's a damn union hosejock (:P), but he's a good guy.

I just do what I'm good at. I come off as an asshole at times to people, but eh. Everyone does.
 
2013-03-04 03:09:47 PM

hardinparamedic: And, to be fair, you CAN get a veggie back by doing CPR


Not if they've suffered legitimate brain death.
 
2013-03-04 03:13:31 PM

FarkinSneakyBastage: Can I please have the freedom to choose how and when I die and not rot to death in one of these depressing shiatholes they call a retirement community? That'd be great, thanks


So you would rather be alone in a house,  with no one to talk to, no one to help you, no one for company,  With overgrown garden and a house in ill repair.    I  would rather go to a retirement village and have people around,  people to care, people to help.   What I would not like is to be in a hospice or a single bed nursing home with piss filled sheets and staff completely fed up with wiping the shiat of old people's arses.  Those nursing homes are simply the waiting rooms of the dead,   I wish to make sure that I have departed before reaching that point.  But a retirement village that is fine by me.


Of course if you are still at the stage of life with good health and a wife (husband) then stay in your own house but to insist when it is obviously a burden seems rather stupid and most people start looking at retirement villages when taking care of a house is a burden or they are on their own.
 
2013-03-04 03:14:37 PM

Relatively Obscure: hardinparamedic: And, to be fair, you CAN get a veggie back by doing CPR

Not if they've suffered legitimate brain death.


Yeah, but the body has a way of shutting it down when that happens.

static.ddmcdn.com
static.ddmcdn.com
www.uninet.edu

/Damn you Akin, you have given the world a funny joke in that comment.
//Disclaimer: The Last Picture is from a University in Spain. It is public domain, found on a GIS, and not taken by myself, or with any patient that my system has been involved with.
 
2013-03-04 03:23:04 PM
Ugh, a cold caloric. Why not do an apnea test and be done with it?
 
2013-03-04 04:21:48 PM

nmemkha: BarkingUnicorn: nmemkha: BarkingUnicorn: nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?

Yes, I would.  An 87 year-old who survives such an incident is very unlikely to enjoy her remaining days.

Much of the dying's suffering is caused by their survivors.

You say that now, but your not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.

Yes, it is easy now.  My mother died in 1995, as I watched.  It was the best thing that could have happened to her, and I'd have been a poor son had I clung to her.

Did she die alone and sacred on the floor of some two-bit care facility as people just stood and gawked at her?

Would you have been pissed if she had?


How my mother died is nobody's business.

No, I wouldn't.  Everyone dies alone and most die scared.  Rarely is death dignified, contrary to what you've learned from movies.
 
2013-03-04 04:23:20 PM

catzilla: Comedy gold right here....


Yeah it was hilarious singlehandedly reviving a guy and saving his life.

Dictatorial_Flair: A lot of people in this thread have not seen the aftermath of being "saved" by CPR. I hope you never have to.

 Guy was up and around later that night.
 
2013-03-04 04:38:24 PM

hardinparamedic: starsrift: Ahhh. Didn't see that one, both TFA and and the local story didn't mention she was DOA as that sentence suggests, only that she "later died".

I'm not trying to be an asshole to you, either. Sorry if it comes off as such. I'm getting off a 24 hour shift, so mondays and all.

The problem is, and it's been pointed out over the course of the thread, that the nurse didn't just tell the dispatcher that she disagreed with him, and that she felt he was breathing adequately, if not in distress, but rather that she absolutely refused, and she's on tape as saying her facility policies will not let them perform CPR.

The facility is going to stand behind her now because they have to circle the wagons with that statement being public knowledge. By now, I'm willing to bet the State Nursing Board, as well as the Long-Term Care facility licensing board have begun an investigation into the matter.


Under California law, unlike at a nursing home, staff members at independent living facilities are not legally required to provide medical aid, according to Mary Winners, an expert on senior care.
"It's really more like a hotel where they will offer you concierge services, you'll get meals, they'll have housekeeping, they'll change your bed, but you can't even get care," she told TODAY.

As for the nurse, she has no legal obligation to put herself at risk of losing her job.  We might admire her for doing so or scorn her for not doing so, but that has nothing to do with her license.
 
