I Think I my CPR Instructor Didn't Know What She Was Talking About

  1. I am a CNA/CMA in Oklahoma and I have taken paramedic training so I know CPR and this isn't an ego thing where I disagreed strongly to the point where I am crying to the internet. It was to the point where we were basically handed out books at the facility I work at detailing what we can and cannot do with first aid/cpr however the instructor was saying the total opposite!
    The books we were given detailed CPR and First Aid and the use of tourniquets however my instructor said that since we were lay people that we could only do direct pressure and that applying tourniquets was out of the scope of practice for us. (I haven't been able to find anything to back that claim up)

    I was a bit confused but rolled with it anyway I didn't think CNA/CMAs were lay people since we are trained?

    I was reprimanded for going over 100 compressions in one minute (I did 140) and I asked why that was a problem "Is for my benefit to straddle 100 for stamina sake until EMS arrives? Or am I doing damage to my patient?"
    She gave me some sort of strange explanation that didn't really explain anything stating "If you go too fast the blood and oxygen goes through the body to fast to perfuse..."

    I thought that was weird since you make up 25% percent of the heart doing chest compressions.

    At the end of the class I apologized for pressing questions so hard about the tourniquets and said "This is my first time learning CPR and First Aid from this perspective I was taught the EMT way first and when I was told to not apply tourniquets if the bleeding continues I panicked a little and I'm sorry."

    She replied "Well would you violate scope of practice?" I stared blankly at her for a minute and said "no"

    Have they added tourniquets for just EMS!? I cannot find anything backing this up.

    I am thoroughly confused over this and am worried that I could be putting clients' lives in danger if I listen to this woman.

    Thoughts? Opinions? Am I wrong?
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  2. 50 Comments

  3. by   nowim clean
    What is the setting? Are you working in a facility? If so you follow policy and procedure, and stick to CPR.
  4. by   darobow
    We are in an Assisted Living Facility. But we went over both First Aid and CPR.

    It is just strange alot of things that was covered just flew in the face of how I was taught on how to handle things in other First Aid/CPR classes.
    Last edit by darobow on Jan 24 : Reason: Omitted info
  5. by   blondy2061h
    When you're doing cpr you need to allow full recoil. This means pushing the sternum in and waiting for it to return to its original position. This allows the heart to refill with blood that you can push out in your next compression. When you preform cpr at a rate significantly above 100 you aren't allowing full recoil.
  6. by   Cowboyardee
    The most commonly cited reasons for limiting cpr compression rate to 100-120 beats per minute are that faster rates not only wear out personnel but also dont provide enough time between beats to allow the heart to refill with blood optimally, and thus compromise perfusion.

    As for whats in your scope of practice, that depends on your role and the laws in your particular state.
  7. by   klone
    And no, I would not expect a CNA/CMA to apply a tourniquet, but rather just to stanch the bleeding and provide direct pressure.

    So, I disagree with your assessment that the instructor didn't know what she was talking about - I didn't see anything that I disagree with regarding what she said.
  8. by   Tenebrae
    Tourniquets are not used here routinely. There have been issues with them staying on too long and then resulting in permanent tissue damage.

    I looked after someone who had nicked their radial artery in an episode of self harm. Direct pressure and a blood pressure cuff were used to stem the flow of bleeding and the suturing had to be done without anaesthetic because they couldnt wait that long
  9. by   Rocknurse
    Doing chest compressions too fast won't allow full recoil of the chest wall and therefore will compromise blood return to the heart lowering cardiac output.

    I can't comment on the tourniquet issue because it's not part of the AHA BLS protocol.
  10. by   RotorRunner
    140 bpm is too fast. No way you're getting full recoil, which means the heart doesn't have enough time to fill. It's counter productive.

    Tourniquets have been in and out of favor even in the EMS world over the years. I would never expect that sort of bleeding control to be taught in this setting. It's not part of AHA CPR, in any case. I can't even imagine when you would need a tourniquet in a SNF...

    Just follow the protocol at your facility.
  11. by   Horseshoe
    Quote from darobow
    Am I wrong?
    ^^^^Yes.
  12. by   darobow
    Well I work at a facility where most of the staff are nurse aids and have an RN consultant. My issue was "Where do we go from here if the bleeding continues if direct pressure doesn't do anything and are there alternatives since we cannot use tourniquets?" No alternatives. And the only reason I got was basically "Just Cuz"
    She went from saying tourniquets are out of scope of practice to it's a strictly military thing. So whatever the material she was trying to teach she did a poor job of it.
  13. by   Sour Lemon
    Quote from darobow
    Well I work at a facility where most of the staff are nurse aids and have an RN consultant. My issue was "Where do we go from here if the bleeding continues if direct pressure doesn't do anything and are there alternatives since we cannot use tourniquets?" No alternatives. And the only reason I got was basically "Just Cuz"
    She went from saying tourniquets are out of scope of practice to it's a strictly military thing. So whatever the material she was trying to teach she did a poor job of it.
    I'm imagining a small child asking, "Why? Why? Why?" after every statement the instructor made. I'm glad I wasn't in the class with you. I would have needed a drink.
    They're there to teach you CPR ...not account for every biological "what if" that might/maybe/could occur. CPR is not the end game ...it's just buying time (hopefully) until the patient can get to a higher level of care.
  14. by   Triddin
    If the bleeding doesn't stop with appropriately applied pressure to a compressionable arterial site, the patient needs surgery ASAP. Being at a facility, I would hope that if a patient was bleeding that much, that you would be calling 911 to get the patient to the hospital. So I don't disagree with your for instructor that it is out of your scope. I would expect your RN consultant being the one to apply pressure.

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