This is my first post other than saying hello! Thanks to all for being here and posting!
I did have a question though, while looking into taking a CPR class today, someone mentioned that actual CPR, done correctly, will almost ALWAYS end up cracking the injured's sternum, and that "frankly," (that was the term she used) until it cracks, you won't get the best compression.
I was just really curious about this, as it seemed odd to me. If you are performing CPR, and crack the sternum, then wouldn't you crack ribs as well? :imbar
Any thoughts, ideas, or places on the web for further research?
I can understand that a cracked sternum that ends up saving one's life is better than letting them die, I guess I didn't realize the CPR could be so invasive, or injurious, for lack of a better term.
Specializes in ER, ICU, Nursing Education, LTC, and HHC.
I'm sorry, but I've done CPR many many times, I'm a CPR instructor, a medic, and I work in the ER/Trauma Unit, and have NEVER seen someone crack clavicles while doing compressions, where were you doing them??? 2 fingers widths above the xyphoid process, not upper sternum, is the correct hand placement. You can expect rib cracks, but that is just improper CPR if you are cracking clavicles.
Yup.. Biffs25.. I thought the same thing immediately... CPR to break a clavicle would be like... somewhere in the shoulders.. (Wow....)
quite a distance from the heart.. but as she sid it was her "first time" .. I still have to wonder how one can not realize they are not over the heart.... even though it was a first time... no CPR class would ever teach such a thing..
The most common injuries from chest compressions are rib fracture (∼30 percent) and sternal fracture (∼20 percent). [78 ] Other common complications include aspiration, gastric dilatation, anterior mediastinal hemorrhage, epicardial hematoma, hemopericardium, myocardial contusion, pneumothorax, coronary air embolus, hemothorax, lung contusion, and oral and dental injuries. [78 ] - [80 ] The liver is the most commonly injured intraabdominal organ, with rupture occurring in about 2 percent of cases. The spleen is infrequently injured and ruptures in less than 1 percent of resuscitation attempts. [78 ]
Rare injuries (incidence less than 1 percent) include tracheal injuries, esophageal rupture, gastric rupture, cervical spine fracture, vena caval injury, retroperitoneal hemorrhage, and myocardial laceration. [78 ]
Complications may occur even with properly performed CPR, especially rib and sternal fractures. The possibility of injury should not deter the vigorous application of CPR, since the outcome without effective resuscitation is certain death. Life-threatening injuries from CPR, such as laceration of the heart or great vessels, are rare. Proper techniques will lessen the incidence of serious complications.
Yes they will crack but NOT 100% of the time and you DO NOT repeat NOT have to crack ribs to perform effective CPR. In my career in ICU I have nursed a LOT of post resuscitation patients I have seen 1) and only 1) case of flail chest where multiple ribs were broken - saw the occasional broken rib but fewer than would be expected if you took the earlier posts on this thread as a guide.
We all do our best in emergencies, ribs break, 100/minute on a bloody sweaty chest is hard work. If I accept fractures as absloutey unavoidable I will not try to correct things that can be improved, like handpositioning.
I wish I knew more about what happens to p/t after a sucessful code.
Monica RN,BSN
603 Posts
Yup.. Biffs25.. I thought the same thing immediately... CPR to break a clavicle would be like... somewhere in the shoulders.. (Wow....)
quite a distance from the heart.. but as she sid it was her "first time" .. I still have to wonder how one can not realize they are not over the heart.... even though it was a first time... no CPR class would ever teach such a thing..