What happens if you perform CPR on a non arrest

bigbaldguy

bigbaldguy

Former medic seven years 911 service in houston
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So another thread got me thinking. If CPR is performed on someone who isn't in arrest what happens? For instance lets say some guy OD's on heroin and has no detectable distal pulses and breath so shallow a lay responder thinks they're dead and starts hands only CPR, besides being sore as hell the next day what could the consequences be?
 
I should think that if the CPR is any good then it could possibly upset the hearts normal rhythm somewhat. Also broken ribs/sternum and possibly coronary contusions??? Either way he/she will be sore in the morning.
 
I've only seen chest pain become a complaint along with the original complaint.

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rmabrey said:
I've only seen chest pain become a complaint along with the original complaint.

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You mean after CPR? My mom arrested in hospital and was worked as a code and she was sore as hell for quite a while. Of course she is in her 70s so I'm sure that was a factor.
 
bigbaldguy said:
You mean after CPR? My mom arrested in hospital and was worked as a code and she was sore as hell for quite a while. Of course she is in her 70s so I'm sure that was a factor.
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After CPR on someone who didn't need it.

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rmabrey said:
After CPR on someone who didn't need it.

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You've seen it more than once? Ouch. I know first hand how someone could make the mistake.

16 Years ago when I first started with the airlines I had a older guy do a face plant in the back of the plane and I couldn't find a pulse (we were not taught to take the pulse at the carotid back then just the radial) and couldn't really tell if he was breathing. I was seconds from starting CPR when a nurse who happened to be sitting near by stepped in. The question of what would have happened had I started pumping on him has always kind of stuck in the back of my head.
 
We do compressions on Pedis with a pulse under 60 with signs of hemodynamic instability if the cause is not directly and quickly reversible.

Also no pulse check after defibs. So you could have a perfusing rhythm that still gets CPR for 2 minutes before the next pulse check.
 
They told us in ARC instructor training it was found not to be deleterious.
My personal feeling is that most field "saves" are due to this. But I'm a grumpy old bolshie.
 
bigbaldguy said:
You've seen it more than once? Ouch. I know first hand how someone could make the mistake.

16 Years ago when I first started with the airlines I had a older guy do a face plant in the back of the plane and I couldn't find a pulse (we were not taught to take the pulse at the carotid back then just the radial) and couldn't really tell if he was breathing. I was seconds from starting CPR when a nurse who happened to be sitting near by stepped in. The question of what would have happened had I started pumping on him has always kind of stuck in the back of my head.
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Seen it twice in seven months in EMS.

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Parallel thread:
http://emtlife.com/showthread.php?t=27785


Quote:
princess-bride_320.jpg


"Sometimes they're not ALL the way dead"

(Photo courtesy of Florin EMS)
 
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bigbaldguy said:
So another thread got me thinking. If CPR is performed on someone who isn't in arrest what happens? For instance lets say some guy OD's on heroin and has no detectable distal pulses and breath so shallow a lay responder thinks they're dead and starts hands only CPR, besides being sore as hell the next day what could the consequences be?
Click to expand...

I've seen this exact situation. Opened up the doors of the BLS rig to find BLS doing compressions and bagging an unconscious Pt. As I sat down on the bench seat I could actually see the carotid pulse... After some Narcan was given and he miraculously regained adequate respirations, they all patted themselves on the back after their excellent CPR... :o
 
bigbaldguy said:
So another thread got me thinking. If CPR is performed on someone who isn't in arrest what happens? For instance lets say some guy OD's on heroin and has no detectable distal pulses and breath so shallow a lay responder thinks they're dead and starts hands only CPR, besides being sore as hell the next day what could the consequences be?
Click to expand...
Nothing worth mentioning.* It's the real reason why Rochester, MN and King County, WA have such high rates of successful resucitations; the dispatch criteria for telling the caller to start CPR is very low, and there are big public campaigns for rapid initiation of CPR.

And I've had the scenario of an apneic OD where CPR was done; worked great for the guy and given that he was completely apneic, the best thing that could have happened.

*yes, CPR can cause problems, but generally much better to do it than not.
 
I've seen CPR once on a patient that might not have needed it. It was at a stand-by event (concert in a large amphitheater). Patient was a young-ish girl who had ingested unknown quantities of unknown substances. Completely unresponsive. I arrived APS after a 2-person crew was already there. They assured me that she was breathing with a steady, weak pulse. Because she was totally unresponsive, I didn't want to delay moving her just so I could be 100% sure of her vitals when 2 other qualified EMTs told me she was good. We quickly threw her on the Reeves and transferred her to the waiting ATV to take her back to the ambulance area. I told the EMT riding on the back of the ATV that I hadn't gotten a chance to verify ABCs (even though the first arriving crew said they did) and asked that they check again (trust but verify).

As we were walking back to the staging area, we heard over the radio that the ATV crew was inbound with CPR in progress. 2 different EMTs on the ATV said they were unable to detect breathing or a pulse (although the back of a moving ATV is perhaps not an ideal environment). We got her into the back of the ambo and got the Lifepak hooked up and she had a pulse (pretty good one too).

The medics on scene swear that the patient must not have ever coded, the ATV crew swears that neither one was able to find a pulse. In the end, the patient lived and that's the end of it, I suppose.
 
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one side effect of doing CPR on a patient who doesn't need it is the chance that they are going to punch you at the first opportunity. I had a medic student do a pre cordial thump on me as a joke; he didn't mean to hit me as hard as he did. I hurts; he was lucky I couldn't breathe for about 5 minutes.
 
"Why the :censored::censored::censored::censored: does it feel like I was hit by a semi?!" Expect to hear a lot of that.
 
Im probably not the only one who has heard stories of a first responder or EMT saying over the radio "CPR initiated, patient combative".
 
NVRob said:
We do compressions on Pedis with a pulse under 60 with signs of hemodynamic instability if the cause is not directly and quickly reversible.

Also no pulse check after defibs. So you could have a perfusing rhythm that still gets CPR for 2 minutes before the next pulse check.
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Just to add to this,

you can find studies showing that CPR after a heart is defib'd correctly that produces a perfusing rhythm, is found to be beneficial to the newly restarting heart. Rather that wait the 10 seconds to check for a pulse to find none and having to worry about "re-priming the pump". It is better to just do 5 cycles of CPR again even if the heart is back in a perfusing rhythm. It helps the heart get going...
 
How does CPR help a heart to get going? Besides maybe affecting (how much?) coronary circulation?
 
A heart that is defib'd and then begins perfusing the body does not put out the same CO as a heart that never arrested would obviously. By performing CPR for the 2 minutes after your defib you help raise CO rather than letting the heart work on its on.
 
So your are assisting it's output rather than not making it beat better. A fine distinction. OK, I can go with that. Good deal, because unless it was electrocution or blunt trauma, seeing as how the reason it was defibbed was not determined or corrected, it is not unlikely that heart will fail again shortly or be in EMD/electro-mechanical dissociation (whatever the new phrase is for that).

But it won't help the heart "get going"; it will perhaps provide an increase in output if done right. Of course, always follow your applicable protocols.
 
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