2013-03-04 04:52:11 PM
hardinparamedic:
I think what's infuriating to me more given the situation and tape is that there is a "facility policy against doing CPR".

Don't forget that the source is a news story. "Facility policy" is a bit of a stretch. More likely that is part of the directives for staff, residents and family that they (resident/family) agree to when admitted.
Also, I'm glad you said that you actually worked in a care facility as a CNA. So many paramedics have no idea what working in a health facility is like, and therefore have no business giving judgements on the abilities or skill levels of the staff. We are all in the same business of caring for sick people.

Ps. I always enjoyed the old macho Fireman/Paramedic rivalry. What a hoot. I hope you know where my support lies. ;)
 
2013-03-04 05:15:22 PM

BarkingUnicorn: Under California law, unlike at a nursing home, staff members at independent living facilities are not legally required to provide medical aid, according to Mary Winners, an expert on senior care.
"It's really more like a hotel where they will offer you concierge services, you'll get meals, they'll have housekeeping, they'll change your bed, but you can't even get care," she told TODAY.

As for the nurse, she has no legal obligation to put herself at risk of losing her job.  We might admire her for doing so or scorn her for not doing so, but that has nothing to do with her license.


Really?

I pulled up the California State Board of Nursing website. They seem to disagree.

As used in Section 2761 of the code, "gross negligence" includes an extreme departure from the standard of care which, under similar circumstances, would have ordinarily been exercised by a competent registered nurse. Such an extreme departure means the repeated failure to provide nursing care as required or failure to provide care or to exercise ordinary precaution in a single situation which the nurse knew, or should have known, could have jeopardized the client's health or life.

As used in Section 2761 of the code, "incompetence" means the lack of possession of or the failure to exercise that degree of learning, skill, care and experience ordinarily possessed and exercised by a competent registered nurse as described in Section 1443.5.

In addition

2761. Grounds for action
The board may take disciplinary action against a certified or licensed nurse or deny an application for a certificate or license for any of the following:

(a) Unprofessional conduct, which includes, but is not limited to, the following:

(1) Incompetence, or gross negligence in carrying out usual certified or licensed nursing functions.

(2) A conviction of practicing medicine without a license in violation of Chapter 5 (commencing with Section 2000), in which event the record of conviction shall be conclusive evidence thereof.

(3) The use of advertising relating to nursing which violates Section 17500.

(4) Denial of licensure, revocation, suspension, restriction, or any other disciplinary action against a health care professional license or certificate by another state or territory of the United States, by any other government agency, or by another California health care professional licensing board. A certified copy of the decision or judgment shall be conclusive evidence of that action.

(b) Procuring his or her certificate or license by fraud, misrepresentation, or mistake.

(c) Procuring, or aiding, or abetting, or attempting, or agreeing, or offering to procure or assist at a criminal abortion.

(d) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violating of, or conspiring to violate any provision or term of this chapter or regulations adopted pursuant to it.

(e) Making or giving any false statement or information in connection with the application for issuance of a certificate or license.

(f) Conviction of a felony or of any offense substantially related to the qualifications, functions, and duties of a registered nurse, in which event the record of the conviction shall be conclusive evidence thereof.

(g) Impersonating any applicant or acting as proxy for an applicant in any examination required under this chapter for the issuance of a certificate or license.

(h) Impersonating another certified or licensed practitioner, or permitting or allowing another person to use his or her certificate or license for the purpose of nursing the sick or afflicted.

(i) Aiding or assisting, or agreeing to aid or assist any person or persons, whether a licensed physician or not, in the performance of, or arranging for, a violation of any of the provisions of Article 12 (commencing with Section 2220) of Chapter 5.

(j) Holding oneself out to the public or to any practitioner of the healing arts as a "nurse practitioner" or as meeting the standards established by the board for a nurse practitioner unless meeting the standards established by the board pursuant to Article 8 (commencing with Section 2834) or holding oneself out to the public as being certified by the board as a nurse anesthetist, nurse midwife, clinical nurse specialist, or public health nurse unless the person is at the time so certified by the board.

