CPR for the frail and obese - page 2

I've been reading a thread here about CPR (started by Rags2RichesRN) but I have a slightly different question than hers. My question is that I, too, am a new nurse and although I, too, took the... Read More

  1. by   NotFlo
    1. If someone is found with no pulse/not breathing you are going to scream for help and the crash cart. You should direct someone to get the crash cart and someone else to call the code blue (or whatever the code is in your facility). After calling the code you should have more people than you know what to do with on the scene very, very quickly.

    2. You need the person either on the floor or in the bed with the board under them. (If they are sitting in a chair, get them to the floor. On the toilet, get them to the floor. In the shower chair, on the floor, etc. etc.)

    The board is on the crash cart. If the person is on an air mattress make sure you PULL THE CPR hose which deflates the mattress instantly. If you haven't seen this look for it next time you see an air mattress so you'll know where it is in an emergency.

    Just start compressions until the crash cart and ambu bag arrive. Compressions are the most important thing and a lot of the most recent classes for the public and teaching compression-only CPR. Doing compressions with the best technique you can is much better than doing nothing until the supervisor or other nurses arrive.

    Once the crash cart is there breaths can be given with the ambu bag with the O2 connected to it wide open. By now, you should have tons of people...someone should be calling 911 to tell them CPR is in progress, someone calling the MD, someone calling the family, someone doing the paperwork, and plenty of people in the room to switch off CPR/fetch stuff/take notes or whatever your facility policy dictates.

    No, chances are it's not really possible to do compressions effective enough to be life saving on a super-morbidly obese person but you just do whatever you can do and know when it's over you did the best you could...
  2. by   onthemark
    Dear MustLovePoodles and ColleeRN2B ~ Thank you both SO much for your practical suggestions and walking me through this. I'll ask my supervisor if there's a written protocol.

    And JessKidding, As you said, I'm probably psyching myself out over this and hopefully when the time comes, I'll remember what I learned. Meanwhile, I'll look for an AMA course for healthcare providers, as you suggested. Thanks!
  3. by   onthemark
    Dear NotFlo, I just saw YOUR comments, too! Thank you so much! I will definitely look into all these things! Very helpful!

    Wow! I can't get over how supportive you all have been
  4. by   Gently.me
    Quote from onthemark
    Although I appreciate your reminding me to check their DNR status, that fractures will be probable, and also that it's apt to not work with them but a try is better than nothing, I still don't see how I can do this when most of the patients are in wheelchairs. Do I ask the aides to help me get them out of their chair and laid down on the bed/floor, and then proceed with CPR while I ask another aide to call the supervisor? Do I keep my breathing mask with me at all times for the 2 rescue breaths? I have never even taken the mask to work with me but if the CPR is my responsibility then maybe I should.

    I'm sorry to be such a newbie at this and really appreciate any advice and tips you can pass on to me. Thanks!!!
    Review the protocol in your head. If you really are unsure, practice on a family member (not full compressions mind you but just scenarios). Talk it over with your DON.

    You have different circumstances that I do, in the fact that people WILL go into cardiac arrest and die in your facility. It is your job as the nurse to provide CPR if not contraindicated via DNR. If you do not think you are up to this, maybe re-think your position? Once a patient goes into cardiac arrest, they have minutes so calling your DON is not really going to do much but waste precious time.

    I have seen it on here a few times, and I think it is a great theory. Cardiac arrest=death. You cannot get worse than dead, so a few broken ribs are nothing in comparison to potentially saving a life.
  5. by   runnergirl86
    If you find yourself needing to perform CPR then move the w/c out from them and lie them on the floor. It's great if someone else can help you (one with the w/c the other with the patient's upper body and head. Once again, even if they get a bruise from quickly being transferred to the floor, you have to give your 100% and perform CPR.

    In the case of someone choking and sitting in a w/c, if they can have them lean forward then you can position your body closer and more of an upward fashion as opposed to being stuck perpendicular. When you're in an emergency your training will come back to you and you'll know what to do.
  6. by   onthemark
    bfrei, thank you for bringing up the scenario of a choking victim in a w/c because I've been thinking about this, too. My CPR book shows the nurse kneeling behind the wc with arms around victim and giving thrusts. This would work for most of the residents but there are still a few who are so obese there's no way I could put my arms around them. All I can think of is using a sash and giving back blows. Would this be all right or is there anything else I should do for these obese people? It almost seems that it would work better to face the person when giving the thrusts instead of pulling from the back.
  7. by   AnonRNC
    You're right: if someone is so obese that you absolutely cannot get around them from the back, go to the front and give abdominal thrusts. You'll probably need to get low in order to thrust up and in.
  8. by   gentlegiver
    Quote from AnonRNC
    You're right: if someone is so obese that you absolutely cannot get around them from the back, go to the front and give abdominal thrusts. You'll probably need to get low in order to thrust up and in.
    As a new Nurse I had a 400lb pt choke on lunch. I couldn't get my arms around the pt so one of the CNA's and I joined hands and circled the pt and that did the job. It was cumbersom but it worked!!
  9. by   nurse2033
    You are being very proactive to think about these issues. You are certified, it is your job to act when appropriate. It is also your job to be ready to act. Do what you are trained to do to the best of your ability.
  10. by   onthemark
    Thank you ALL so very much! Reading your comments is making me feel much more secure. I just needed your feedback and confirmation, and now I have it. I love this site
  11. by   kkorn
    There is a new CPR board available for obese patients, its called BariBoard!
  12. by   onthemark
    Good to know, kkorn! I just googled it. My facility doesn't have one but maybe they will soon.
  13. by   That Guy
    I have seen some of the most productive compressions from little 5 foot nothing girls climbing up on the bed and getting a good straight line shot down on the person. I like to do the same. Heck on the ground is the best because you can just get over them and drop straight down on top of the bigger people. Proper technique and alignment helps tremendously.