# First time doing CPR



## EMSBabe18 (Feb 21, 2011)

For my first clinical in my EMT-B class, I signed up for 11p-7a in the ED. After a long quiet night, at 6:59am, a code came in and adrenaline kicked everyone into motion. The tech who was my proctor let me get in on the action. Unfortunately, apparently I wasn't tall enough to do effective CPR and the docs told me to just let the techs do compressions. After 20 min of CPR, the pt was still asystole and they took him up to the OR. Shift changed and I went home in tears.

Anyone else have an unsuccessful first attempt at CPR? What are your stories?


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## samiam (Feb 21, 2011)

I am short... but they usually have a stool in the resus rooms just for that purpose. It is still a lot harder for short people to do cpr on a high gurney then it is on the floor or in the rig.


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## Ewok Jerky (Feb 22, 2011)

You don't need to cry. You were there to help, and that's what you did. You didn't stand by and watch, you didn't clam up or back down, you got in there and did what you were trained to do. I am 5'4 and I was doing compressions today and I swapped out as soon as some one taller was available because I knew mt compressions weren't deep enough. 

 For the future:
-there are usually stools to stand on on the ER, if you are on compressions ask one oud those people standing around to get it.
-climb up on the rails of the bed if there are rails.
-sometimes when its all shorties we drop the gurney a few clicks when we offload  for the walk into the ER
-sometimes I just hop on the rails of the gurney and ride in.


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## FrostbiteMedic (Feb 22, 2011)

EMSBabe18 said:


> For my first clinical in my EMT-B class, I signed up for 11p-7a in the ED. After a long quiet night, at 6:59am, a code came in and adrenaline kicked everyone into motion. The tech who was my proctor let me get in on the action. Unfortunately, apparently I wasn't tall enough to do effective CPR and the docs told me to just let the techs do compressions. After 20 min of CPR, the pt was still asystole and they took him up to the OR. Shift changed and I went home in tears.
> 
> Anyone else have an unsuccessful first attempt at CPR? What are your stories?


I know of very few people who have ever had a save first time out with CPR.....you did your best and that is all that matters.


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## certguy (Feb 22, 2011)

Frostbite's right,we've all been there.All you can do is give the pt your best&leave it to God.My first time I was 20 min out from the nearest ER by myself in the back,on a windy mt. road with no a/c in the back.I nearly became a pt myself.After all that,he didn't make it.You're gonna lose some and that sucks,but the saves will make it all worthwhile.


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## Tommerag (Feb 22, 2011)

If it makes you feel better I'm 0/7 on cardiac calls that needed cpr


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## akflightmedic (Feb 22, 2011)

This where you as a student recognize a need and request it, this is all skill building for your career in EMS.

What I mean by this is when you realized you were doing ineffective compressions, did you attempt to fix it on your own or did someone else notice and then got the other techs involved?

As a student, you were there doing the most basic skill anyone in our profession will ever do, but you also had a missed opportunity to practice one of the more demanding skills in our profession.

That skill is recognizing you were wrong and then correcting it. It also involved commanding of the scene slightly by confidently expressing your needs, effective communication.

Food for thought and future use (instant replay with a twist): While doing compressions, you realize they are not effective. You look up and make eye contact with whoever is standing around idle. You state to them in a calm yet firm voice, please get me a stool. (Alternative is to look at doctor or whoever is at the head of the bed and say Please can we lower the bed)?

Either scenario would show that you are professional enough to manage your own shortcomings :0 (love puns) but you also have the skills to bring a solution on your own without prompting from another.

If someone insisted they take over, you can always say I am a student and would like to continue this lesson, can we please get a stool or lower the bed....if they say no, then you hand off and move on....


And finally...asystole x 20 minutes goes to the OR???? You sure it was not the morgue?


