Ineffective Compressions

Nurses General Nursing

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5 hours ago, Davey Do said:

This is such a good discussion and it's nice to be able to relate to something that is medical in nature without me being puzzled, scratching my head and saying, "Whaaa?"

And I learnt a few things, like about the cardiac monitor, the metronome, and feedback pads!

Years ago, WRMC didn't have CPR manikins with feedback for the practical portion of our BLS renewal. Instead, we had a rather elderly nurse educator who would call out directions like "Harder! Faster!"

One nurse complained that she felt like she was listening to the soundtrack from some geriatric Mediao flick.

Davey I really want a one of your famous illustrations, but I feel like your account might get banned. ?

Compressions should fall between 100-120 per minute, at least 2" deep on an adult, and should allow for complete chest recoil as you said. These guidelines are neither the "jackhammering" nor the "slow" compressions you described. Best done compressions only have a cardiac output of 25-30%. If this was the patient's 4th code within several hours, I'm assuming she was intubated; capnography is a great tool for determining if compressions are adequate. End tidal CO2 during compressions should be at least 10 mmHg. And remember, part of being an effective member of a code team is communication. If you have a concern about the safety/efficacy of someone's intervention, calmly and respectfully speak up. I like one of the above poster's ideas to verbalize the actual rate. "Right now, compressions are at a rate of 143 per minute. The recommended rate is 100-120 for optimal outcomes." That eliminates any kind of you/blame statements. And remember, standards of practice don't change if a nurse personally determines code efforts to be futile (even if correct). As long as the patient is being coded, he deserves best efforts.

Specializes in ICU.
11 hours ago, adventure_rn said:

Nearly all of our patients have arterial lines. From the a-line you can determine the rate and the depth/effectiveness/pulse generation. The rate as read on the a-line should give you the compression rate. You can assess the depth/intensity/recoil of the compressions by looking at the BP on your a-line. In a perfect code, the BP that you generate with your compressions should be equivalent to your ideal BP (120/80). If you're going to overboard, your a-line BP is going to be way higher. If you're getting tired, it's going to be lower. If you're not getting enough chest recoil, your pulse pressure is going to be super narrow. You can also figure out the rate from just the EKG (assuming they aren't in some crazy rhythm) or just the pulse-ox (assuming your compressions are generating enough force to give you a decent pulse), but they aren't as accurate and don't really tell you about blood pressure.

I thought it was amazing during my first code that I had somebody there telling me, "Ok, your rate is good, try to go a little deeper," or, "your blood pressures are starting to drop--are you getting tired or do you need to switch out?"

This is wicked -- thank you so much! This patient had JUST arrived to our ICU, so she didn't have an A-line and her pulse ox wasn't reading even on her forehead.

I don't hope for another code soon, but should they have one, I'm definitely hoping for an A-line. Thanks!!

Crash_Cart

446 Posts

Specializes in ER OR LTC Code Blue Trauma Dog.
19 hours ago, chare said:

How, exactly? Please be specific, and provide credible source.

Come watch me doing CPR during a real life code and i'll show you sometime.

Credible source... Lmao. ?

Hey until you have seen 150,000 pt's / yr. in an ER trauma center like I have, you can come back and talk to me about what's credible exactly ok sweetheart? ?

Editorial Team / Admin

Rose_Queen, BSN, MSN, RN

6 Articles; 11,663 Posts

Specializes in OR, Nursing Professional Development.
On 8/12/2019 at 3:09 AM, Crash_Cart said:

Come watch me doing CPR during a real life code and i'll show you sometime.

Credible source... Lmao. ?

Hey until you have seen 150,000 pt's / yr. in an ER trauma center like I have, you can come back and talk to me about what's credible exactly ok sweetheart? ?

That doesn't answer the question, and is rude to boot. @chare has quite a bit of experience. Anecdotal =/= factual. Just because you think your monitor tells you if your compressions are effective doesn't make it so. What exactly is it that you are looking at? The AHA itself recommends monitoring waveform capnography as an indicator of effective compressions. Is this the number you're looking at? If so, why aren't you coming right out and saying it?

Specializes in Critical care.

Please don't ever sing or hum "Staying Alive" during a code on a real person, if the family walks in or is in the hallway they may be seriously offended. The code leader during the code is responsible for monitoring compressions, they should provide the feedback. There should be a hot debrief after the code where you can bring up your recommendations. Rather than point fingers, you could just mention that as the recorder you noticed large variances in the rate of compressions. Also as regards to the cardiac monitor, the ETCO2 may still be hooked up, which is a good indicator of effective compressions. The RT may have unhooked it to start bagging the pt however.

Cheers

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