(k) Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines of the board, thereby risking transmission of blood-borne infectious diseases from licensed or certified nurse to patient, from patient to patient, and from patient to licensed or certified nurse. In administering this subdivision, the board shall consider referencing the standards, regulations, and guidelines of the State Department of Health Services developed pursuant to Section 1250.11 of the Health and Safety Code and the standards, guidelines, and regulations pursuant to the California Occupational Safety and Health Act of 1973 (Part 1 (commencing with Section 6300), Division 5, Labor Code) for preventing the transmission of HIV, hepatitis B, and other blood-borne pathogens in health care settings. As necessary, the board shall consult with the Medical Board of California, the Board of Podiatric Medicine, the Dental Board of California, and the Board of Vocational Nursing and Psychiatric Technicians, to encourage appropriate consistency in the implementation of this subdivision.

The board shall seek to ensure that licentiates and others regulated by the board are informed of the responsibility of licentiates to minimize the risk of transmission of blood-borne infectious diseases from health care provider to patient, from patient to patient, and from patient to health care provider, and of the most recent scientifically recognized safeguards for minimizing the risks of transmission.

(Added Stats 1939 ch 807 § 2. Amended Stats 1953 ch 1053 § 1; Stats 1977 ch 439 § 1; Stats 1978 ch 212 § 2, effective June 6, 1978; Stats 1979 ch 933 § 2; Stats 1983 ch 696 § 2; Stats 1984 ch 144 § 11; Stats 1987 ch 850 § 15; Stats 1991 ch 1180 § 4 (SB 1070); Stats 1992 ch 1350 § 4 (SB 1813); Stats 1994 ch 26 § 61 (AB 1807), effective March 30, 1994, ch 1275 § 16 (SB 2101); Stats 1997 ch 759 § 17 (SB 827). Amended Stats 2000 ch 568 § 8 (AB 2888).)

Considering the failure to provide CPR when indicated constitutes gross negligence or incompetence, depending on the situation, if what is being portrayed here is true then this woman has a good chance of losing her license if her actions were put to the reasonable nurse standard.

At any rate, this woman has no future in nursing. No place will hire her after a foul-up this big.
 
2013-03-04 05:15:49 PM

hardinparamedic: 1. Put snakes on plane: hardinparamedic:

Hey. Just wanted to say I appreciate what you do, both here and out in the real world.

I really appreciate you saying this, but, there's a lot of people on FARK that deserve that. Not me.  Medic Zero, Lizyrd and many others also do the same job as I do, and they deserve it just as much. As much BS and crap as Lizyrd puts up with being a Fire/EMT, I'd say he deserves a lot more.

I may rib him because he's a damn union hosejock (:P), but he's a good guy.

I just do what I'm good at. I come off as an asshole at times to people, but eh. Everyone does.


This will be my last circle-jerk comment, but what you do is great. I'm scared to death when I'm working the ambulance and a serious pedi call comes in. I'd rather go to 200 drunk, belligerent skells than one seriously hurt or sick kid. My hat's off to anyone that chooses to specialize in that area.
 
2013-03-04 05:28:31 PM

Dumski: Ps. I always enjoyed the old macho Fireman/Paramedic rivalry. What a hoot. I hope you know where my support lies. ;)


Since you worked in the ER, I'm going to assume with whatever one you were sleeping with at the time. :P

/srsly. it's like a soap opera in thar.

Dumski: Don't forget that the source is a news story. "Facility policy" is a bit of a stretch. More likely that is part of the directives for staff, residents and family that they (resident/family) agree to when admitted.
Also, I'm glad you said that you actually worked in a care facility as a CNA. So many paramedics have no idea what working in a health facility is like, and therefore have no business giving judgements on the abilities or skill levels of the staff. We are all in the same business of caring for sick people.


You're absolutely right. Nursing homes and assisted living facilities ARE limited in what they can do in an emergency, and shockingly restricted to the point they have to call for orders to put someone in active respiratory distress on oxygen before EMS arrival. But what I saw as a CNA made me realize I'd never put my family in a nursing home, especially one that was a medicare-only facility. Two LPNs in a facility at night with 60 patients, and 15 total care patients to one CNA meant that you could only do the best you could. Every two hour round ended in time to do the next one, usually.