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## Sandog (Feb 22, 2011)

+1 billion



> Food for thought and future use (instant replay with a twist): While doing compressions, you realize they are not effective. You look up and make eye contact with whoever is standing around idle. You state to them in a calm yet firm voice, please get me a stool. (Alternative is to look at doctor or whoever is at the head of the bed and say Please can we lower the bed)?
> 
> Either scenario would show that you are professional enough to manage your own shortcomings :0 (love puns) but you also have the skills to bring a solution on your own without prompting from another.



Dang, that was awesome insight...


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## Akulahawk (Feb 22, 2011)

We can provide a good nudge towards life with all the medicines and care techniques we have. Many times that nudge is not powerful enough. You do your best, provide the best care you can, and understand that your patient may be far enough down their last trail that they don't want to (or can't) heed that nudge and pass on. You move on.

As to doing CPR, I remember my first. The rest are a blur. If you need help getting into position to do your job, ask for it. If you're too short to do adequate compressions on a gurney, do what you can and ask for a stool to provide you the height you'll need. If you see it coming, get ready and have at hand what you need so that you're not delayed getting into action. Learning to anticipate things from what you see will take time and experience.


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## Rev.IKON (Feb 22, 2011)

I had one in my clinical. I got to do compressions for like 20 seconds, then the doctor called it. Afterwards i got to take his rectal temperature. This was definitely and eye opening experience.


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## 8jimi8 (Feb 22, 2011)

beano said:


> You don't need to cry. You were there to help, and that's what you did. You didn't stand by and watch, you didn't clam up or back down, you got in there and did what you were trained to do. I am 5'4 and I was doing compressions today and I swapped out as soon as some one taller was available because I knew mt compressions weren't deep enough.
> 
> For the future:
> -there are usually stools to stand on on the ER, if you are on compressions ask one oud those people standing around to get it.
> ...



Tears are ok if they do not hold you back from the job that must be done.  Bottling up emotions is the quickest beeline to burnout.

There is usually a red button, switch, pedal, foot pump, etc to push on EVERY gurney that says CPR.  Jam your foot on that and get busy.  Or ask for a stool/ find one when you hand off at 2 minutes.  Use all of your body weight on locked arms and with your feet flat on the ground.  No tip toes and really put your weight into it.  You can do it.


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## akflightmedic (Feb 22, 2011)

Rev.IKON said:


> Afterward I got to take his rectal temperature. This was definitely an eye opening experience.



If the eye was the only thing opening, you did it wrong....


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## 8jimi8 (Feb 22, 2011)

would be ok with eyes closed too...


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## CAOX3 (Feb 22, 2011)

I agree it it would have been more beneficial to correct your actions rather then dismiss you.

We dont have the luxury of picking our teams on the street, so everyone needs to be competent in there actions, shame on them for not helping you get there.

And head up trooper if you continue in EMS there is probably another thousand or so unsuccessful resuscitations in your future.  Sometimes we catch lightning in a bottle and thats why we do it, so keep on trucking.

Good luck.


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## Aidey (Feb 22, 2011)

8jimi8 said:


> There is usually a red button, switch, pedal, foot pump, etc to push on EVERY gurney that says CPR.  Jam your foot on that and get busy.



Just make sure no one is about to intubate or start and IV when you do that.


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## NJdude24 (Feb 22, 2011)

my first time was a guy overdosed on 90 pills and he wasnt coming back but the medics said he wasnt dead enough.  I did compressions for like 20 minutes and he was not coming back.  Dont cry you did what you could, if it was his time to go, it was his time.


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## 6.5diesel_therapy (Feb 22, 2011)

I was a lifeguard for 6 years so the first ppl iv done CPR on made it.  but everyone in clinical's didnt.  i felt like trash and questioned if i was doing it right.  but one of my preceptors told me you have to think about there quality of life after if you did save those ppl.   keep you head up most them docks are :censored::censored:  anyways lol just remember everyones advice and the next code grab the stool and jump in there and work away.   good luck to ya


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## EMSrush (Feb 22, 2011)

akflightmedic said:


> If the eye was the only thing opening, you did it wrong....



