CPR in the Hospital

CPR

Cardio Pulmonary Resuscitation (CPR) can be life-saving especially when performed in a hospital with all the talent, knowledge and equipment that is available. It has become routine for patients to be asked on admission to the hospital some form of the following question: “Do you want emergency measures to be performed if your heart stops?” 

That question can be daunting in myriad ways. If one is being admitted for a routine procedure it can be a bit of a shock. If the patient is critical and/or of advanced age then it might be even more upsetting. Three things can help at this point, #1. Expecting such a question, #2. Being an informed patient about just what “emergency measures” entails and the risks involved, and #3. Having already considered this question and having discussed it with your loved ones. https://crookedcreek.live/2017/01/25/death-decisions/

Expectations

The first thing we all need to acknowledge is that we will one day die. Sobering as that thought might be, it is essential to know that regardless of how we answer the question above we may not be saved by CPR or any of the extraordinary measures taken if our heart stops beating. Perhaps worse yet might be to survive and be dependent upon breathing machines, feeding tubes and narcotics for pain relief. Cardiac arrest can cause organ failure leaving such organs as the liver and kidneys unable to function. Neurological deficits as the result of brain damage from lack of oxygen can occur. Unrealistic expectations can cause physical and psychological pain for both the patient and their family.

An Informed and Prepared Patient

An informed patient will have realistic expectations, will ask questions and will be prepared to make an informed consent. When a patient decides that they do not want heroic measures they can have a DNR (do not resuscitate) order to alert staff that the patient does not want CPR performed. Some hospitals now use the less promising acronym DNAR (do not attempt resuscitation). Before making this decision it is imperative that a patient know what resuscitation is and is not. It does present a chance at survival but it is nowhere close to a guarantee. The average chance of successfully resuscitating a healthy young person, i.e., to be neurologically intact, is only 30 percent overall. 

Once you have researched these issues and are armed with scientific information the next step is to discuss your wishes with your loved ones. Finally, prepare the legal documents that leave no doubt if the time comes when you need to inform your healthcare provider of your decision.  https://crookedcreek.live/2017/01/19/death-intro-ii/

In the end, what matters most, quantity or quality of time here on this planet? 

 

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CPR in the Field

CPR

Everyone knows what CPR means. It means saving a life with certain breathing techniques and chest compressions when one’s heart has stopped beating. Right?

Cardio Pulmonary Resuscitation literally means heart lung revival. That puts it in a slightly different light but still sounds promising.

We’ve all seen it work over and over again on television, but is that a reflection of real life CPR? I can tell you that it is not whether in the hospital or on the street. Fewer than 20% of in-hospital recipients of CPR live to be discharged. And, this is with a team of highly skilled professionals, IV medications, and defibrillators to shock the heart.

Expectations

Many people today are trained in CPR, and that is a good thing. I’m sure that most take the training with the expectation of being able to save lives. It does happen, but the chances of being unsuccessful are high and this is often an extremely hard outcome to accept. If occurring in the clinical area there are several people involved, but if you are performing CPR as a layperson or even a professional in the field you are often alone and it is a formidable responsibility. It can be extremely difficult to overcome emotionally when one is unsuccessful.

My Experience

Many years ago I was an Emergency Department (ED) Registered Nurse (RN). I was used to “codes” which was the word we used when a patient went into cardiopulmonary arrest. Everyone worked together as a team. We started IVs,  did chest compressions, charged and used a defibrillator and we continued until the patient was either revived or pronounced dead. Needless to say with all the needed supplies and professionals working together we often were able to revive the patient and send them on to the Intensive Care Department. From there we lost track of their progress or lack thereof. We went on to the next emergency. I was used to “saves” in that environment.

When my own sixty-nine year-old father had a cardiac arrest at home it was a totally different world. My Mom wept nearby. A neighbor wrung her hands. There was no one to help as I did CPR alone for over twenty minutes while we awaited the ambulance and EMTs to arrive. I felt his sternum crack. Was I compressing his chest too hard? I became short of breath. Was I breathing the right ratio for him? My mouth bled. My father turned blue, first his ears and then his lips.

My father died that day and I have never stopped blaming myself. How could an ED RN not save her own father? My brain itemizes many factors to answer that question, but my heart keeps saying, “I’m so sorry Daddy, I’m so sorry.”

I’ve shared this to warn those of you who are so altruistically prepared to perform CPR that it might not work. It might not be possible. 

Please do be trained. Please do try if you are given the opportunity. But, please also know that it is not always in your power and be prepared to live with that possibility.

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What I Know for Sure 3

8. April had a baby.

On April 15 the calf, reportedly a male, was born. It was thrilling to watch the delivery and the newborn appeared healthy. Apparently we have seen the last of him, because the camera has not been live streaming for the past 24 hours. As many others, I have been concerned by some aspects of this fun experience. The giraffe pens look small and Upstate NY is not a normal environment for this species. The park has made well over $135,000 with a GoFundMe account, in addition to charging for such privileges as submitting a name in the naming contest. I have boycotted circuses for most of my adult life and am conflicted by zoos, but this is an “animal park,” so perhaps is not even as well equipped as an actual zoo. Not having visited this establishment, I have no evidence that its animals are not being well cared for, but I have questions. 

