A witness to CPR

[michuria]

I was able to witness a code one day during my clinical. I was in the cardiac cath lab when they brought him in. One of the guys who worked there started doing compressions, he was a very muscular man who worked out at the gym frequently. Once he initiated compressions, the patient started bleeding from the mouth and nose. They had been working on this patient in the ER for over an hour already and did not have this problem. Was this staff member doing compressions too deep?

[bill4745, RN]

Possibly he broke some ribs and punctured a lung. Or a traumatic intubation?

[LoveMyBugs, BSN, CNA, RN]

Ribs break during CPR, and they can puncture things causing bleeding. Was this your first time witnessing CPR, as it can be hard to see for the first time, it is not quite what you think it will be. There could be many resons why the patient began bleeding, not just from CPR

[mommy.19, MSN, RN, APRN]

It could have also been a result of ruptured esophageal varices, as well as the aforementioned ribs causing trauma to the lungs.

[suanna]

They were doing compressions-ie- the patient was mostly dead. It isn't uncommon for mostly dead people to have a significant amount of pulmonary edema. When you force blood flow through mostly dead lungs you can get some bloody fluid leaking across the aveolar membrane- they don't work so well keeping blood fluids separated from the air space once they have undergone some cellular death.

[SFRN]

I supose he could have been compressing too hard. However, this would be the exception to the rule. In my experience most people don't compress hard enough OR they don't allow enough chest recoil. You should be able to palpate a pulse with good chest compressions.

[Michelle123]

The bleeding could have been from something other than the CPR.

It is a very unique experience, the feeling of ribs breaking under your hands as you perform CPR....

But it could have been a number of things. I assume that it wasn't a good outcome?

Were you able to debrief about it?

[Da_Milk_of_Amnesia, MSN]

If you aint breaking ribs you aren't doing effective CPR..IMHO

[rngolfer53]

I supose he could have been compressing too hard. However, this would be the exception to the rule. In my experience most people don't compress hard enough OR they don't allow enough chest recoil. You should be able to palpate a pulse with good chest compressions.

Studies back your experience on the depth of compressions........most people, even trained ones, don't do them effectively.

[nerdtonurse?, BSN, RN]

When we do them, we get one person who's job is to feel for a femoral pulse -- if they don't feel the pulse with the compressions, we do it harder until they do. And wait until you see flash edema pouring out of the ambu bag from a person with essentially disintergrating lung tissue. Think mixed peptobismol and fizzy soda. Nasty. And if they've got a peg, remember to throw something over the site, you push down, Jevity and stomach acid go shooting out.

Hard ones are the folks with severely distended abdomens -- acites or extreme morbid obesity. I dang near broke my wrist on one because the pt's habitus meant I was pushing at almost a 30 degree angle -- there wasn't anything "flat" to push down on. He came back and survived another 3 days before his final code, so I guess we did something right, but my wrist ached for days.