The first one I worked at I was fired after I reported a CNA for striking an elderly patient and stealing his food. Turns out the ADON was relatives with the CNA I reported, and the next morning I was told I should quit, otherwise they were reporting me to the state for leaving a "total care patient unchecked all night", despite the fact I had documentation the patient was clean and dry 15 minutes prior to going off shift. Strangely enough, there was not an incident report or photograph taken, which was their corporate policy for accusations of abuse.

As a Paramedic, I've worked multiple patients in nursing homes that were in unrecognized cardiac arrest. I know of a nurse who was fired and reported to the state for diverting drugs who went to work in one while under active investigation. I've seen a sepsis patient that was left to lie in their own filth for a day, and when the diaper was taken off her labia came with it.. I've seen DKA and hypoglycemia all go unnoticed.

While I agree that there are good nurses and aides that go into Elder Care for the purpose of helping people, they're few and far between, and usually found in facilities which are not medicare dependent, or hospice care. Most nursing home nurses, and aides are there because they have to be.

They are underpaid for what they do, abused - by both the administration, patients and their families - and often understaffed to the point they either burn out and take it out on the patients, or injure themselves.
 
2013-03-04 05:54:38 PM
Hippocrates weeps from his grave.
 
2013-03-04 05:55:53 PM

hardinparamedic: Dumski: Ps. I always enjoyed the old macho Fireman/Paramedic rivalry. What a hoot. I hope you know where my support lies. ;)

Since you worked in the ER, I'm going to assume with whatever one you were sleeping with at the time. :P


Unless they were a woman. I'm a guy. Not so much of a soap opera in the ER where I worked. Just a bunch of burned out RN's and Dr.s doing more with less. Thats why I went to a cozier job like ICU!

Your descriptions of what you encountered are not good. I guess I am talking about the hospital employed Nurses rather than LTC ones. I live in Canada, and everyone is working with bigger patient loads and sicker patients. As we Baby Boomers start the downward slide, the system will get even more bogged down. I'm glad I'm out.
Oh, and I have no intention of ending up in a bed in a care facility with someone wiping my ass. I have a plan!
 
2013-03-04 06:14:44 PM

Dumski: Your descriptions of what you encountered are not good. I guess I am talking about the hospital employed Nurses rather than LTC ones. I live in Canada, and everyone is working with bigger patient loads and sicker patients. As we Baby Boomers start the downward slide, the system will get even more bogged down. I'm glad I'm out.


Oh. You mean floor nurses! Floor nurses are pretty cool. They have a thankless job, and they dont get the props that the ICU and ER nurses get.

Yeah. The State of Long Term Care systems in the US is scary. You have good nursing homes that take great care of people, but these are often private pay only facilities, or they provide some niche specialty care, like ventilators, eventual discharge-to-home ortho rehab, or long-term pediatrics.

Most survive on Medicare Part A funding, and Medicaid from the state if you meet their criteria (typically co-morbid conditions, like end stage dementia and renal failure requiring dialysis). They're underfunded, understaffed, and dependent on keeping costs as low as possible.

There's a reason that litigation stemming from LTC facilities are a boom industry in the United States.
 
2013-03-04 07:33:49 PM

hardinparamedic: Considering the failure to provide CPR when indicated constitutes gross negligence or incompetence, depending on the situation, if what is being portrayed here is true then this woman has a good chance of losing her license if her actions were put to the reasonable nurse standard.

At any rate, this woman has no future in nursing. No place will hire her after a foul-up this big.


Oh, I think any employer that wants employees to follow orders regardless of their personal feelings would have a look at her.

The nurse might lose her license if she was performing the job of nursing at the time, or representing herself as a nurse to residents who reasonably relied upon her representation to  their detriment.  A nurse is under no obligation to render aid while she's moonlighting as a stripper.  It appears that the old lady's contract specified that no medical care would be provided.  The old lady's daughter, who is also a nurse, seems to understand this.

