I had one of THOSE patients last night. One of the ones who can't do much other than blink. Peg tube, contractured, trached, Fortunately for me, he was already a DNR, so I didn't have to initiate that awkward conversation with his family, trying to make sure they understood what trying to save this man's life would actually do to him. Between some of the patients I've had lately and my impending transfer to and training for the ICU, I've been thinking a lot about CPR and codes again and how we've done such a great job at telling people that "CPR saves lives!" but have done such a lousy job of explaining what happens during a code and what the long-term consequences can be.
I work on a cardiac-focused, monitored, med-surg floor. In translation, that means that patients come in for various reasons and usually have a complement of chronic conditions, with arrhythmias, congestive heart failure, hypertension, diabetes, COPD, and end-stage renal (i.e., folks on dialysis) as the most common co-conspirators. Many of these patients qualified for AARP membership many, many years ago. They all wear a heart monitor so we can constantly see how well (or not well) it's beating. Most of them say that they want full code status, meaning that if they stop breathing or their heart stops, then we should take all measures.
When I have time, and when I think the patient and/or the patient's family will receive it well, I usually try to explain how CPR works and what actions we'd take during a code. It's not a comfortable conversation, but I've actually had more than one patient tell me they felt grateful for the info and made some different choices. I decided to write this post in hopes of prompting a larger conversation about codes and CPR and what "saving" a patient's life can really mean.
When television shows the performance of CPR, it's usually quiet except for the flurry of orders, and it looks like it takes just a little bit of pressure to perform CPR. That's because if the actor mimicking the performance of CPR actually used the correct amount of pressure, the actor playing the victim would end up with a rib cage full of broken bones. Performing CPR literally means using enough pressure to reach the heart--a vessel with thick muscle--and manually squeeze into a contraction. Our bones harden as we age; the older we get, the more likely our bones will snap rather than bend a bit. Good compressions with CPR breaks ribs on any mature adult. The older we get, the longer it takes us to heal. Broken ribs on a healthy 60-year old might take a long time to heal; broken ribs on an 82-year old will probably never heal.
There's more to be said on this topic, but I'm sleepy and ready for bed.
