Did i do something wrong? CPR question

[Chixie]

Ive just finished my 6 week placement in the a+e department and something happened in my final week that is sticking in my mind.

We had a patient bought in by ambulance,cardiac arrest. We started CPR and the nurse doing compressions asked me to step up and take over.This was fine by me,ive participated in 4 previous arrests.I stepped up and on the last round of compressions i felt something crack and something changed. I cannot really explain the feeling but i broke the patients ribs.I carried on for the rest of the cycle and the time of death was recorded.

I started to clear away as normal and i was ok until i picked up the blood pressure cuff and i couldnt wind it up due to my hands shaking. One of the technicians asked if i was ok and that set me off,i started crying and shaking.Its been almost week since this happened but i still hear the noise and i can still feel the 'change' in the compressions after it happened.

Did i do something wrong? has anyone else had this happen to them?

[Short-Stuff 23]

I do not think you have done anything wrong. I was always told that if you do compressions correctly you will break the person's ribs. You tried your best to save this person and I can tell you are a great nurse with compassion. Hang in there:)

[himilayaneyes]

Must agree that if you're doing compressions correctly...you're going to crack a couple of ribs...it happens. Don't torment yourself...you did the best you could...that's all anybody can ask.

[walk6miles]

First of all, you did nothing wrong. If a patient has arrested, CPR is certainly important. And, on occassion, the state of the patient's bone density would and could contribute to compression related fractures.

It is not uncommon to shake after attending to or participating in a code; that's what our natural sense of adrenaline does....some people start in the midst of the code and some start feeling the after affects after things have settled down. Sounds like you are making good progress in your "learning" and "gaining experience" - good luck and god bless.

[hcox1975, BSN, RN]

I once was doing compressions in a code and one of the nurses that did compressions before me broke the man's sternum. This happens. What's more important, breathing or a broken bone?

[casi, ASN, RN]

Broken ribs are just apart of chest compressions.

There are some things in nursing that you just need to talk to someone who knows where your coming from about. I see that you are a nursing student, if you have an instructor that you really trust see if you can make an appointment with them to sit down and talk about what happened and process through it.

[opensesame]

Look at it this way -- your patient was DEAD if you were doing CPR. You were trying to resucitate him. If it was successful, a few broken ribs are a small price to pay for having someone save your life.

I had an immediate post-CABG have a V-fib arrest once about 5 minutes after arrival to my unit. I did compressions right in front of the staff CV surgeon and I heard/felt a bunch of cracks. I felt horrible -- I continued compressions saying "sorry, sorry, sorry" -- I thought for sure I was going to get completely ripped apart for ruining the guy's sternum that he had just wired closed. Nope -- he was thrilled, because I was making a good, solid 100/50 B/P by art line with my compressions. We shocked the guy out of V-fib and he totally recovered and left the hospital with hardly a delay in his care.

EFFECTIVE CPR wins over cracked ribs any day of the week.

[Flare, ASN, BSN]

broken ribs are very common. Recall working a code on a lady and feeling all her ribs snapping.

[AnnieOaklyRN, BSN, RN, EMT-P]

Rib fx happen, sometimes what your actually hearing is the ribs sliding up and down against the sternum where they attach, so the loud noise you hear doesn't always mean you are breaking ribs, and even if you do its not going to affect recus efforts...

[ebear, BSN, RN]

Yes, I've cracked ribs...and I know the sound you're speaking of. You did the best you could. It's OK. :flwrhrts:

[GGT1]

I would say the person who taught you CPR made the mistake... of NOT telling you that it is Normal to crack ribs when doing CPR. It doesn't always happen...but it is NORMAL.

Another thing I remember learning the very first CPR class I went to was... the person is already dead, there heart has already stopped. This helps me cope when the pt doesn't make it.

Hope you feel better soon

[JenniferSews]

I would say the person who taught you CPR made the mistake... of NOT telling you that it is Normal to crack ribs when doing CPR. It doesn't always happen...but it is NORMAL.

Another thing I remember learning the very first CPR class I went to was... the person is already dead, there heart has already stopped. This helps me cope when the pt doesn't make it.

Hope you feel better soon

This has been stressed in my last few CPR renewal classes. I don't remember it being mentioned much before. I have not had to give compessions so far in my short career, but I do know this is a likely outcome. Like others have said, broken ribs are a small price to pay if cpr is successful. On the flip side this is a reason that it might be time to think about being a DNR if you are 90 something with OP and your bones break from falling 12 inches. I can't even stomach thinking of doing CPR on some of my patients!

You did the right thing, you did your job to the best of your ability. You were likely perfusing as effectively as possible and you should feel proud that you did as good a job under tough circumstances. In another situation that patient may have lived and would have you to thank for that.