CPR question

smk1, LPN · Mar 29, 2008

Ok....Because I have not yet performed CPR on an actual human being I wanted to know how I would know if my compressions were adequate to facilitate circulation? This is one of our open book questions and Im not sure if there is even a way to know this. I know that correct rate rhythm and depth are essential.

If someone is able to ascertain a pulse while you are providing CPR that would be the best way. Particularly if they were able to feel lower pulses such as radials, femorals and pedal. Also make sure there is a firm surface underneath the patient's back to push against. I suppose if the person had a urinary catheter in place and you had a long code going on, another sign would be the presence of continuous urinary drainage filling the bag. Means the kidneys are being perfused, so you know that the brain is as well.

poohbear1968 · Mar 29, 2008

That is really interesting....So if CPR were being performed on a patient that had a foley, and doing it correctly. You would see urine filling up the foley bag.

allnurses Guide · Mar 30, 2008

That is unlikely, and definitely not how I would assess my CPR effectiveness. The presence of a palpable pulse, or in a critical care environment the arterial line trace is the best way to measure effectiveness.

smk1, LPN · Mar 30, 2008

That is really interesting....So if CPR were being performed on a patient that had a foley, and doing it correctly. You would see urine filling up the foley bag.

Again though only in the long run, not an immediate thing you would see. The main things are assessing the pulses.

allnurses Guide · Mar 30, 2008

Poahbear, I always teach that any compressions are better than no compressions, as long as the position is correct you will be making some impact. Feeling a pulse during compressions is one way of knowing if you are perfusing the organs and this will let you know that the compressions are doing that. It is also important to bear in mind that efficiency of chest compressions reduces with rescuer fatigue, you should be looking to change the person doing the compressions reguarly, I make a change at least every cycle which is almost a trigger to change as there are other things going on at that point.

There has been some research done on fatigue during chest compressions but I can't recall the references, let me do a bit of digging around to see if I can find it.

poohbear1968 · Mar 30, 2008

Thanks everyone,

Im almost done (May 16th) and I feel sometimes like I dont know everything Im supposed to know. There is soooo much. Im hoping it will all come together once Im on the floor:)

seanpdent, ADN, BSN, MSN, APRN, NP · Mar 31, 2008

Thanks everyone,
Im almost done (May 16th) and I feel sometimes like I dont know everything Im supposed to know. There is soooo much. Im hoping it will all come together once Im on the floor:)

Heh heh Poohbear.... I don't think that feeling will every change...

Congrats on your impending graduation!

Turley007 · Apr 1, 2008

You will see this on the cardiac monitor. You should feel a pulse with every compression. Also it will look on the cardiac monitor like you have a wide abberant rythym (if in asystole and not in PEA). Mostly if you FEEL it.... It's good cpr.

ICUCoOLWaTER · Apr 17, 2008

Hi mate Am Bader BLS instructor the answer for ur question might be already given to u but i just wanted to emphesize on 2 important things which u have to keep in mind. :saint:

1- if u were doing chest compression hard eoungh u will see the ECG Rhythm in the monitor attached to the patient or the victim is wide and steady maintaining remember 30:2 5 cycles with complete chest recoil to improve the circulation.

2- while u r doin the compression the second rescure is checking the Carotid Pulse looking for good pulse with a good volume and he/she will till u to press harder and so on. :up:

anurseuk · Apr 22, 2008

You hopefully would see some sort of output from the arterial line if your in an ITU environment. Much easier when you are because the chances are that your patient will already have multiple monitoring devices attached. :spesc:

rcpals · Apr 28, 2008

Hey Guys,

Generally the best way to determine adequate perfusion during compressions is with a A-line. It displays actual pressure numbers and you can see a difference in compressed BP depending on your compression technique. Recently I was pushing on the chest and had A-line BPs of 140/80. Someone else took over and the BP immediately dropped to 40 over 0( the new compressor was much smaller and couldn't push as hard).

About the ECG waveform as a good indicator of compression depth/perfusion. This method is not accurate at all. While I have seen nice wide, almost Vtach like tracings due to excellent compressions, but I have also seen excellent compressions being performed with a very flat line (ie no reaction due to compressions). The final kicker is there is no scientific data that says it is accurate.

About generating carotid or femoral pulses with chest compressions. Again there are no scientific studies (that I'm aware of) that say pulses correlate with good forward blood flow. Most studies indicate that pulses felt during cpr are generally venous pulsations. The concept being the valves in the SVC and IVC become floppy during arrest and non functional so about 10% of the blood is actually pushed backwards. The kicker is there are no studies saying compressed pulses are actually accurate to determine forward blood flow.

While we still like to feel those compression pulses, generally its not very accurate.

One final way is exhaled CO2. Since Co2 delivery is dependant on pulmonary blood flow, Measuring Co2 and trending CO2 generally is one of the best ways.

We perform many interventions based on hypothesis and tradition, not on the basis of science. So it all comes down to the science. Anecdotal evidence is generally vaild. If you don't have a reproducible,valid study, please question those traditions...

It's all good

Jeff RCP

Regional faculty

ACLS,PALS,BLS