Do you understand that a doctor has no obligation to give you CPR if you collapse on the street while he's walking by, or even if you stagger into his office without an appointment? You are strangers; no relationship exists which creates an obligation to you.  Now, a doctor in an ER is holding himself forth as someone prepared to treat strangers at any time; but in a private practice, a walk-in is a trespasser to whom no duty of care is owed automatically.
 
2013-03-04 10:17:57 PM

BarkingUnicorn: Oh, I think any employer that wants employees to follow orders regardless of their personal feelings would have a look at her.


...The Nuremberg Defense?

BarkingUnicorn: The nurse might lose her license if she was performing the job of nursing at the time, or representing herself as a nurse to residents who reasonably relied upon her representation to  their detriment.  A nurse is under no obligation to render aid while she's moonlighting as a stripper.  It appears that the old lady's contract specified that no medical care would be provided.  The old lady's daughter, who is also a nurse, seems to understand this.


That's a nice, non sequitorial thought there, but she wasn't moonlighting as a stripper, was she? No. She was employed by the facility, and identified herself as a nurse. You don't get to pick and choose which standards of care you go by there. Even if you can only provide basic care, you have to provide it to the level of competency and ability that a reasonable person would have acted in.

Withholding lifesaving care is not a reasonable act. By any means. If the woman had a DNR, they could have told the dispatcher that and it'd been the end of it.

BarkingUnicorn: Do you understand that a doctor has no obligation to give you CPR if you collapse on the street while he's walking by


Of course not, legally. Ethically, yes he does. Morally, yes he does.

BarkingUnicorn: or even if you stagger into his office without an appointment?

BarkingUnicorn: Now, a doctor in an ER is holding himself forth as someone prepared to treat strangers at any time; but in a private practice, a walk-in is a trespasser to whom no duty of care is owed automatically.

BZZZT. WRONG. Big Whammy, no money on that stop. He has a legal obligation to provide basic-level care and stabilization to the extent of his abilities, while awaiting the arrival of an ambulance to transport the patient to a hospital. If you stagger into a doctor's office and he refuses to even just call 911, he's failed to fulfill his duty to act - created when you said you needed help in an office which advertises a physician service.

That MD does not have to see you and treat you in his office, but he does have to ensure you are sent to equal or higher level of care if you collapse in his office.

At any rate, these are completely unrelated situations.

BarkingUnicorn: You are strangers; no relationship exists which creates an obligation to you.


Which is not the same thing as happened in this article. At all. You're going off on a completely unrelated tangent here and trying to present the two situations as similar. The fact of the matter is that the woman was a client of the facility which had hired the nurse/nurse aid to act in the capacity of one.

The fact that this woman claims that she was not allowed to do CPR by her employer does not triumph her requirement as a nurse to act, since she was employed by one, to a reasonable standard of care.
 
2013-03-05 12:02:53 AM

erewhon: Abacus9:
Hmmm... I take your word for it. I've heard though that once the heart stops, they're already dead, so you can't really harm them any further. Although I guess that depends on the case and their wishes. Sounds like a rough thing for the patient, but also for the paramedic to have to do.

I guess you get used to it, I really never expected to have to use the training. But so far, three arrests and a Heimlich under my belt. The Heimlich was the most gratifying in that I popped that chunk of food about 4 feet when I hit the right spot, and the guy was immediately better. The CPR episodes were more like and 15 and 16 and (crack) oh my god and 18 and 19 (crack) jesus palomino and 21 and...

Of course, when the guys got there and relieved me it was "well, he was dead anyway" but still, it's sort of stressful to do to someone you aren't mad at.

The really odd thing was the bystanders, you get the wildest suggestions. "Here, stick this candy in his mouth!" Well, no, I'm pretty sure this isn't hypoglycemia...


Remind me to never piss you off (I keed...)

Seriously, sounds pretty grueling. Still, you did what you had to so don't let it get to you.
 
2013-03-05 12:05:26 AM

digitalrain: Abacus9: Lady Indica: To my knowledge (and I could easily easily be wrong here) there's times where breathing alone is called for. I would think this would be one. Drowning is another. Other than that AFAIK, chest compress is most important (to the tune of Stayin' Alive).

