Chest compressions s/p open heart

allnurses Guide · Jan 16, 2009

Yes, there could be problems with a fresh sternum. There is also the option of reopening the chest (emergent sternotomy). Either option is of course better than dead.

billythekid · Jan 16, 2009

yes, there could be problems with a fresh sternum. there is also the option of reopening the chest (emergent sternotomy). either option is of course better than dead.

... and death is not an option.. lol

Spatialized · Jan 18, 2009

It is a little bit easier to do chest compressions on a fresh sternontomy...

You do CPR just like normal, hard and fast. Better to perfuse and live to deal with the incision than end up dying. In one code I ended up doing compressions on a fresh CABG. A week or two later when he returned from the ICU (yes, he survived fairly intact...) I was helping his nurse do some A.M. care adn he says, pointing to his chest, "Be careful, I'm a little sore right through here." I wanted to say, "Sorry, that would be my fault..." but I held back.

I agree, death is not an option.

Tom

Wile E Coyote, ASN, RN · Feb 9, 2009

I've done a little CVICU, and was taught to compress just as usual. Keep in mind, that proper technique is even more vital, and that it will be noticeably easier to compress. If they survive, then it's off to the OR to explore the chest and try to fix any new boo boo's created.

In hospital, you'd hope to get the surgeon to the bedside and open the chest before they code. Out of hospital, treat them like any other cardiac arrest.

nursejill155 · Mar 3, 2009

I have had a post op cabg of not even an hour go into vfib... Think about your question... Your pt codes regardless of being a cabg or not you should start CPR. More likely then not the chest will be reopened but you should try to preserve the brain if possible! I started CPR and the pt chest was opened. Of course there are complications of doing compressions but what is your other option?

sicushells, RN · Mar 3, 2009

In hospital, you'd hope to get the surgeon to the bedside and open the chest before they code.

I've never seen/heard of the surgeon opening the chest at the bedside unless the patient is coding. If the patient was bleeding they would go back to the OR, right? Other than a cardiac arrest, why would you need to emergently open the chest?

nursejill155 · Mar 3, 2009

My pt was coding... Otherwise there is no reason to open the chest of the pt is bleeding they should go back to the or. The icu is not the or you are missing a lot of important equiptment they need! But you are right no other reason but cardiac arrest is a reason to do an emergent sternotomy.

Broken_Heart_RN · Mar 4, 2009

I agree that if they are asystole or non shockable, a cracked sternum is oreferable t death. However, always shock first. We even have a surgeon who encourages shocking asystole as "you can't hurt anything". Occasionally it stimulates a little something and you have a rhythm ( a gross one but better than nothing).

cruisin_woodward · Mar 8, 2009

My pt was coding... Otherwise there is no reason to open the chest of the pt is bleeding they should go back to the or. The icu is not the or you are missing a lot of important equiptment they need! But you are right no other reason but cardiac arrest is a reason to do an emergent sternotomy.

We have opened a chest or two (actually quite a lot of them) at the BS...I should say "Re OPen". It is scary. We have done it for code situations, and bleeds, and tamponade. We have also opened bellies for Compartment syndrome. It is freaky, even for me, and I have 14 years of OR experience (scrubbing and FA). It is not optimal. I work in a very large hospital, and the OR is 11 floors down. If the pt is really that unstable, we do it at the BS. We even have a cart dedicated to opening a chest at the BS. It is usually a total clust!!

Believe it or not though, I was taught that if you have a fresh pump, and I mean very fresh, you should use a Bed Pan (clean of course) to do compressions. The reason for this is for the nurse doing the compressions...the sternal wires could break and pierce the person doing compressions....I am certainly not advocating this as the proper technique, I'm just saying...But I will say that I've never actually seen it done.

CABG patch kid, BSN, RN · Mar 12, 2009

This is a "dumb" question: What would the surgeon do if the pt was coding and they had to reopen at the bedside? Meaning, what interventions are done after the chest is open and what is the rationale? I'm just starting in CCU and trying to learn about any and all possible very bad scenarios to better prepare myself :)

cruisin_woodward · Mar 12, 2009

This is a "dumb" question: What would the surgeon do if the pt was coding and they had to reopen at the bedside? Meaning, what interventions are done after the chest is open and what is the rationale? I'm just starting in CCU and trying to learn about any and all possible very bad scenarios to better prepare myself :)

of course that is not a dumb question! Never be afraid to ask a question!! People who don't ask questions are the ones who end up killing someone! Well, if he is opening the chest for CPR, he would do an internal cardiac masssage (he would actually manually squeeze the heart) or use the internal cardiac defibrilator. This should be found in a sterile package on your crash cart. I have only seen this done on patients who come to the floor with an open chest...or partially closed.

If it is a bleed, and there is no time to get to the OR, or cardiac tamponde, a nurse would squirt betadine on the chest. We have a chest set on our crash cart along with sterile wire cutters. Make sure you know where it is. All of this should be available sterile on your unit. Sterile towels and a half sheet would drape off the pt if there is time, the Dr will need a sterile gown and gloves, a hat and mask. He will remove the staples with a sterile hemostat, unless you have a staple removal kit available. Or sutures, he will cut. He will need wire cutters to cut the sternal wires. Sterile suchion and Yaunker tip. He will need prayers. Hope this helps!!