CPR and Cracked Sternums - page 2

Hi All, This is my first post other than saying hello! Thanks to all for being here and posting! I did have a question though, while looking into taking a CPR class today, someone mentioned... Read More

  1. by   RN4NICU
    Quote from NurseyBaby'05
    Don't forget about the Good Samaritan Act too. You're covered.
    I thought about that, but I don't think you're covered at work - I think it becomes a practice issue then. However, broken ribs during CPR, while not mandatory, are certainly likely and largely unavoidable. To avoid it, in most cases, one would have to do "Baywatch compressions" that do not meet the standard of care.
  2. by   Antikigirl
    People get so scared about this factor..and I try to remind them...at the point of CPR compressions...the patient is DEAD. So anything you try to do, is a bonus! Try your best..don't get all worried about doing things exactly by the book..that makes you pause or stop! Just do the best you can..and until your first compressions..well you just don't have the exprience to guage. Don't ever beat yourself up, or worry about it that much..you will perform...trust me, honest...not perfect your first time...but you will do what you can..and that is certainly better than nothing!

    I would much rather my nurses or CNA's give it a try then to be so freaked out they are petrified...so do not stress it so much...remember, the patient is dead already...you are trying to do your best to bring them back...a very honorable thing, and you can only do your best (and we get our best through practice).

    Yes, you pop em...you break em, and you will NEVER forget that feeling or sound. It is par for the course. They can be fixed, but only if the patient lives to tell the tale! So the rib pop or break is certainly not as important as saving the life...(if it helps, the feeling I get from this is like those lawn chairs that click as you move the parts..that click click click...well if you moved it fast...that is exactly what is feels and sounds like...that may help you).

    My first time, oh man did I do a great job on the ol rib pop! But I was so lucky that I had great teachers that told me this was going to occur so I didn't do it and freak out! Another great tid bit..they will be fully incontenent..and good chances they may have emisis...something to think of when you can grab an ambu bag vs your simple face protectors!

    And on the 'realistic' end of the topic...oh yes!!!! That is why I am a patient advocate for POLSTS (my states DNR). Almost all my resident have them at DNR level (I work in geriatrics)...So I only have to do CPR on rare occastions.

    LOL, you know what..I trained with paramedics and ED...and it took 3 years before I ever got a code!!!!! LOL! So they don't seem to happen as much as folks think .
    Last edit by Antikigirl on Dec 21, '04
  3. by   Rush
    Quote from TriageRN_34
    My first time, oh man did I do a great job on the ol rib pop! But I was so lucky that I had great teachers that told me this was going to occur so I didn't do it and freak out! Another great tid bit..they will be fully incontenent..and good chances they may have emisis...something to think of when you can grab an ambu bag vs your simple face protectors!
    Thanks TriageRN. My my my, it just keeps getting better. First you go through to their spine and then you're watching for incontinence. Oh, and a mouthful of whatever they had for lunch as well. It's like Christmas every day in CPR land!

    While she did play down these aspects, she happily played up the violence of the whole thing.

    I have so much to learn. Thanks all.

    Rush
  4. by   pinkiepie
    My brother works at the county nursing home as a respiratory tech. and has talked to me at lenght running full codes of the very frail and elderly. He said it breaks his heart to have to run a full code on 90+ year old grandmas. And although he does the best possible job he can, most of the time he hopes they don't revive because of all the CPR trauma they have gone through. He said he ALWAYS experiences breaking ribs. Makes me wonder if these people really knew what they would be going through if they would opt for all the bells and whistles or just pass peacefully.
  5. by   jayne109
    My very first code was traumatic for me and the pt. We were in the field doing a resus and I did CPR and broke every single rib and the clavicles too. My partner saw my eyes get as big as saucers and said , "ready to switch" It was a very good experience for a new nurse/ first responder
  6. by   Biffs25
    Quote from jayne109
    My very first code was traumatic for me and the pt. We were in the field doing a resus and I did CPR and broke every single rib and the clavicles too. My partner saw my eyes get as big as saucers and said , "ready to switch" It was a very good experience for a new nurse/ first responder
    I'm sorry, but I've done CPR many many times, I'm a CPR instructor, a medic, and I work in the ER/Trauma Unit, and have NEVER seen someone crack clavicles while doing compressions, where were you doing them??? 2 fingers widths above the xyphoid process, not upper sternum, is the correct hand placement. You can expect rib cracks, but that is just improper CPR if you are cracking clavicles.
  7. by   jayne109
    It was my first time. IT was in the field and the guy was like 85. My hand placement was probably not correct but The family was watching us and there was a lot of excitement and tension in the room. And it was my FIRST TIME! I KNOW BETTER NOW!
  8. by   gwenith
    Sorry folk s but I am shuddering reading this.

    Fallacy 1) the "popping" sound is more likely to be cartilage rather than ribs and is far far more likely for the cartilage to crack than the ribs.

