# CPR: Alternative Techniques for Chest Compressions?



## Constantine (Jan 8, 2016)

We all know how to do proper CPR (hopefully), I am posting this thread to ask for feedback on a special circumstance:
A provider or bystander needs to modify his or her compressions due to a wrist or hand injury. 
I recently suffered a Boxers Fracture to my right hand (compression fracture of the distal side of my 5th metacarpal/break of the bone in the hand below the pinky closer to the knuckle) and as a result have my right pinky and ring finger casted down to my wrist. This makes performing normal chest compressions somewhat difficult as pulling back my hand at the wrist and interlacing my fingers is not possible.


One solution that has been offered is for me to put my left (uninjured) hand in the center of the chest like one would normally do and grab my left forearm with my right hand so I can apply a compression by forcing down my body onto my left hand. 

Thoughts or suggestions?


*Assume that mechanical CPR is not an immediate option


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## akflightmedic (Jan 8, 2016)

Suggestions:

1. You do not perform compressions. You allow someone else to do them or you instruct a bystander. As a worst case scenario of you being the ONLY person free or able to do compressions, then proceed with the improper/possibly ineffective compressions as it may be better than nothing.

2. As an employer (even if you are volunteer) I most likely would not let you work until you were full duty with no restrictions. The last thing I need is a claim from you for Worker's Comp due to you aggravating or worsening an existing injury while on the job. 

*I sustained a boxer's fracture several months back. It still hurts to make a grip even now. You definitely should not push yourself until it has healed as best as possible.


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## chaz90 (Jan 8, 2016)

Yup. I had a Boxer's Fracture when I began paramedic school. I was unable to make a tight grip or do any kind of chest compressions for almost 4 months after the injury and didn't even try so as not to cause additional injury.


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## COmedic17 (Jan 8, 2016)

I don't think you should be working while you have any injury that limits your ability to preform tasks that are required for your job. Since your profile states your 17,  I'm going to assume your a first responder in a volunteer type role, so you're pretty limited in the care you are able to provide even when you're not injured. If you're injured, there's even less you can do. Just let it heal. You don't want to screw your healing up anyways.


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## Constantine (Jan 8, 2016)

COmedic17 said:


> I don't think you should be working while you have any injury that limits your ability to preform tasks that are required for your job. Since your profile states your 17,  I'm going to assume your a first responder in a volunteer type role, so you're pretty limited in the care you are able to provide even when you're not injured. If you're injured, there's even less you can do. Just let it heal. You don't want to screw your healing up anyways.


 
Yeah, Wilderness First Responder in EMT school, work with a local Search and Rescue service.


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## Constantine (Jan 8, 2016)

akflightmedic said:


> Suggestions:
> 
> 1. You do not perform compressions. You allow someone else to do them or you instruct a bystander. As a worst case scenario of you being the ONLY person free or able to do compressions, then proceed with the improper/possibly ineffective compressions as it may be better than nothing.
> 
> ...




Thank you for your response. That makes the most sense, I'd like to get out of the cast sooner than later. I'm currently not working because of the injury and because I'm in EMT school (currently a Wilderness First Responder with a local SAR service).


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## Constantine (Jan 8, 2016)

I posted this thread more because I was wondering what to do in an off-duty, witnessed cardiac arrest situation


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## teedubbyaw (Jan 8, 2016)

http://paramedictv.ems1.com/videos/...cpr-shows-need-for-better-civilian-education/


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## Constantine (Jan 8, 2016)

teedubbyaw said:


> paramedictv.ems1.com/videos/3748447051001-graphic-feetonly-cpr-shows-need-for-better-civilian-education/



Hahah, this is obviously the most effective solution to the problem.


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## Jim37F (Jan 8, 2016)

This injury sounds like it seriously compromises your ability to do even simple job related tasks such as pick up and carry a first in bag, or manipulate a patient, or perform any treatment or skills so you definitely should not be working in the field until you heal up. As far as still alarming a cardiac arrest...well how many have you come across just out and about, away from work, ever in your entire life? My lifetime grand total is zero, I think I've known one guy at my last job who his dad had a heart attack in front of him at the gym once, otherwise to the best of my knowledge everyone else I know is also zero for zero, so I wouldn't worry too much about coming across one just randomly in the few weeks/months you're healing up.


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## Ewok Jerky (Jan 8, 2016)

As someone who works in orthopedic surgery, specifically hand/wrist...I would advise against doing anything close to compressions or any force more than 3-4 pounds for about 8 weeks.

While the cast provides a good amount of protection , pitting force on the hand and wrist puts you at risk for displacing the fracture enough to warrant surgery, which will start your healing process back at the beginning.

I routinely put patients like you either out of work or light duty for 8-12 weeks.

I would certainly not put myself in a position where I was expected to perform CPR, and it would have to be a literally life or death scenario for me to jeopardize myself like that.

17 y/os with fractures are the bane of my existence... Well, them and 90 y/o demented patients with hip fractures.


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## Constantine (Jan 8, 2016)

Ewok Jerky said:


> As someone who works in orthopedic surgery, specifically hand/wrist...I would advise against doing anything close to compressions or any force more than 3-4 pounds for about 8 weeks.
> 
> While the cast provides a good amount of protection , pitting force on the hand and wrist puts you at risk for displacing the fracture enough to warrant surgery, which will start your healing process back at the beginning.
> 
> ...



I was more interested in the hypothetical circumstance, obviously purposely putting myself in such a position is dangerous for the patient as well as myself. I posted earlier that I wasn't intending on working. Or at least until after ortho says its alright for me to do so. But, I'm glad to know that your 90 y/o demented patients and I are the bane of your existence.


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## RedAirplane (Jan 9, 2016)

Tap dance on the sternum.


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