CPR for the frail and obese

BuckyBadgerRN, ASN, RN · Nov 19, 2011

I've been reading a thread here about CPR (started by Rags2RichesRN) but I have a slightly different question than hers. My question is that I, too, am a new nurse and although I, too, took the American Red Cross CPR program last year, I really don't feel qualified to save lives in the LTC facility where I work. Most of these residents are already frail and I could easily injure them, and some are morbidly obese and there's no way I could do thrusts on them. My feeling is that there should be special CPR techniques taught for these types of patients. I just started working 6 weeks ago and I'm really worried that when I'm the only LPN on the unit that someone will choke or otherwise need life support quickly. What do you suggest I do? Just call the supervisor and hopes she gets to my unit really fast? Your thoughts will be appreciated. Thank you.

I've done CPR probably 100 times (20 years of EMS) and ribs fracture almost every single time, of people of every size and shape. Remember, you'll need to vary your chest compressions in strength so you're depressing the # of inches that you're supposed to. It won't take much for your 90 lb LOL and a whole lot more for your 400 lb pt re-habbing for his hip replacement.

I can only think that calling your supervisor and hoping she gets to you quick will not endear you to her. CPR is a skill you must know as a nurse and even more importantly, be willing to perform if and when you are called to do so.

Biffbradford · Nov 19, 2011

You can't hurt the dead. Do the best you can. :)

Sun0408, ASN, RN · Nov 19, 2011

haha biff.. my ACLS instructor said the same thing.. If you do nothing they will die so compared to that, you can't hurt them anymore.. Ribs will break more times than not if you are doing compressions the way you were taught...

CAPPYBARA BREAKFAST · Nov 19, 2011

You may be shocked at what you can do one the adrenaline starts pumping!

mustlovepoodles, RN · Nov 19, 2011

If you're not breaking some ribs, you're not doing it right. Don't worry so much about "hurting someone." If you have to do CPR, they're DEAD. Either you'll revive them with your amazing chest compressions or you won't. And often the outcome isn't in your hands at all. Sometimes the ones you think will make it, won't. And the ones you're sure are headed for the pearly gates pull through. Either way, you just have to go at it full throttle, no holding back. Sometimes you have to hurt people to help them get better. :nurse:

Ertech2088 · Nov 19, 2011

I am quite small and I've cracked ribs while doing CPR in the ER but when it's life or death you have to do what you have to do. Use less force when doing compressions on frail individuals. As far as the larger patients go I will usually ask a male to step in or if none are available I have knelt up on the bed next to the patient and used my whole body weight when doing compressions.

NamasteNurse, BSN, RN · Nov 19, 2011

Most of the really frail ones in LTC are DNR anyway. Make sure you know their code status before you save them.

Biffbradford · Nov 19, 2011

[color=silver]i am quite small and i've cracked ribs while doing cpr in the er but when it's life or death you have to do what you have to do. use less force when doing compressions on frail individuals. as far as the larger patients go i will usually ask a male to step in or if none are available i have knelt up on the bed next to the patient and used my whole body weight when doing compressions.

yup, i've seen that. hop up there if you have to ... if you're in the right unit, and it's your lucky day, you just might get a ride right into o.r. :eek: "watch out for the door ... duck!" :yeah:

i've seen that. one of those 'never forget' events.

onthemark · Nov 20, 2011

Although I appreciate your reminding me to check their DNR status, that fractures will be probable, and also that it's apt to not work with them but a try is better than nothing, I still don't see how I can do this when most of the patients are in wheelchairs. Do I ask the aides to help me get them out of their chair and laid down on the bed/floor, and then proceed with CPR while I ask another aide to call the supervisor? Do I keep my breathing mask with me at all times for the 2 rescue breaths? I have never even taken the mask to work with me but if the CPR is my responsibility then maybe I should.

I'm sorry to be such a newbie at this and really appreciate any advice and tips you can pass on to me. Thanks!!!

jesskidding, LPN · Nov 20, 2011

I would recommend taking a American Heart Association BLS for Healthcare Providers class. Most hospitals prefer AHA over Red Cross, at least around here.

If someone codes in a wheelchair, please don't start CPR while they are still sitting it it! Get them on the floor! We had a pt code on the toilet not to long ago and a veteran RN started "compressions" while they were still sitting on the toilet, leaned up againist the bathroom wall. OMG. Yes. She. Did. :smackingf *Pt died*

I sounds like your are just psyching yourself out about it. Everything you learned will kick in if you are ever in this type of situation. Trust me.

I really do recommend the AHA course over the Red Cross. You should look into it.

mustlovepoodles, RN · Nov 20, 2011

Although I appreciate your reminding me to check their DNR status, that fractures will be probable, and also that it's apt to not work with them but a try is better than nothing, I still don't see how I can do this when most of the patients are in wheelchairs. Do I ask the aides to help me get them out of their chair and laid down on the bed/floor, and then proceed with CPR while I ask another aide to call the supervisor? Do I keep my breathing mask with me at all times for the 2 rescue breaths? I have never even taken the mask to work with me but if the CPR is my responsibility then maybe I should.
I'm sorry to be such a newbie at this and really appreciate any advice and tips you can pass on to me. Thanks!!!

It's okay. You probably just need to talk this through, give yourself a sort of "practice run." Your facility should have a written protocal which covers exactly how you need to handle a code. If you haven't seen that, ask your supervisor to direct you to it.

It doesn't matter if they're in a wheelchair, in bed, or walking down the hall. If they need CPR, the first thing you're going to do is put them on a hard, flat surface. That would be the floor or a bed board. Don't try to do CPR on a squishy mattress; it will be ineffective. If you are in a public area (cafeteria, hallway, activity room), direct someone else to go get help--if there is no staff around, send a visitor or family member to get help. The quickest way to get help when you're in a patient's room is to hit the emergency button in the restroom. That will alert others while you're getting the person in position to begin CPR. While you're doing compressions, you can direct others to get the crash cart and call the supervisor. Delegate that stuff. There should be an Ambu bag on the crash cart. If you do not have a mask in your pocket, just do compressions until the crash cart & Ambu bag arrives. This should all happen very quickly. It will feel like hours are ticking away, but it is more likely that these actions will take only seconds to minutes to accomplish.