    Fallacy 2) IF you don't break a rib you are not doing it right OKAY where is the little loudmouthed junior intern that came up with THAT one!!! I want his shins for a darn good kicking.

    THIS is the site you should be referncing

    http://www.ilcor.org/ which unfortunately is under construction but the advisory statements from ILCOR can be found all over the web.

    Try googling ILCOR and cardiac compressions
  9. by   gwenith
    Here is one article

    http://medind.nic.in/maa/t04/i1/maat04i1p52.pdf

    This explains some of why you try to AVOID cracking ribs (by elevating your fingers fingers crack ribs)

    Theory of chest compression

    The original term "cardiac massage" and its successor "external cardiac compression" reflect the initial theory as to how chest compressions achieve an artificial circulation- by squeezing the heart. This "heart pump theory" was criticised in the mid-1970s, firstly because echocardiography demonstrated that the cardiac valves become incompetent during resuscitation, and secondly, because coughing alone was shown to produce a life sustaining circulation. The alternative "thoracic pump" theory proposes that chest compression, by increasing intrathoracic pressure, propels blood out of the thorax, forward flow occurring because veins at the thoracic inlet collapse while the arteries remain patent.

    The recommended rate of 100/minute reflects a compromise between scientific evidence in favour of faster compression, and the ability of the rescuers to maintain the higher speeds. It is important, however, to recognise that even when performed optimally chest compressions do not achieve more than 30% of the normal cerebral perfusion.

    The three elements of basic life support after initial assessment are commonly remembered as "ABC": Airway / Breathing / Circulation

    back to contents
    http://www.resus.org.uk/pages/bls.htm
  10. by   gwenith
  11. by   Monica RN,BSN
    Quote from gwenith
    Sorry folk s but I am shuddering reading this.

    Fallacy 1) the "popping" sound is more likely to be cartilage rather than ribs and is far far more likely for the cartilage to crack than the ribs.

    Fallacy 2) IF you don't break a rib you are not doing it right OKAY where is the little loudmouthed junior intern that came up with THAT one!!! I want his shins for a darn good kicking.

    THIS is the site you should be referncing

    http://www.ilcor.org/ which unfortunately is under construction but the advisory statements from ILCOR can be found all over the web.

    Try googling ILCOR and cardiac compressions

    Thanks for the link....
    however,
    I have been an RN for 16 years and am also a CPR instructor of many years. I previously worked in the ER on the code team, and yes it is without a doubt absolute truth that ribs will break, agreed that raising fingertips can help decrease or reduce broken ribs, but good proper compressions are essential, and in order to achieve.. ribs will crack..
  12. by   Monica RN,BSN
    Quote from Biffs25
    I'm sorry, but I've done CPR many many times, I'm a CPR instructor, a medic, and I work in the ER/Trauma Unit, and have NEVER seen someone crack clavicles while doing compressions, where were you doing them??? 2 fingers widths above the xyphoid process, not upper sternum, is the correct hand placement. You can expect rib cracks, but that is just improper CPR if you are cracking clavicles.

    Yup.. Biffs25.. I thought the same thing immediately... CPR to break a clavicle would be like... somewhere in the shoulders.. (Wow....)
    quite a distance from the heart.. but as she sid it was her "first time" .. I still have to wonder how one can not realize they are not over the heart.... even though it was a first time... no CPR class would ever teach such a thing..
  13. by   gwenith
    COMPLICATIONS OF CLOSED CHEST MASSAGE

    The most common injuries from chest compressions are rib fracture (∼30 percent) and sternal fracture (∼20 percent). [78 ] Other common complications include aspiration, gastric dilatation, anterior mediastinal hemorrhage, epicardial hematoma, hemopericardium, myocardial contusion, pneumothorax, coronary air embolus, hemothorax, lung contusion, and oral and dental injuries. [78 ] - [80 ] The liver is the most commonly injured intraabdominal organ, with rupture occurring in about 2 percent of cases. The spleen is infrequently injured and ruptures in less than 1 percent of resuscitation attempts. [78 ]

    Rare injuries (incidence less than 1 percent) include tracheal injuries, esophageal rupture, gastric rupture, cervical spine fracture, vena caval injury, retroperitoneal hemorrhage, and myocardial laceration. [78 ]

    Complications may occur even with properly performed CPR, especially rib and sternal fractures. The possibility of injury should not deter the vigorous application of CPR, since the outcome without effective resuscitation is certain death. Life-threatening injuries from CPR, such as laceration of the heart or great vessels, are rare. Proper techniques will lessen the incidence of serious complications.
    http://www.ctsnet.org/edmunds/Chapter14section3.html

    Yes they will crack but NOT 100% of the time and you DO NOT repeat NOT have to crack ribs to perform effective CPR. In my career in ICU I have nursed a LOT of post resuscitation patients I have seen 1) and only 1) case of flail chest where multiple ribs were broken - saw the occasional broken rib but fewer than would be expected if you took the earlier posts on this thread as a guide.

close