CPR question

[Sand_Dollar]

Hi there!

I am a student and was on the CVCU last week. I saw my first code and noticed the doctor doing compressions was going at least twice as fast as I thought we were supposed to (had the song Staying Alive going through my head). I asked a nurse about it later and she said we are supposed to give compressions of AT LEAST 100/minute.

I thought 100 bpm or so was optimal, was his 200 bpm appropriate or just off the charts? I attributed the increased speed to adrenaline, but maybe he was going that fast on purpose.

Thanks for taking the time to answer this, I want to have my facts straight for the time when I'm the one giving compressions.

~SD

[umcRN, BSN, RN]

@umc - I'm very intrigued with the cooling of the coding ped pt. I understand it from a hyperthermia situation and for spinal cord injuries from my first career as an athletic trainer, but never thought of applying it in other situations. I'm going to keep an eye out when I start my program in June at a major teaching hospital and see / ask about it.

Our hospital is currently conducting a study for therapeutic hypothermia after cardiac arrest. Any patient who receives greater than 2 minutes of chest compressions is eligible All patients have their heads cooled during resuscitation, post resuscitation they are randomized into a control group or study group. Control group is kept normothermic 36-37 degrees. Hypothermia group is cooled to 33 degrees. Cooling lasts three days and a variety of labs are drawn on both groups at set time intervals.

The study is similar to what is done for neonates who are cooled for hypoxic birth injury, something my hospital also does in the NICU.

As of right now I can't really comment on the outcomes. I have seen it go either way for both groups but I've only worked in this particular unit for two years.

[Dodongo, APRN, NP]

We use the ArcticSun machine to initiate and carry out our hypothermia protocol. We do it for most all of our cardiac arrests. It's quite nice. It uses a core temp probe and circulates cold water through blankets on the skin and then cold saline infusing. The machine adjusts everything to keep the temp at goal and the cooling and rewarming controlled and gradual.

[umcRN, BSN, RN]

We use the ArcticSun machine to initiate and carry out our hypothermia protocol. We do it for most all of our cardiac arrests. It's quite nice. It uses a core temp probe and circulates cold water through blankets on the skin and then cold saline infusing. The machine adjusts everything to keep the temp at goal and the cooling and rewarming controlled and gradual.

We use something quite similar, I don't know the brand name, blanketrol? I think. Anyways, rectal probe and a cooling blanket they lay on that circulates the water and keeps their temp regulated

[Dodongo, APRN, NP]

We use something quite similar, I don't know the brand name, blanketrol? I think. Anyways, rectal probe and a cooling blanket they lay on that circulates the water and keeps their temp regulated

Oh, we have the blanketrol for sure. Same thing really. The arcticsun blankets just stick to the patient's skin.

[limaRN, BSN, RN]

Probably just adrenaline. One of our doctors does CPR so hard that the patient flies off the bed with each recoil!

Yikes. Careful there.. I heard of a situation where a new resident with a lot of adrenaline did compressions so hard that it caused massive internal injuries and bleeding and was the likely cause of pts death.

[wooh, BSN, RN]

Yikes. Careful there.. I heard of a situation where a new resident with a lot of adrenaline did compressions so hard that it caused massive internal injuries and bleeding and was the likely cause of pts death.

Considering the patient was DEAD before compressions were started...

[morte, LPN, LVN]

but wooh, would you really want to go to court on that one???

[wooh, BSN, RN]

but wooh, would you really want to go to court on that one???

Would love to. It would be entertaining watching an attorney try to convince a jury that the doc killed a dead person.

[morte, LPN, LVN]

you need to remember that juries are not medical persons..If the lawyer can get an "expert" to say the person would have been saved by appropriate care....

[wooh, BSN, RN]

you need to remember that juries are not medical persons..If the lawyer can get an "expert" to say the person would have been saved by appropriate care....

That's true of EVERYTHING. The other lawyer then gets an expert to say, "THEY WERE DEAD."

I'm not going to practice in fear of a lawyer being able to find an expert that will say anything. An expert can go and tell a jury I gave a toddler liver failure from one dose of tylenol. I'm still going to give tylenol the next time I go to work.

[andi.w]

I work in open heart recovery. We had a post-op valve code one evening and the surgeon advised us to do compressions at a rate that kept the patient's systolic BP in the 70s per the arterial line. However, I don't quite remember the exact rationale for this.

[limaRN, BSN, RN]

Considering the patient was DEAD before compressions were started...

The pt recovered from the code and later passed of internal injuries I believe... I definitely see where you're coming from as the pt is definitely dead without the compressions but having the pt come up off the bed may be a bit excessive.