CPR so you think you are doing it right !

[derwoodwithasherwood]

If a person has a femoral pulse, then the brain is being oxygenated. It takes more pressure to get a femoral than a carotid pulse. Unless there's blockage in the carotid, you won't have a femoral pulse without a carotid.

Absolutely correct. I was responding to an earlier comment suggesting it's not realistic to try for a femoral pulse with all the other urgent activity. The point I was trying to make is that a femoral pulse check is not necessary -- a carotid check is adequate, quick and easy. I did not mean to imply that a femoral check was irrelevant -- if that's the best point of access in a particular situation, then go for it. The important thing is to verify that compressions are effective.

 

[Dive-aholic]

Absolutely correct. I was responding to an earlier comment suggesting it's not realistic to try for a femoral pulse with all the other urgent activity. The point I was trying to make is that a femoral pulse check is not necessary -- a carotid check is adequate, quick and easy. I did not mean to imply that a femoral check was irrelevant -- if that's the best point of access in a particular situation, then go for it. The important thing is to verify that compressions are effective.

Agreed, it is important to verify effective compressions. But if you're not compressing enough to get a femoral pulse, then they're not effective enough to adequately perfuse the brain. I realize in the field, carotid is the pulse of choice to check. This is probably because it's easier to teach the lay person where it is and most lay people won't want to feel for a femoral. In the hospital setting, femoral is the pulse of choice. We know where it is, it doesn't bother us to feel for it, and it shows better perfusion.

 

[MASS-Diver]

In the hospital setting, femoral is the pulse of choice. We know where it is, it doesn't bother us to feel for it, and it shows better perfusion.

Exactly

 

[goodknight411]

One thing they didn't seem to mention in the original posted article is the survival rate of "perfect"CPR to "wrong"CPR. And they forget too that you can't do something 'harmful' to a dead person.

Here's the other study they mentioned in this article. This is how the lay person is doing on average.
http://jama.ama-assn.org/cgi/content/full/293/3/299

 

[TheAvatar]

Guidelines I was taught in my Wilderness EMT course:

Palpable Cartoid pulse: >60mmHg systolic
Palpable Femoral pulse: >70mmHg systolic
Palpable Radial pulse: >80mmHg systolic
Strong radial pulse: >100mmHg systolic

 

[goodknight411]

Are you sure pulse is measured in mmHg? Maybe your thinking of Blood Pressure? or Estimated Blood Pressure?
A pulse would be measured in beats per minute.

 

[derwoodwithasherwood]

He's saying that if you can feel a pulse at such-and-such a point, it indicates a minimum systolic blood pressure of XX mmHg. (Systolic is the bigger number in a blood pressure reading -- the maximum pressure.) It's just a way of estimating blood pressure, not a method of measuring a pulse.

 

[goodknight411]

OK. I get it now. I thought he was trying to say that that was the pulse you wanted in each location and I knew that didn't make a lick of sense.

 

[ArcticDiver]

All this posting reminds me what I was taught all too many years ago.

-Don't do CPR unless the person is Dead; i.e. they have no pulse or respirations.
-Since the person is dead you can't hurt them any more regardless of what you do. So, don't be timid!
-Don't expect too much. Due to end organ hypoxia even if you do CPR perfectly the odds are the person isn't going to walk out of the hospital anyway.
-Beyond CPR: Even more so today than then we have the tools to almost literally resucisate a rock. So think about what you are doing and the quality of life involved.
-Once you commit to CPR and Resuscitation; Put everything into it. Don't be delicate. If when you get done you ain't wrung out you didn't do it right!

Don't see that the process has changed all that much. Oh, folks still tinker with the details. But the core doesn't change. CPR was, and is, a long shot to prolong a person's life. Sometimes it pays off.

 

[firemedic296]

I've seen docs do chest compressions 3 or 4 times. At night on many floors, there aren't that many people around and often times untill the code team arrives there may be only be a few nurses around - any doc that happens to be on the floor is grabbed and made to get to work. With multiple codes on the same floor or even in the same hosptial, docs are fair game to recurit for CPR. These days we have a big nurse shortage and new nurses will sometimes defer to doc.

BTW: Did you even read the article that this whole thread is based on? It's based on nurses AND DOCTORS doing CPR

And, of course, there aren't many medics in the hosptial.

And, btw, yes - a nurse runs the code.

i'm not talking about all the time, but you are right the nurse usually runs the code if the Dr is not in the room. the key to tx care to an RN and then for the RN to "run it" is getting some to start making the desicions. I have seen it happen!