Oddly, "Another One Bites The Dust" also works (roughly the same beats per minute)...

But its not nearly as optimistic...


I suppose there's always YMCA or Dancing Queen. Disco's not really known for its versatility.
 
2013-03-05 12:17:02 AM

hardinparamedic: BarkingUnicorn: Oh, I think any employer that wants employees to follow orders regardless of their personal feelings would have a look at her.

...The Nuremberg Defense?


It's not a defense.  It's the way of pharmacies who expect pro-lifers to dispense morning-after pills.

BarkingUnicorn: The nurse might lose her license if she was performing the job of nursing at the time, or representing herself as a nurse to residents who reasonably relied upon her representation to  their detriment.  A nurse is under no obligation to render aid while she's moonlighting as a stripper.  It appears that the old lady's contract specified that no medical care would be provided.  The old lady's daughter, who is also a nurse, seems to understand this.

That's a nice, non sequitorial thought there, but she wasn't moonlighting as a stripper, was she? No. She was employed by the facility, and identified herself as a nurse. You don't get to pick and choose which standards of care you go by there. Even if you can only provide basic care, you have to provide it to the level of competency and ability that a reasonable person would have acted in.

Withholding lifesaving care is not a reasonable act. By any means.


"Colleen" identified herself as a nurse to the dispatcher.  We don't know if she told residents she's a nurse, or if anyone did.  But we do know that the facility informed all customers that no medical care would be provided and the customers agreed.  Therefore, Colleen was not working as a nurse at the time.  She might as well have been stripping for all the duty of care that she had to the old lady.  Standards of nursing care do not apply to people who are not nursing.

Following the terms of your employment and the terms of your employer's contract with a customer is a perfectly reasonable act under the law.  How often do we see clerks fired for trying to stop robberies?  They have no recourse just because we think they're heroes.

No, an ordinary citizen (including a nurse who isn't nursing) does not have to provide any care, even if she can.  In some States, you have a duty to call 911, and that's what these people did.

Colleen was caught in a conflict between her boss, who was right there, and the dispatcher.  She chose her job over the old lady's life.  She had every right to do that.  She did not have a duty to harm herself in order to help that woman.
 
2013-03-05 03:31:20 AM
hardinparamedic:
BarkingUnicorn: or even if you stagger into his office without an appointment?
BarkingUnicorn: Now, a doctor in an ER is holding himself forth as someone prepared to treat strangers at any time; but in a private practice, a walk-in is a trespasser to whom no duty of care is owed automatically.

BZZZT. WRONG. Big Whammy, no money on that stop. He has a legal obligation to provide basic-level care and stabilization to the extent of his abilities, while awaiting the arrival of an ambulance to transport the patient to a hospital. If you stagger into a doctor's office and he refuses to even just ...


Actually a doctor in a private clinic is under no obligation or legal responsibility to act. Morally, yes,  legally, no. EMTALA does not apply to non-emergency facilities. It is his liability, business policy, as well as a possible BSI concern as to whether or not chooses to act. I've been to multiple doctor's offices and some urgent care centers for patients who were not going to be seen by that clinic due to the lack of accepted insurance.

"Any public, private, or non-profit hospital that offers services for medical, psychiatric or substance abuse emergency conditions is obligated to comply with all of the EMTALA requirements found in 42 CFR 489.20 and 489.24. This would include a freestanding psychiatric hospital that receives persons with emergency psychiatric conditions. All licensed general hospitals are required to comply with section 395.1041, F.S. A hospital that does not offer emergency services is not required to comply with EMTALA. Conversely, a facility that is not licensed as a hospital, such as a CSU, nursing home, assisted living facility, outpatient clinic or doctor's office is not required to comply with EMTALA or section 395.1041, F.S. "
http://www.bakeracttraining.org/files/faq/ba_emergency_medical_condi ti ons.pdf
 
2013-03-05 07:11:13 AM
My, My. This is interesting.

http://www.ems1.com/communications-dispatch/articles/1413956-Police- in vestigating-death-of-woman-denied-CPR/


Firefighters and ambulance personnel arrived at the facility seven minutes after the call came in, Miller said. The county does not know who made the call, he said.

