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Calif. woman dies after nurse refuses to perform CPR

Although I've had a change of heart on this issue based on information I have received from a few doctors and nurses I'm associated with and now believe that the nurse actually did the right thing I still have serious concerns about this kind of issue.

My grandmother is 96 years old and has dementia. In early December of last year she was beginning to become belligerent which is very much unlike her. The doctors put her on some kind of mood altering drug. When that didn't seem to be working they upped the dosage. Another doctor figured that she'd had a stroke and that was what was causing the behavior change so they put her on another med for that and soon upped that dosage as well. The week before Christmas she was like a damned zombie. When you looked into her eyes there was nothing there and she was exhibiting signs of being in a lot of pain. One of the caregivers at the assisted living facility she was in suggested that perhaps she had a UTI but getting a doctor to coordinate with the staff and all was getting ridiculous so we took her to the ER where we explained the situation and had them test for a UTI. She did have a serious infection and we were asked what we wanted done.

We opted to have the infection treated and see how things went. We also had them take her off of all the medications except the antibiotics. It was a rather "interesting" couple of days but by day 3 she was coming around and doing fine. Today she is just as much off her rocker as she was before but once again she is happy and wandering around as usual. I mention this because if the decision was left completely to the medical professionals she would have been left to die....needlessly.

In the case of the woman in CA it seems that there was a significant likelihood that CPR would have damaged ribs, punctured lungs, etc. My understanding from the pros is that it was more likely than not that even if her life were saved at the time that she would have been on her way out anyway and in substantial pain along the way. I can understand that. I don't like it but I can understand it. I would just like to say, however, that the definition of "extraordinary means" to save ones life seems to be getting less and less "extraordinary" over time and that the DNR is easily used as an excuse to simply do nothing and if you have a loved one in some kind of managed care I would HIGHLY recommend that you make it a point to be as clear as possible about what you do and do not want done in a given situation.

What makes most sense is to give medical power of attorney to someone you trust to decide to "pull the plug" rather than a blanket DNR agreement.

I agree the medical profession is too quick to just drug people in to zombie-ish as a cure-all. It's like when ERs and Doctors give people "Z-packs" (steroids). Its just feel-good zombie medicine that cures nothing.
 
Let's have a link to that info, because it's 100% wrong and would lead to premature death and likely injury. If they are breathing and you force CPR, you can kill them.
You're spreading disinformation. Official 2010 AHA recommendation is to immediately start chest compressions in cases where victim is "unresponsive" and there's "no breathing or no normal breathing (only gasping)"

F3_large.jpg


http://circ.ahajournals.org/content/122/18_suppl_3/S676/F3.large.jpg

"For example, if a lone healthcare provider sees a victim suddenly collapse, the provider may assume that the victim has suffered a sudden VF cardiac arrest; once the provider has verified that the victim is unresponsive and not breathing or is only gasping, the provider should immediately activate the emergency response system, get and use an AED, and give CPR. " - 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science
 
Since the article states she died later at the hospital, she didn't need CPR and doing so on an 86 year old woman who didn't need it could have been lethal on it's own. Pounding and pressing on the chest of someone that old can break ribs pressing them into lungs and heart.

This appears an opportunity for the media to create some OMG RAGE! crap before knowing the facts - and sadly too many people go along with it.

Here is what appears the real story.
1. An 86 year old woman collapsed.
2. Per policy, a staffer promptly called 911
3. A 911 telephone receptionist - with NO medical license - decided to play doctor and tried to get the staffer to be her nurse, for which the nurse refused.
4. The woman was transported to the hospital, still alive, meaning CPR was fully not necessary and would have been harmful or lethal.

IF those are the facts, then ABC and those raging along with that for-profit corporation (that makes money by making attention getters) are 100% wrong factually (and therefore also otherwise.)

yes l see , joko

however l believe that the nurse should have helped her no matter what happens after her medical attention to old woman
 
Thanks for the link, but wow, they jumped the shark assuming a lay person would understand the difference between difficulty breathing and gasping for breath. I'll go by my hospital training and what I learned in nursing school which is that you never start compressions on a breathing patient (unless you need the bed - sorry, gallows humor).
 
Is it just me - or does this seem actually to be quite confusing.

Who said they wouldn't do it? The 911 dispatcher? Someone at the residence facility? The emergency crew?

