[JohnW]

We do regular (i.e. aggressive) compressions on our open hearts until the surgeons arrives. Does anyone know of anything is the literature re: coding open hearts? Does the red cross have a set of recs? Last time I took ACLS I didn't work with hearts, but I don't remember anything specific?

[pinoyNP]

This is a very interesting thread. As someone who works in a cardio-thoracic surgical critical care setting, my colleagues and I have participated in ICU re-sternotomies or "cracking open a fresh chest" in the setting of strong suspicion of cardiac tamponade. However, more often than not, patients who do so poorly and have to be coded are ones who were really sick on arrival and already have an open chest which makes it easy to do direct cardiac massage. It is also fortunate for our unit, that we have 24-hour coverage from mid-level providers like myself who are trained in re-sternotomies.

But what does one do in settings where nobody trained in ICU re-sternotomy or open cardiac massage is immediately present during a code requiring chest compressions. I honestly couldn't find any literature or standard of care on the matter. However, Robert Bojar's Manual of Peri-operative Care in Cardiac Surgery covers the topic and states that external cardiac massage at a rate of 100/min should be initiated at a rate of 100/min if unable to defibrillate or establish pacing within 30 seconds of onset. It also adds that external massage can result in disruption of the sternal closure, injury to the bypass grafts, or damage to the ventricular myocardium from prosthetic valves. Well we all know that. So I guess this goes along with the concensus that current ACLS guidelines should still apply until someone trained to open the chest arrives.

One should also remember that opening the chest is only indicated when strong suspicion of a cardiac tamponade as the cause of the cardiac arrest is present.

[Zookeeper3]

Calcium and Bicarb and used often in our hearts, even without code situations.

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 ?

[caflrn]

No compressions is strange, you might need to re eval that, but we have pretty much stuck with the standard acls round of drugs

[pawashrn]

The only thing I get take from your question. Is when I have my OHS I have to ask the hospital if they are going to do compressions on me if I need them. An arrest is an arrest is an arrest, ACLS no matter and that includes compressions. Please talk to your educator and have them do just a little bit of research, in order to change your policy.

[meandragonbrett]

Originally Posted by pawashrn

An arrest is an arrest is an arrest, ACLS no matter and that includes compressions.

Unless they have a biVad.

[pawashrn]

Originally Posted by meandragonbrett

Unless they have a biVad.

As a nurse your responsibilities are the same and you follow acls and you apply the appropriate recovery steps. Remember as a nurse you do not diagnose nor treat. you follow the treatment directed by the diagnosing physician. As you may see I don't agree with acls. I feel it takes the responsibility off the physician and places it on the nurse. Which is not nurses role. To read an ekg and determine to give epi/atropine is a diagnosis and a treatment. I do it alot as part of the code team, but don't agree with the it.

[meandragonbrett]

Originally Posted by pawashrn

As a nurse your responsibilities are the same and you follow acls and you apply the appropriate recovery steps. Remember as a nurse you do not diagnose nor treat. you follow the treatment directed by the diagnosing physician. As you may see I don't agree with acls. I feel it takes the responsibility off the physician and places it on the nurse. Which is not nurses role. To read an ekg and determine to give epi/atropine is a diagnosis and a treatment. I do it alot as part of the code team, but don't agree with the it.

No, chest compressions are not done when a patient has a biventricular assist device.

As far as you not agreeing with ACLS, you always have the option to not obtain certification or to work in an area that does not require ACLS certification.

[pawashrn]

not to insult your feelings. I know not to do chest compressions w/ a bivad. That is why I said you still do acls and just like any other code you use the protocol as it applies. chest compressions would not apply. Sorry, I didn't explain myself more simplistically. And where I choose to work has no impact on my personally feelings about a nurse doing a doctors job.

[SEOBowhntr]

Originally Posted by Dinith88

I hope thats not a policy at your place.

Time is brain. Dont twiddle your thumbs. Do compressions.

Unless you have a surgeon standiong at the bedside 24/7 with a bottle of betadine and a razor...

It's unfortunate (and kinda gross) compressing a fresh sternotomy but in the event of cardiac arrest you have no other choice. (or...if you choose to wait until someone comes and cracks the chest you'll likely just be watching the patient die...)

Ditto this, our policy is follow basic ACLS!! (and pray!!!!) As Dinith say, it is NOT fun pushing on a fresh sternotomy, however if you want that patient to live and have a normal functioning brain, then that's what you do.