Thready Pulse in Cardiac Arrest

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Should we be continuing chest compressions when the team gets a thready pulse after epinephrine administration and the NIBP cannot read a pressure? Anecdotally there have been times when we have what sounds like a great doppler pulse and a thready carotid/femoral pulse but can't get a pressure to read?

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Hmm ACLS protocol would normally have the pt go to cath lab and/or start targeted temperature management once any pulse was obtained BUT the pt should have a BP. I just renewed ACLS and this was in several scenarios but all with a BP.

i would get back on the chest as the drs placed an art line and/or a different extremity was used to try and get a cuff reading.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

ACLS is also rhythm focused so you would have to know what the rhythm is to determine what your next step is. You could be getting a thready pulse with no BP because the pt is in V tach.

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Specializes in ICU.
On 9/17/2019 at 2:34 PM, juan de la cruz said:

ACLS is also rhythm focused so you would have to know what the rhythm is to determine what your next step is. You could be getting a thready pulse with no BP because the pt is in V tach.

I agree. It all depends on rhythm. If the patient is v-fib or v-tach, that's not a perfusing rhythm. Ask the MD, if possible. "Doc, patient is in [insert rhythm here] with a thready pulse. Would you like to continue CPR?"

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Specializes in ICU.

If they have a palpable pulse, you do not continue with CPR. If there is any question that there is a pulse, just continue with CPR, but if you have a pulse, even if weak, you dont need to continue compressions. You can get some pressors going like levophed to help with blood pressure.

If you have a pulse and the BP is not able to read, you still dont need to do compressions. You have a pulse. The BP is just quite low that many monitors have trouble reading.

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Specializes in ER OR LTC Code Blue Trauma Dog.

The question states the pt. is in "cardiac arrest."

How do you already know that exactly?

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I need new glasses, I read that title as "Steady pulse in Cardiac Arrest" ? and thought hmmm... ?

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Specializes in anesthesiology.

Calcium, more pressors, fluid, trendelenburg to perfuse the brain, whatever to get the BP up. You may be providing the pt with a better BP with compressions than when you stop doing them, but you can't do them forever, so you need other measures to sustain them. Organized rhythm with a pulse I say give meds.

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Specializes in ER OR LTC Code Blue Trauma Dog.

I'm the jedi master of codes and any patient that is considered to be in "cardiac arrest" means they are already connected to a cardiac monitor and you can see what rhythm they are in.

So i'm not sure what all this nonsense is about...

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