9. Alot is not a word. It is not, even though a lot of people believe otherwise. 

10. I am no Oprah. Oprah speaks and people listen. Oprah advertises and people buy. Oprah recommends and people read. Oprah is self-assured and wealthy. I am neither.  

11. CPR does not always work. Sadly, I know this first hand. 

12. Grandparents are not infallible.  Last weekend I saw a grandfather spaying weedkiller all over the yard, entusiastically squirting every dandelion. I thought how sad it was that honeybees would not be safe collecting pollen on those round circles of sunshine. Then only minutes later, to my amazement, I saw the grandmother accompany three little preschoolers into the yard with brightly colored buckets to hunt Easter Eggs.

“So cling tightly to the pursuit, but hold your conclusions loosely.” 

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What I Know for Sure 1 & 2

1. There are few things of which I am 100% sure, but one of those certainties is the fact that I love my family with all my heart.
2. Having time alone is a necessity for me, but I sometimes forget how much I need to be with people.
3. Native Americans should not be called Indians.
4. Dish towels and dish cloths should be laundered separately, i.e., not with underwear. 
5. April is not delivering in March.
6. Love at first sight is a real phenomenon. 
7. Depression should be renamed.  

Part 3 of 4

Theme photo by Akiko Kobayashi (Japan)

Death-Hospice

Follow Up

To follow up on important topics from the last post in this series, please read the comments left by “Lula.” Remember that little black bubble at the end of each post?  Just click the bubble on Death Decisions (Jan. 25, 2017) to read the important information she has shared with us. 

Lula shared interesting information about a service which sounds like a good idea for anyone, but especially those who travel often. I am not familiar with Living Will Registry, but you can read about Lula’s own experience as a frequent traveler (in her comments) as well as reviewing the service Online.*

One issue that Lula mentioned is Emergency Medical Services (EMS), when called to a home, will likely begin CardioPulmonary Resuscitation (CPR), even if one has a Do Not Resuscitate (DNR) order on a Living Will. I have always heard the same thing, but an official form** in this state (KY) is meant to address this problem. You should check with your own state, city and/or county for the law where you live. Regardless of one’s current health status it would be helpful to fully understand the guidelines before a need arises. It is understandable this is a potential for problems. The very fact EMS is called indicates an emergency and they come prepared to do what is necessary to save lives. If one has a terminal condition CPR is not likely an appropriate response, but it is unfair to expect emergency personnel to make that distinction or take that responsibility. 

Hospice

Having Hospice involved in end-of-life care can often prevent such situations from occurring. Hospice is a national organization with local offices across the US, providing palliative care to patients facing advanced illnesses and to their families. Palliative care involves relieving pain and enhancing quality of life (as opposed to addressing a cause and/or cure) and may be provided in the home, special centers, extended care facilities or special units within an acute care hospital.

When Hospice care began gradually in the US, during the second half of the Twentieth Century,  there were specific parameters regarding how long a patient was expected to live in order to be admitted into palliative care. Although this is no longer the case, it is a lingering belief and can make it hard for families to approach the subject. I personally feel Hospice is extremely valuable in providing clinical, pastoral and grief support as well as practical assistance with medical supplies, equipment and even volunteer and respite care. Extensive information is available from National Hospice & Palliative Care Organization*** (NHPCO).

Possibly many of you used Hospice services for your family or maybe a close friend and I invite you to share your experience with us if you are comfortable doing so. I will share that in my experience with loved ones the service was not instituted soon enough. In one case, incredulously, it was not possible to get the physician to admit the patient was dying and by the time a referral was made the patient only lived a few hours. The other personal case was just the opposite. The physician recommended, even urged, Hospice service, but the patient wanted to wait a little longer, not realizing the time would approach as quickly as it, in fact, did. In each case the patient did not receive care that would have perhaps eased their passing. I painfully share this hoping it might prevent others from waiting too long. 

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Websites referenced:

*Living Will Registry http://www.alwr.com

**KY DNR Form http://manuals.sp.chfs.ky.gov/Resources/sopFormsLibrary/Do%20Not%20Resuscitate%20Form.pdf

***NHPCO http://www.nhpco.org

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Coming Up

We will look at Funeral and Burial Planning in the next post. I realize this may be a bit too pushy, but if you are so inclined how about working on writing your own Obituary before then? Then we will work together. Your participation is great and makes our experience together so much richer. Thank you!

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“I find it delightful that the optimal way I can live my life from moment-to-moment is also the optimal way I can prepare for my death, and equally delightful that acknowledging our future death is a prerequisite for living a truly joyful life now.”  Ram Dass, Still Here