[Dinith88]

Originally Posted by krzysiu

Dont forget the pacer wires.

Very Good point.
Unfortunately, pacers wont help in certain situations/arrests.

Do you mean you withhold compressions in all patients with wires??

[krzysiu]

Originally Posted by Dinith88

Very Good point.
Unfortunately, pacers wont help in certain situations/arrests.

Do you mean you withhold compressions in all patients with wires??

Just the ones where the surgeon tells me to withhold compressions.

[Kymmi]

I agree with most of the other posters....been working CVICU 10 years. If patient is asystole I'd be doing compressions unless I had a surgeon standing there opening the chest. No compressions means no circulation so you can push as many drugs as you want without any response and how do you explain that to a jury when asked why chest compressions werent done? I'd rather deal with the complications that might occur if compressions are done on a fresh open heart patient then explain to the family why the patient is dead.

[Grifter]

Originally Posted by rickard

this question is only concerning the first 24 hour period. do you deviate from ACLS protocols or do you give 1 mg epi q3-5 mins? anyone use calcium chloride ?

from my experience still follow acls protocols but no chest compression attach pt to external pacer using the pericardial wire then get you IABP ready for they might insert it

[Grifter]

Originally Posted by Kymmi

I agree with most of the other posters....been working CVICU 10 years. If patient is asystole I'd be doing compressions unless I had a surgeon standing there opening the chest. No compressions means no circulation so you can push as many drugs as you want without any response and how do you explain that to a jury when asked why chest compressions werent done? I'd rather deal with the complications that might occur if compressions are done on a fresh open heart patient then explain to the family why the patient is dead.

that is a very good point for a client that is already flatlining then chest compression is a must

[kimprn]

Our facility's practice is to do compressions lateral to the sternotomy site utilizing two people

[CVICURN2003]

Originally Posted by Grifter

from my experience still follow acls protocols but no chest compression attach pt to external pacer using the pericardial wire then get you IABP ready for they might insert it

With no compressions?? How are you circulating your drugs? By the time the IABP is inserted or chest opened..pt has already been anoxic.
We do chest compressions on our open hearts. We do them from the side (toward the heart, from the sternum) and we do them hard and fast. Our CV Surgeon REALLY does them hard and fast. Even the time it would take to prep for a sternotomy the pt would have been pulseless and anoxic. Even if you had an open chest cart in every room. We have had to take someone back to evacuate a hematoma and do a stat echo on all pts after compressions. We are usually having the echo tech look for tamponade all at the same time.
PLEASE do chest compressions on ME!!!

And we give bicarb and calcium chloride routinely..when they are crashing.

[TopherSRN]

Originally Posted by Dinith88

Very Good point.
Unfortunately, pacers wont help in certain situations/arrests.

Do you mean you withhold compressions in all patients with wires??

they meant trying to pace and get capture first rather than immediately starting compressions. you'd be surprised how often peope forget about their wires. Though oftentimes you wont capture anyway :/

To not do compressions on a pt. with a non-perfusing rhythm is assinine. CPR can be done on a sternotomy pt, it just needs to be done differently.

There are very few cases in which you're gonna do a re-entry at the bedside, and hopefully the surgeon is smart enough to take them back before it gets to that point.

Why would acls be any different on a fresh heart? If anything its more liberal.

[putmetosleep]

Compressions!!! Always, if the pt has a non-perfusing rhythm--otherwise all of your other efforts will be futile.

[mummer43]

Had an open chest code today and compressions were done until the surgeon was at the bedside to open the patient up.