That was just.... awful. LOL


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## MEDIC802 (Feb 22, 2011)

My first time doing CPR was back in the early 80's probably around or 84 when i got my basic, I was doing my first clinical rotation on the Ambulance we responded way out in the county to an unresponsive elderly male, back then there was no such thing as enhanced 911, you were lucky to even have a 911 system, anyway, we got to the pt pulseless and apnic,I was scared to death myself I had never really seen a dead person before other than a funeral, I had a great proctor who made sure I did all my BLS skills air way ect , I remember doing one handed CPR in the back of the ambulance and holding on with the other, my hand kept slipping off his chest because i was sweating so bad on the pt , back then it was load and go and high flow diesel, any way the guy didn't make it the doc called it as soon as we rolled through the door, for my first call it was a great start, the medic's let me do my BLS skills before jumping in with ALS.


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## Foxbat (Feb 22, 2011)

My first resuscitation attempt was actually a couple of months ago. If I could describe it in one word, it would be "useless".
The downtime was ~20 minutes; family refused CPR and actually didn't want us to attempt resuscitation either, but they could not produce a DNR and there were no obvious signs of death, so we had no choice. The entire thing just felt very pointless and undignified. The only thing we succeeded in doing was to turn asystole into PEA, and medics ended up calling medical command on the phone to terminate the efforts.
As far as CPR itself, medics said I did well. I'm not sure; I was pressing hard and deep and there was much less chest recoil than I expected. Could it be because I pressed to hard, cracked many ribs and that prevented the chest from recoiling?


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## nakenyon (Feb 22, 2011)

Foxbat said:


> As far as CPR itself, medics said I did well. I'm not sure; I was pressing hard and deep and there was much less chest recoil than I expected. Could it be because I pressed to hard, cracked many ribs and that prevented the chest from recoiling?


 
I'm a pretty big guy and have pressed pretty hard when doing compression and cracked more then my fair share of ribs -- I can't recall a time where I didn't see chest recoil. 

Perhaps you are used to the way the manakins pop right back? A person doesn't respond quite the same same way. Just like I've always found it way easier to get a seal on a person then the manakins.


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## 8jimi8 (Feb 22, 2011)

EMSJunkie91 said:


> I'm a pretty big guy and have pressed pretty hard when doing compression and cracked more then my fair share of ribs -- I can't recall a time where I didn't see chest recoil.
> 
> Perhaps you are used to the way the manakins pop right back? A person doesn't respond quite the same same way. Just like I've always found it way easier to get a seal on a person then the manakins.





I'm ringing in usually >85kg.  I've been the first responder on CPRs feeling the whole sternum pop... yes every joint.  I still to this day do not believe I have broken a rib over > 30 pt's that i've done CPR on.  

Yah they pop a little, but i highly doubt people are breaking ribs.


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## reaper (Feb 22, 2011)

Yes, normally it is the cartilage popping.


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## Veneficus (Feb 22, 2011)

*rest assured*

You are not the only one.

One of the best emergency physicians I have ever met broke down after her first night of residency. By the time her 3rd year came around she was a goddess among men.

It is all part of the experience.


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## EMSBabe18 (Feb 22, 2011)

Thank you all for your encouragement. It's nice to hear I'm not the only one who had difficulties first time out.
I did have a stool available and used it but even so, I was still too short to get deep enough compressions. I think that was my problem... But now I know for next time. 
Thanks for all your stories! Keep them coming! Especially from those of you who have been in EMS forever.


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## lampnyter (Feb 22, 2011)

Im a guy and i like being short. I can stand up in the back of the ambulance without having to duck or bend my head =p


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## AndyK (Feb 23, 2011)

EMSBabe18 said:


> For my first clinical in my EMT-B class, I signed up for 11p-7a in the ED. After a long quiet night, at 6:59am, a code came in and adrenaline kicked everyone into motion. The tech who was my proctor let me get in on the action. Unfortunately, apparently I wasn't tall enough to do effective CPR and the docs told me to just let the techs do compressions. After 20 min of CPR, the pt was still asystole and they took him up to the OR. Shift changed and I went home in tears.
> 
> Anyone else have an unsuccessful first attempt at CPR? What are your stories?