I think it's just me...
 
I want to know under what authority this phone call recording was released. Why is this public interest? No laws were broken.

If you've had a parent in one of these types of facilities, you know that allowing a person to pass away when her time comes is sometimes more compassionate than rushing her to the hospital, sticking IVs in her arms, ordering $10K worth of tests (charged to medicare), pumping them full of antibiotics or some expensive medication to prolong cancer.

And I hate how the nurse is being characterized as unfeeling. I've been there, watched both parents die peacefully. The nurse on the phone was very brave. Her only mistake was not hanging up on the 911 operator. People who work in these facilities watch death happen slowly all day everyday. It sounds like she experienced peaceful final moments. The other residents and the family are not upset by this at all. That is very telling.

"Independent" living is a misnomer. Most residents have to have their own private nurse part-time or full time. If you're "independent" you can drive a car and fix your own food, file taxes and pay bills. People enter these facilities because they can no longer live without some level of help and the social aspect is therapeutic. That's why this facility is listed as "independent/assisted/Alzheimer's care." It's for people who can not live alone and need a little more help with each passing day.

This is a private matter for the family who seems to be at peace with their 87yo mother passing away. The media and blogs hyping this should be ashamed.
 
Thanks for the link, but wow, they jumped the shark assuming a lay person would understand the difference between difficulty breathing and gasping for breath. I'll go by my hospital training and what I learned in nursing school which is that you never start compressions on a breathing patient (unless you need the bed - sorry, gallows humor).
Good enough for me:

"The 2010 AHA Guidelines for CPR and ECC are based on the most current and comprehensive review of resuscitation literature ever published, the 2010 ILCOR International Consensus on CPR and ECC Science With Treatment Recommendations. The 2010 evidence evaluation process included 356 resuscitation experts from 29 countries who reviewed, analyzed, evaluated, debated, and discussed research and hypotheses through in-person meetings, teleconferences, and online sessions ("webinars") during the 36-month period before the 2010 Consensus Conference. The experts produced 411 scientific evidence reviews on 277 topics in resuscitation and emergency cardiovascular care. The process included structured evidence evaluation, analysis, and cataloging of the literature."
 
There's no such thing, and that has nothing to do with this thread or the non-problem it's about.

but your post was more interested in this.......
 
Is it just me - or does this seem actually to be quite confusing.

Who said they wouldn't do it? The 911 dispatcher? Someone at the residence facility? The emergency crew?

I think it's just me...

Ok - I read several other articles, etc - I understand who did what, now.

:shrug:

The nurse wasn't required by her job description - so she's not liable for anything. If she went out a grabbed a passerby and asked them to help and they said no - would they be sued? (No)

So - if there's a problem it's the policy that keep a staff on hand which is not required to perform emergency services of this nature. . the policy/employment requirements should be considered here -the why she was told not to . . . not the fact that she did so.

CPR isn't a fun and simple thing - a lot of times ribs can be broken, lungs punctured . . . and so on. What if that happened? (this is why they were told not to do it in the first place).

I'm sure there are facilities that do required and expect their staff to do such things - and so I suggest people figure out what's what before sticking granny there to begin with.
 
The American Heart Association is dealing with odds - and openly admits that CPR they recommend will break or facture ribs 1/3rd of the time! And that includes for ALL people - including perfectly health and young - not the elderly with frail bones as is so common.

Learn More

So... let's be RELEVANT and in terms of someone 87 years old and of such low health as to already be in Assisted Living and now with "difficulty in breathing" (no indication of heart problems nor "gasping."

Here is the opinion of doctors SPECIFICALLY IN THE AREA OF THE ELDERLY - where the Heart Association is talking about EVERYONE as generic:


It is speculated that the success rate for cardiopulmonary resuscitation (CPR) has been steadily declining since it was introduced nearly 40 years ago. Initially designed for limited clinical situations, this procedure is now used on many individuals who would have been considered inappropriate candidates in the past.1 Elderly patients may fall into this category. The US Patient Self-Determination Act,2 followed by aggressive public campaigns during the past few decades, has expanded the role of CPR so that it is now considered the current standard of care. Thus, many patients are subjected to medically futile procedures that offer little, if any, acceptable survival benefits. The introduction of the do-not-resuscitate (DNR) order has allowed patients the opportunity to weigh personal beliefs against the perceived risks and benefits of CPR.

