Open Fracture During CPR

[Music in My Heart]

During a recent code, during the rhythm check, a small wound was noted on the patient's chest -- it appeared to be an open fracture. The MD said that the patient had had a sternotomy in the past and that the staples had probably abraded through the skin. Either way, it kind of freaked us out.

Has anybody else ever encountered this?

As compressions continued, the concern was for an exposure to the compressors; which risk was mitigated by placing a folded towel over the chest.

Another war story added to the collection.

[Sisyphus_01]

Damn.... that's hard core.

Since I started the thread, I guess I have the right to jerk the tangential acceleration

{Note: Jerk is the term applied to the rate of change of acceleration... that is, the derivative of acceleration or the third derivative of position}

The username came as I was fiddling around and seeing if I could register with extended ASCII characters. This is the only site I've tried which accepted them -- though I did receive a message saying that I would have to change it... they never forced it, though.

Some characters are obtained by using the "Alt" codes (on a PC)... that is, hold down the "Alt" key and simultaneously type a 4-digit number on they 10-key keypad:

ALT-0181 = µ

ALT-0176 = °

ALT-0177 = ±

The note symbols can be found using the character map (generally found under Program Files -> Accessories -> System Tools. From there, they can be copied and pasted.

If I try to log in to AN from my phone or a computer which doesn't have the character map, I Google my pharmacology flashcards and then copy/paste the username from the thread.

OK, back to your regularly scheduled programming...

[delphine22]

Once when I was a float tech I watched a cardiac nurse use a fracture bedpan (the flat part to the patient) to give CPR on a post-op CABG that went into v-fib. Thankfully the patient still had the pacing wires in and a CVICU nurse came to the code with the machine to pace the patient with. Don't think they lived but the sternum didn't "crack"...I really don't know how effective the CPR could have been though but I don't blame the nurse for not wanting to wait too long before someone brought the pacing gadget! I'm guessing since the pacing wires were still in this is why they didn't try defibing with the code cart instead...

What an interesting idea to use a bedpan! My second job is on a cardiac stepdown; we often have patients with wires but we also have the transvenous pacer (it's the same box for transvenous or epicardial pacing) on our code carts. How can you take care of pts with wires if you don't have the means/training to pace them?!

I have no reason to believe that using the fracture pan would result in less effective CPR. Or that defibrillating with the code cart wouldn't work either -- just keep in mind that defibrillating and pacing are two different things. If they're in vfib, the cart will shock (defibrillate) them. If they are then too brady but have a pulse and rhythm, they can be paced either with their wires, or using the transcutaneous pads on the cart.