Did i do something wrong? CPR question

MassED, BSN, RN · Sep 10, 2016

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?

broken ribs happen with good compressions, especially on elderly with weaker ribs ie osteoporosis. You did a good job, don't worry. You did what you had to do. I always think that broken ribs are a sign you pushed hard and fast.

Nursedee1 · Sep 10, 2016

After the code, my immediate reaction was I did something wrong... And I kept thinking it, until I looked it up & saw that, that cracking noise is normal. And that multiple people have experienced it, I feel better.

Linka · Sep 22, 2016

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.

I thought you started with meds over compressions. would the fresh sternotomy wires go through the myocardium?

and is there a special protocol for acls s/p CABG?

Ruby Vee, BSN · Sep 22, 2016

I thought you started with meds over compressions. would the fresh sternotomy wires go through the myocardium?
and is there a special protocol for acls s/p CABG?

Sternotomy wires close the sternum, so they'd be really out of place if they went through the myocardium. (Not that I haven't seen that, but it's rare.)

As far as starting with meds over compressions -- which meds would you recommend for a dead patient? "High quality CPR" is the first intervention and continues while some else runs to get the crash cart, defibrillator, code meds. High quality CPR tends to break ribs.

ALCS post CABG is fascinating -- they'll sometimes open up the chest at the bedside and you can look inside and see the heart and the lungs. Really cool!