chest wounds and cpr

[Darkfield]

We have a guy with an open chest (I haven't taken care of him) and someone mentioned in report that there are paddles on SICU, we can't do cpr on him. He has a sternal wound and a wound vac. Does anyone know-if someone with a chest wound flatlines, can we not to cpr? It wouldn't work to shock, right?

[Biffbradford]

Sounds like he has a non-healing, dehissed sternal wound rather than an "open chest'. An "open chest" is one that has not been closed after surgery because there is too much swelling in the lungs. They leave the retractor in, which keeps the sternum spread a good 6 inches, then they cover it with a sterile dressing, paralyze and sedate the patient, and try to get the swelling down with a Lasix drip if the kidneys are working, or CVVH if they aren't.

Dehissed wound? Check the doctor's orders. "Open chest" - no CPR (no turning, no CXR). Defib by surgeon only (remember, you've still got that stainless retractor in there holding the ribs apart) and internal paddles only (well, maybe by a nurse, but that depends greatly on the surgeon and which nurse it is at the time). We always had a 'chest opening tray' in the code cart. That had the internal paddles and lots of other heavy duty stuff for such emergencies.