The observation that age is not a clinical predictor of mortality in CPR is being challenged by the current literature.3 Survival-to-discharge rates vary among these studies; however, they rarely exceed 10% of the patients leaving the hospital alive. Outcomes predominately reveal that a mere 3% to 5% of patients are surviving CPR to discharge, and a survival rate of 0% has been reported.3–6 The emerging consensus is that CPR may not only be inappropriate therapy for some patients, it may constitute medical futility in many cases.

http://www.jaoa.org/content/106/7/402.full

Only 5% to as low a 0% (none) of elderly survive CPR - and that is not even considering that 87 year old woman was still breathing and no indication given of any heart ailment.
 
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Another reason some people won't give mouth to mouth without a respirator is because of possible infection. Not likely in an 87 yr old but HIV, Hep C and other deadly diseases can be passed through saliva.
 
911 operators are telephone receptionists and nothing else. They have no authority and nothing they say offers any protection.

Setting aside an DNR agreement, CPR on an 86 year old woman could easily be lethal. Show me medical material that CPR in that situation was correct. Was the 911 operator a licensed doctor? Seems you think so.

Are any ambulance workers licensed doctors? None that I am aware of, and I personally know several. So is it then your opinion that they not make the CPR call either? This counterargument is based upon your argument that it needs to be a licensed doctor to make that call. Furthermore, there are many 911 operators who ARE trained in such matters, many whom are retired or former EMT's who do know when to make that call.

As to the DNR, the news reports I have heard stated that the woman who dies did NOT have a DNR. At no point on the 911 recordings that I heard did the nurse tell the dispatcher that the woman had a DNR. I know here that would have stopped the call then and there or at least the effort of the operator to push for CPR. Is there some reliable source that states whether or not a DNR was in place? The director of the facility didn't even mention it in his statement. I'm remembering back to Sandy Hook where so much news was put out that wasn't even near correct, so I am taking the whole DNR/no DNR with a grain of salt.

She didn't interfere with anyone. Doing nothing is not interfering.

Deliberately not handing the phone to someone who could save the life could very well constitute interference.

Since the woman died at the hospital, she didn't even need CPR. So the 911 operator could have just been giving incompetent and even life threatening advice/demands.

That is simply a bad argument, although I do understand what you mean about the unintended consequences of aid. However, CPR too late can be just as bad as no CPR to begin with. We will never know in all honesty whether or not timely CPR would have saved the woman's life, mostly because we don't know what other complications there might have been. But to say that just because she got CPR later and died at the hospital that she didn't need CPR right away, is simply ignorant.

The story says the woman was still breathing. That she died later in the hospital. Accordingly, CPR would NOT have helped in any way and only poised potential to harm or kill the woman. You NEVER do CPR on someone who is breathing for MANY reasons.

For example, difficulty breathing could be the result of some obstruction (such as food) restricting breathing. Blowing into a person's mouth is exactly what NOT to do as it pushes the obstruction deeper and can cause total blockage - and DEATH. A person "barely breathing" is NO indication of ANY heart problem whatsoever! Doing CPR on someone having difficulty breathing would make less sense than putting a bandage on the person's leg - other than putting a bandage on the person's leg wouldn't harm the person.

I Understand and agree with your point on the chocking potential and all, but if such was the case why did the fire dept personnel start CPR, according to the article? If it was not necessary, then they, who are trained to recognize such things, should not have done CPR.

CPR in the field is indicated ONLY if the patient has stopped breathing. A 911 operator should not be dispensing or suggesting medical treatment. Had the staffer started CPR as per the operator's instructions and the patient had died then because of it, the operator should be on the hook for negligence.

But that is one of the points of these 911 operators. To provide medical guidance and assistance within certain guidelines while EMT's are en route. This is what they are trained to do.

Naw, the 911 operator was wrong, but it is well understood that 911 operators have to be best-guess know-alls. That's just reality. It is then UP TO YOU do decide to follow the best-guess-advice or not. You, then, are responsible for your decision and can't blame it on the 911 operator - even if doing what the 911 operator said.

Depends upon the local laws, but most places I am aware of limit or eliminate the liability of a person following directions from a 911 operator.

Got to go. I'll catch up on the rest of this thread later. And Joko I'm not trying to pick on you personally. Your posts just had the comments that I felt that I needed to respond to. In fact I didn't even notice all but one was yours until just a bit ago.
 
