CPR question WWYD?

[Sassafras]

Not that this happened, however, I started to wonder as we transported a post bypass patient from hospital to rehab today with rapid shallow respirations...WTH would I do if he coded?

Can you really do compressions on a chest incision/thoracic cavity split open and recently tied back together with wires? He's post op 3 days. Incision very scabbed, and eeesh...what would I do if he coded? Could I split things open all over again? Things they don't discuss in EMT class, so enlighten the probie wise ones. What would you do?

BTW: We delivered patient safe and sound to rehab facilitiy so I didn't have to face my fear.

 

[firecoins]

If he coded, you would do chest compressions. I doubt you would be allowed to open the chest and pump the heart directly.

 

[MasterIntubator]

What we usually do when doing interfacility transports, we have a chat with the physician signing the order to transport with a "what if" session. These usually take about 10 minutes of the doc's time, and if there are any special instructions, we know them up front.. to include any drugs we don't carry but are given to us "just in case".

No way am I gonna accept a planned transport pt with questions in my head, and when I do accept that pt, I will be confident of what I will need to do within my abilities.

Sooo... you should find out from that Doc... WTH can I do if.......
Then it won't be a mystery. Never be afraid of asking questions in our field. The day you don't when you were offered the opportunity to...it will bite you.

 

[SoCal]

I have done this before. The incision splits open and oozes blood, and the chest is easier to compress because most likley they separated the ribs from the sternum. Very fun code to work.

 

[firetender]

You'll figure out how to modulate your pressure so as not to squish the heart too hard by about compression #3.

 

[Veneficus]

Call medical control.

I might be able to get a way with a little more than most with my duality.

really though, if faced with such a situation, I don't see anyway around doing CPR.

Will it mess up the closure? Probably.

Will somebody be mad? Most likely.

Could it cause complications like a tamponade, or vessle/wall disruption? Yep.

If they have no perfusion are they going to die? For sure.

If you do CPR they might die or they survive. If you do nothing, they will most likely die. Sort of makes the choice rather simple I guess.

 

[AtlantaEMT]

I have done this before. The incision splits open and oozes blood, and the chest is easier to compress because most likley they separated the ribs from the sternum. Very fun code to work.

That would be a cool one to work.

I'd give a precordial thump for good measure and do a chest crack. Then I'd go look for another job to pay my lawyer fees.

 

[Akulahawk]

I'd do compressions for the reasons Veneficus posted.

 

[gw812]

Kudos for having the conversation with the doc first. I'd definitely do that, and in the absence of anything special from that conversation I'd fall back on my basic training - in the absence of a valid DNR start CPR. Maybe with an extra layer of gloves and the expectation that the cleanup after we hand off the patient could be a bit more intensive than usual...

 

[CAOX3]

Not that this happened, however, I started to wonder as we transported a post bypass patient from hospital to rehab today with rapid shallow respirations...WTH would I do if he coded?

Can you really do compressions on a chest incision/thoracic cavity split open and recently tied back together with wires? He's post op 3 days. Incision very scabbed, and eeesh...what would I do if he coded? Could I split things open all over again? Things they don't discuss in EMT class, so enlighten the probie wise ones. What would you do?

BTW: We delivered patient safe and sound to rehab facilitiy so I didn't have to face my fear.

Place the AED, defibrillate if advised. This is a witnessed arrest, if ROSC isnt achieved, begin CPR as stated.