I qualified 15 years ago.. 2 days out of training I got my first arrest Pt. I can still remember exactly what the guy looked like and every intervention (although we called them treatments back then! hehe) I made and I remember how crap I felt when it didn't work.

I still get that feeling when one dies on me.. I've just now come to realise that it's a good feeling, it reminds me that i'm still human. It's not supposed to get any better... it just becomes easier to deal with! 

You will get jobs that upset you. There will be jobs that leave you mad as hell and some that have you wondering why you bother, but hang on in there.. it's worth it


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## Rev.IKON (Feb 23, 2011)

akflightmedic said:


> If the eye was the only thing opening, you did it wrong....


well i had to see where i was poking


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## certguy (Feb 23, 2011)

You can do picture perfect CPR and still break ribs,but if you don't do it,they're dead anyway.You cringe inside,thank God they can't feel it,and do what you have to do.


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## CapnSmurf (Feb 24, 2011)

I had my first CPR experience a couple days ago too. He was a patient from an accident on one of the mountain passes here in Oregon. The patient was talking and LOC X 4 on the way in, unfortunately he coded the second the helicopter landed. I was with the nurses when we did a "hot off-load" on the helicopter pad (the cool part). Like you see them do in the movies one of the nurses hopped on the guy and started compressions while the rest of us wheeled him in the ER. I was determined to get the experience of "real" CPR despite the grim circumstance. I rotated doing compressions with the nurses for 30 minutes before they called it (the sad part). It was a surreal feeling seeing the life pass from somebody, but it's something I have prepared myself for coming into this career field...

It is sad, but good training to do the real thing and experience it first hand. It isn't even similar to the CPR dummies!

And as for the height thing. I'm not a very tall person (or heavy) so I found it slightly tough too, halfway through I just put my knees on the table to get some good leverage. Not so much about comfort but more about the life you're trying to save!


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## Sandog (Feb 24, 2011)

I heard the pooping noise was caused from the bursting of air bubbles betwixt and between moving cartilage and muscle, can anyone confirm?


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## Sandog (Feb 24, 2011)

Sandog said:


> I heard the pooping noise was caused from the bursting of air bubbles betwixt and between moving cartilage and muscle, can anyone confirm?



Of course I meant to say popping noise, not pooping... :blush:


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## reaper (Feb 24, 2011)

Most of the popping heard is the cartilage between the ribs and sternum, seperating.


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## MEDIC802 (Feb 24, 2011)

CapnSmurf, wow! you actually witnessed a nurse doing cpr? most of the time it has been my experience that the ems crew, er tech or security usually end up doing compressions
 nothing like riding the stretcher while holding on and doing compressions all while worring about dislodging the tube.


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## lightsandsirens5 (Feb 24, 2011)

frostbiteEMT said:


> I know of very few people who have ever had a save first time out with CPR.....you did your best and that is all that matters.



I know of people who have very few saves in general.


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## Tigger (Feb 25, 2011)

+1 for the stool.

I'm 6' 2" and while I can do compressions standing on the floor, you can use much more of your upper body if you're really standing over the patient.


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## MonkeySquasher (Feb 25, 2011)

Sandog said:


> I heard the pooping noise was caused from the bursting of air bubbles betwixt and between moving cartilage and muscle, can anyone confirm?
> 
> Of course I meant to say popping noise, not pooping...




Heh..  No, the pooping noise is the sphincter releasing.  ;D  But seriously.  Two things to remember.

One, our ribcage is designed specifically to give structure to our thoracic cavity, allowing negative pressure caused by the diaphragm to suck air in during inspiration, and then passively push air out during exhalation without collapsing on itself like a beachball.  It's also designed for protection of our internal organs... Hence why the heart is protected behind the ribs, deviated to the left, in its own little niche of the chest, in it's own shock-absorbing sac, behind strong chest muscles (and in some people, fat).  It's arguably the most important organ, and the body therefore protects it the most.  During CPR, your job is to manually squeeze this organ from the outside...  If you aren't breaking ribs, you probably aren't going deep enough to effectively cause a compression of the heart to force blood into the system.