You do NOT do CPR on someone who is breathing! Even if "barely" breathing. .....Don't you people know that?!

Nonsense. You don't know what you're talking but that doesnt stop you from spouting off

Cardiopulmonary resuscitation - Wikipedia, the free encyclopedia

Cardiopulmonary resuscitation (CPR) is an emergency procedure, performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.
 
I am a certified rescue diver which includes first aid, oxygen & even defibrillation etc. As a security officer I am not allowed to help anyone due to lawsuits. It is sad, but in this sue happy society we live in it's best just not to get involved.
 
So... let's be RELEVANT and in terms of someone 87 years old and of such low health as to already be in Assisted Living and now with "difficulty in breathing" (no indication of heart problems nor "gasping.")
Perhaps you didn't read the transcript or listen to the call. The call began with with "We have a lady that looks like she’s fainted or had a heart problem or something." The call lasted for over 7 minutes. Around 5-6 minutes into the conversation, the nurse says "She's taken three breaths."

Indication of heart problems? Yes.
Indication that patient was not breathing sufficiently? Yes.

Seriously, if you're waiting several minutes in between breaths to see if she'll breathe again, you're doing it wrong.
 
Actually you probably would not preform CPR on someone who is breathing. Wiki is probably not the best source. I have been CPR certified for a long time. You do not do CPR if the person is breathing. You can cause more damage than good.

Well, Wiki isn't the best source for anything, there are reasons to not perform CPR on someone who is having trouble, and that having trouble breathing does not automatically mean "start CPR". However, the claim I was refuting was that CPR is never to be performed on someone who is still breathing, no matter how poor their breathing was. That is just untrue
 
Perhaps you didn't read the transcript or listen to the call. The call began with with "We have a lady that looks like she’s fainted or had a heart problem or something." The call lasted for over 7 minutes. Around 5-6 minutes into the conversation, the nurse says "She's taken three breaths."

Indication of heart problems? Yes.
Indication that patient was not breathing sufficiently? Yes.

Seriously, if you're waiting several minutes in between breaths to see if she'll breathe again, you're doing it wrong.

If she only took three breaths in several minutes, I would not have given her CPR either. I mean outside of breaking a few ribs, lung over expansion etc are all dangers if someone is still breathing. Giving her oxygen would have been a better idea if available. Until the laws are such you cannot be sued for rendering aid, what can you do?
 
I don't understand why there is so much debate about this. The woman had a DNR. Had they disobeyed that and revived her, they probably would've been sued.

If I had a DNR and someone brought me back to life, I'd be pissed.
 
Well, Wiki isn't the best source for anything, there are reasons to not perform CPR on someone who is having trouble, and that having trouble breathing does not automatically mean "start CPR". However, the claim I was refuting was that CPR is never to be performed on someone who is still breathing, no matter how poor their breathing was. That is just untrue

An emergency first responder would not give CPR if still breathing. Now Paramedics etc it is probably different, but I am not at that level of training. So you are probably correct.
 
An emergency first responder would not give CPR if still breathing. Now Paramedics etc it is probably different, but I am not at that level of training. So you are probably correct.

I see no evidence that a 1st responder would not perform CPR in *this* situation, though that may be the case.

However, that is not the point. Again, I was responding to joko's absurd claim that CPR should only be performed on people who were not breathing at all. He wasn't just commenting on *this* case. He went far beyond into wacky-land.
 
I see no evidence that a 1st responder would not perform CPR in *this* situation, though that may be the case.

I am a certified first responder and rescue diver. We would not give CPR if the person is still breathing. The chances are to high of doing more damage than good.

However, that is not the point. Again, I was responding to joko's absurd claim that CPR should only be performed on people who were not breathing at all. He wasn't just commenting on *this* case. He went far beyond into wacky-land.

Joko aside, as I said Paramedics etc have specialized equipment and a much higher degree of training. So yes I agree.
 
Until the laws are such you cannot be sued for rendering aid, what can you do?
That *is* the law in California. The 911 operator has legal immunity over giving advice, and "existing law expressly provides immunity from civil liability to any person who completes a designated cardiopulmonary resuscitation (CPR) course and who, in good faith, renders emergency cardiopulmonary resuscitation at the scene of an emergency"
 
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