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?
Let's put it this way, if you're doing CPR and you never break any ribs, then I would say that you're doing CPR wrong. I've probably pumped on more chests than I care to remember, and "broke" ribs in more than half of them. But frankly, the term "breaking" is a misnomer. What you're actually doing is dislocating or partially dislocating (subluxation) any combination of the sternomanubrial, sternoxiphoid, or sternocostal joints. For those that have never done it and felt it, it feels like someone cracking a very large knuckle.
That said, your emotional response to your thinking that you yourself, may have done something wrong and had caused harm to the patient, while understandable, is entirely misplaced; you did nothing wrong. Don't keep beating yourself up over this.
OP, you are fine. I cannot count the number of people whose ribs I have broken during CPR. It happens, it is an "expected" thing. IF you are able to bring them back, a few broken ribs are nothing compared to the alternative (death).
You are definately not alone and sounds like you did everything right. The only difference is I think I was in a state of shock frome that sound and feeling because it didn't hit me until my drive home 2 hours later then I cried. I do remember being told that you will break ribs which didn't set in until I actually did.
Specializes in Peds, School Nurse, clinical instructor.
Broken ribs are a very common occurance during chest compressions. As a Paramedic I broke many ribs. Please know you did nothing wrong...it just is part of CPR...unfortunately, it will happen again and it won't be any easier on you next time. Just remember, without CPR, your patient will have no chance to survive.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
It happens........maybe not everytime.....but it happens. NOw you know what it feels like and it won't scare you so much the next time........you did good!
Crepitus is never a good feeling. You most likely separated the cartilage that joins the ribs to the sternum. This is a common complication of CPR. I shows that your compressions were vigorous, a good thing. :)
Thank you for taking the time to reply. I am writing up a reflection on this incident for my portfolio and i shall highlight that i need to learn to assess stress in myself and find ways to cope with it
Thank you. I performed compressions on a patient on cardiac arrest yesterday, and it kind of freaked me out the feeling of the dislocations/ detachments of the intercostal ribs. That made me slow down thinking I was hurting the patient or I was going to puncture his liver. It was my first real-deal. I am a work in progress, and even though we couldn't save him, I feel that since he had been in my hands I had to give him the best I could. One thing I have to clear out though, is that I have a soared back from yesterday and if I would have gotten on the bed like I did at the end, my pushes would have been better for both of us...
I am a fairly new nurse, still experiencing things. I actually participated in my 1st code today & I heard cracking & it's been on my mind every since that I didn't perform CPR properly. I wanted to google this to see if I was the only one whose ever experienced it. And I'm glad to know that I am not & that it is in fact normal & that I did perform properly. I love this website, it has almost every topic u could think of & if it's not here you can post it yourself.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Cracking ribs is pretty common. Sound like you did your CPR correctly! But I know the feeling of cracking the ribs, and then perseverating over the incident for hours.
PostOpPrincess, BSN, RN
2,211 Posts
Before you beat yourself up again, like everyone else has said, cracking ribs is typical...less so in the patients who are morbidly obese.
You ought to have asked your co-workers before you ended up so upset.
You wouldn't have spent so much energy. Next time keep that in mind so you can ease your mind a lot sooner.