Second, as Vene said, it's perfectly natural to be very upset after certain calls, especially the first one.  Our job requires us to see the worst (and occasionally, best) that life has to offer, and see it over and over.  Everyone else's "worst day ever" becomes our typical work day.  There -IS- a learning period where you adjust to this profession, and it can be confusing and eye-opening and emotional.  And frankly, it scares me if people -DONT- have these reactions, because it makes me wonder if they truly care about patients or outcomes.

Just remember, you are still a human, and still have human emotions.  It's perfectly acceptable to express them and deal with them, so long as it doesn't impact your patient care.


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## CapnSmurf (Feb 25, 2011)

MEDIC802, the hospital doesn't have too many staff to utilize. They are really good at getting the students in on the action though. Once we got the patient into Trauma room 1 the helicopter crew came in and started helping with intubation and IV's. It's pretty neat seeing everyone working for the same thing and knowing exactly what to do.


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## MEDIC802 (Feb 25, 2011)

It is amazing to watch when everything goes as expected, was not trying to be a smart a** with my comment earlier, just my experience is that the er nurses generally will not jump in and do compressions unless there is no other choice but this is at a larger ER with lots of help.


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## dispatcher447 (Apr 18, 2013)

*CPR for the first time*

Just had my first full arrest pt. I was doing an 8 hour clinical in the ER. I was second to do compressions. The girl didn't make it, but it was a weird experience. Definitely will not be forgetting this experience.


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## kurtemt (Apr 18, 2013)

Don't feel bad, and don't cry. It's part of the job. People WILL die on you. But at least you tried to help. Good job. 

I also work in a hospital and when we are working codes sometimes the RNs raise the bed up to start more iv's or the docs or respitory to intubate. I'm not a short guy but with the bed high I find it hard to get leverage to do proper compressions so I will hop up on the mattress and kneel beside the pt. I even had a doc tell me to do it once while watching the monitor. 

So in the future don't be afraid to get right up there if that's what it takes for you to do it.


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## JPINFV (Apr 18, 2013)

kurtemt said:


> Don't feel bad, and don't cry. It's part of the job. People WILL die on you. But at least you tried to help. Good job.
> 
> I also work in a hospital and when we are working codes sometimes the RNs raise the bed up to start more iv's or the docs or respitory to intubate. I'm not a short guy but with the bed high I find it hard to get leverage to do proper compressions so I will hop up on the mattress and kneel beside the pt. I even had a doc tell me to do it once while watching the monitor.
> 
> So in the future don't be afraid to get right up there if that's what it takes for you to do it.




1. There's nothing wrong with crying. It get's easier with time, but there's definitely no reason to keep emotions bottled up. 

2. If you're having issues with height, make sure one of the stools are around. There's no reason not to use one to get maximum leverage.


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## Nelg (Apr 19, 2013)

I'm 1/2 (Still unknown on second one honestly.) Both times at a casino I work at. The first one I still remember the guys face. We did compressions for about 15 minutes before ALS finially arrived. According to our AED Zoll report, we had him back into a a slight rythem for 2 minutes. Second attempt, we had him back into v-fib from pulseless, blue, and cold when he was loaded up into the ambulance. 

It's always a gamble, and you always just have to remember you did your best. I still think of the first guy, and sometimes still remember the look on his face, even if he was AnO 0 and preety much DOA.


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## mcdonl (Apr 22, 2013)

I work in a large rural region perdiem/volunteer... best case scenario call comes in 0600-1800 and the call is near the station. Typical call is 5-7 minutes away. Off hours, lucky to be there in 15 minutes.

So... I almost never see succesful CPR and I have seen plenty. Our protocols in Maine now dont have us tranfer codes. We work it on the scene and call it afyer 20 minutes with OLMC....


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