Medical Response?

Why do you think you would do CPR with a pulse? Can you give me your rationale on why you would?

OK,

Just a general nursing questions. I was attending a training for basic EMT's that a Para medic was protoring. Here is the scenario; A patient found down at the scene 24 yr male patient with head trauma, unconscious, lying supine on the floor, with decordicate posturing, cheyne stokes breathing, Oxygen Saturation 88%, HR 28, thats all the vitals you have. You have an AED, EMT basic bag, 911 is called. No drugs or transcutaneous pacing available. You do have oral adjuncts, 02 and bag valve mask. My questions is would you start CPR with this scenario? I said yes. He said no, not with a palpable pulse!

I'm not even sure these are "nursing questions". This isn't a situation that 99.9% of working nurses would find themselves in.

Nope.

What would you do instead?

My rationale would be perfusion of the brain and vital organs. I give the oxygen and control the airway but is it getting to the brain with a HR of 28? If I had a blood pressure. I would know that a MAP less than 50 would not perfusion the vital organs.

Review Cushing's triad. You likely have a widened pulse pressure in this scenario although that information isn't given.

My rationale would be perfusion of the brain and vital organs. I give the oxygen and control the airway but is it getting to the brain with a HR of 28? If I had a blood pressure. I would know that a MAP less than 50 would not perfusion the vital organs.

You don't have a blood pressure though. So you don't know what the MAP is. You don't do compressions with a heart rate. The heart is still pumping. The EMTs will probably intubate because with decorticate posturing, your GCS is less than 8.

With a rate if 28, I'm guessing they will also get some atropine as well.

But no compressions.

I guess I'm confused as this is an EMT class but it's just the lay person on the scene?

How about: Hook him up to O2 and let the AED decide if shocks or CPR is warranted?

I guess I missed having O2 on scene.

This is a very weird scenario.

My rationale would be perfusion of the brain and vital organs. I give the oxygen and control the airway but is it getting to the brain with a HR of 28? If I had a blood pressure. I would know that a MAP less than 50 would not perfusion the vital organs.

Why is the HR low in this scenario? The problem is neurological and CPR isn't going to fix that. I'd guess, based on the information given, that this is sinus brady caused by increased ICP and therefore the AED wouldn't recommend a shock. This patient needs mannitol and probably emergent neurosurgery.

Why do you think you would do CPR with a pulse? Can you give me your rationale on why you would?

There are times when you would. In babies, for example, with severe bradycardia and signs of poor perfusion despite oxygenation and ventilation, it is recommended to initiate CPR.

There are times when you would. In babies, for example, with severe bradycardia and signs of poor perfusion despite oxygenation and ventilation, it is recommended to initiate CPR.

I did this once during an adult code. His HR was in the 20s and we were essentially buying time until the epi drip was mixed. He coded about four times before we got him up to the unit.

Where was the pulse taken? According to Trauma life support guidelines, a palpable radial pulse suggests an SBP of greater than 80, although there are studies that say it's only reliable indicator of a systolic greater than 70.