Doppler placement during code

[gtmoore]

Does anyone know the proper doppler placement during a code to check pulses during CPR? I've seen it placed over the pedal pulses, radial pulses, femoral pulses and carotid pulses. Which is the correct/best location for the doppler during CPR?

Thanks

[canoehead, BSN, RN]

If you can't feel a pulse with your fingers why are you wasting time during a code getting out the Doppler? If there isn't a palpable pulse at the carotid they need to compress further.

[Jen2]

I agree with Canoehead on this one. When we are coding in the ED and cannot get a BP, the Doc always wants us to get a BP via doppler. If they don't have a pulse they don't have a BP. All the doppler does is record the sound of blood rushing through the vessel. This is not a true BP. If compressions are effective, you may here something, but it's not a true BP. I don't know why the Docs always insist on this.

[gonzo1, ASN, RN]

Some of our ER docs do this too. Weird. I also don't see how it could be diagnostic for anything.

[Cardiac-RN]

We use the doppler at the femoral pulse area to check for a 'compression pulse', letting us know that the compressions are of adequate depth/ speed etc to circulate the blood.

[Antikigirl, ASN, RN]

LOL!!!!!!!! One of my funniest stories is about this! An intern checking for pedal pulses with a doppler on a patient that just went a-systole checked by three leads three times! Well..guess he was so into what he was doing he forgot some simple rules...ONE, a-systole isn't going to get you any thumps hon...no pulse! LOL!, and TWO...metal probe, didn't hear 'clear'...very bad! I pushed him as the shock was being sent just in time to save him! (now for people saying you don't shock a-systole, at that time they witnessed, gave precordial thump and the MD said to shock him since we caught it early!).

I don't see the immediate need for checking pulses with a doppler during a code...lets handle the immediate...like the cessation of pulse and respirations???? LOL! Heck, want to check to see if circulation is happening...use a pulse ox on the toes and feel for pedal pulses...that will tell ya if you really really need to know about the legs/feet so badly when the patient is almost/ or is dead. I just don't see the point...treat the patient not the machines I always say, and that pesky death thing tends to take presidence to a doppler check anyday!

[hrtprncss]

One can say that pulse palpation can be dependent upon the skill of the person performing the palpation. Sometimes, during a code there's a lot of chaos, and a doppler could be another aid. There are times when you have flow with less than palpable pulses, and at these times, when you have a weak pulse that's not palpable but is evident thru the doppler, then your interventions could change - for example not doing extra defibs on a patient with a weak pulse that's found only by a doppler, as oppose to defibrillating a person because the staff couldn't palpate the weak pulse. Technicality I know, but can be helpful at times.

[tridil2000, MSN, RN]

we commonly use a doppler for pea. mostly to confirm that although there's a rhythm, there indeed is no pulse.

we do it on the femoral artery. you should know that if the pt is tubed and being baged, you'll hear each breath through the doppler too. when doing a pulse check, hold compressions AND bagging to be sure of what you're hearing.

sometimes, we will use the echo machine to check for any wall movement as well.

[traumaRUs, MSN, APRN]

A bedside sono is the gold standard to check cardiac motion. We have sonos in each trauma bay.

[glasgow3]

In my opinion, the use of a doppler serves no useful purpose during a code. Speed and adequacy/depth of compressions are clearly observable by the code leader. More importantly, a patient whose pulse is so weak that it can't be palpated would probably find greater benefit from continued/adequate CPR; in my experience way too much time is spent fumbling around with dopplers causing lengthy interruptions in cpr. The use of a doppler should not prevent unnecessary defibrillation attempts (as one poster suggested) since rhythms with the potential to generate an adequate pulse are for the most part unshockable...and in the case of V-Tach the patient would be so severely "symptomatic" at that point that electricity would still be advised.

[Otessa, BSN, RN]

I've NEVER used a doppler during a code(18 years of healthcare and my share of codes in 3 different states....) we palpate femoral,popliteal,carotid,etc......

[gtmoore]

Thanks to all for the input