The woman had no pulse and wasn't breathing when fire crews found her lying on the floor, Bakersfield Fire Department spokesman Anthony Galagaza added.

They started CPR and loaded her onto a gurney. The woman was later declared dead at Mercy Southwest Hospital.


So yeah. About that nurse saying the patient didn't need CPR.
 
2013-03-05 07:37:17 AM
I've walked into many arrests that went to hell (arrested) on us as we walked in. If patient was breathing, then odds are they were perfusing the brainstem. Any respiration will negate an BLS response. Those respirations won't last long, and when they stop, BLS/EMR responses will go into play.   Admittedly I've seen high quality CPR w/ advanced airway actually cause spontaneous respirations over 50 minutes after BLS efforts started.

Read my earlier post about CPR and ALS interventions if you need.

People can be sued, dispatchers are medics who can't hack the streets IMO, so quit trying to persecute them.
87 year old people won't meet most ER Doctor's criteria for progressive therapy. you know that.

My service allows us to pronounce if dead when we arrive....

/realmedic.
 
2013-03-05 07:59:51 AM

thehobbes: Actually a doctor in a private clinic is under no obligation or legal responsibility to act. Morally, yes,  legally, no. EMTALA does not apply to non-emergency facilities. It is his liability, business policy, as well as a possible BSI concern as to whether or not chooses to act. I've been to multiple doctor's offices and some urgent care centers for patients who were not going to be seen by that clinic due to the lack of accepted insurance.


I think you missed my point, there. I was not talking about EMTALA. I was talking about what the state considers a civil duty to act. Calling 911 for a patient who collapses fulfills that duty to act. If that doctor so much as touches that patient's shoulder to ask if he's okay, he's created a patient encounter.

thehobbes: I've walked into many arrests that went to hell (arrested) on us as we walked in


So have I. However, based on the information presented and given to the dispatcher, the "nurse" in the story should have recognized a peri-arrest condition, and fulfilled her legal duty to act since she was employed AS a nurse, based on what she was telling others.

I know, for a fact, that had this happened in Tennessee as presented by these articles, the nurse would likely be  facing losing her license and civil penalties, if not criminal charges for negligent homicide for failure to act.

thehobbes: If patient was breathing, then odds are they were perfusing the brainstem. Any respiration will negate an BLS response.


You should know better, hobbbes. What's the first thing they teach you as an EMT-Basic in assessment? Not all respiration is effective.

thehobbes: Those respirations won't last long, and when they stop, BLS/EMR responses will go into play.   Admittedly I've seen high quality CPR w/ advanced airway actually cause spontaneous respirations over 50 minutes after BLS efforts started.


I've seen ROSC after four hours of CPR with a good neurological outcome in myocarditis, too.

thehobbes: Read my earlier post about CPR and ALS interventions if you need.


Yes. I know about the Hs and Ts, and arrest rhythms in adult arrest situations. I also know that effective, high quality CPR in a healthcare setting, performed before the arrival of an EMS agency or code response team is responsible for the high rates of resuscitation we see in facility cardiac arrests since the 2005 and 2010 guidelines.

thehobbes: People can be sued, dispatchers are medics who can't hack the streets IMO, so quit trying to persecute them.


Just because you're mad that you get held over for a BLS interfacility call, don't sell out a part of your profession. And the EMD protocols are evidence based.

thehobbes: 87 year old people won't meet most ER Doctor's criteria for progressive therapy. you know that.


Depends. We don't really know what this woman's morbidity was before she suffered her arrest. If the only reason she was in an assisted living facility was because she had a little hip trouble, yes she would.

At any rate, you don't get to make that call without a DNR in hand, or without very specific criteria being fulfilled.

thehobbes: My service allows us to pronounce if dead when we arrive....


Yeah. So do mine. If they meet very specific criteria. This woman would not have met that criteria since it was a witnessed arrest.
 
2013-03-05 09:19:46 AM
how the f is a nurse not trained in CPR at a nursing home.
 
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