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CPR Question?

Posted · Report post

So the other day my sister had a friend over and he spilled hot soup on his shirt when he changed shirts I saw something that was odd. He was born with what he said is a sunk in chest I have never seen this before and it got me thinking;



  • How would you do CPR on someone like him?
  • Would you go as deep with compressions?
  • would hand placement be the same?
  • Would every thing be the same?
  • Has any one ever had this issue or a similar one?

    Sorry if these are dumb questions but they don't ever teach about this kind of things in CPR.

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Posted · Report post

Sounds like pectus excavatum. No hard rules on this. Do the best you can if CPR is needed. In people who are status post some types of corrective surgery, an anterior/posterior pad/paddle placement is recommended for defibrillation. I have had a few cases of thoracic and spinal abnormalities and CPR was difficult.

Take care,

chbare.

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Posted (edited) · Report post

So you answered some questions but the one i want to know is would it change the hand placement/depth of compressions?

So this condition would change the placement of the pads?

and thanks for the help

Edited by sportygirl
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Posted · Report post

So you answered some questions but the one i want to know is would it change the hand placement/depth of compressions?

So this condition would change the placement of the pads?

and thanks for the help

For this condition you really don't need to change anything. You wouldn't move your hands off the sternum because you would do more damage doing compressions on the actual ribs than the sternum. The depth is still going to be the depth that gives you a palpable pulse as no one really measures it during CPR. You adjust to what works best for that particular pt.

You wouldn't need to change the pad placement for pectus excavatum. It is the same amount of bone just the anatomy is slightly different shaped and it's not really going to interfere with the electricity in this case.

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Posted · Report post

This is commonly known as "Pigeon Chest".

OM1822a.jpg

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Posted · Report post

that is what it looked like but a little more caved in

Thanks.

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Posted · Report post

The depth is still going to be the depth that gives you a palpable pulse as no one really measures it during CPR.

I was under the impression that the palpable pulse during CPR was somewhat debunked due to the possibility of venous backflow into the femoral vein at the rhythm of compressions being confused with a palpable femoral pulse?

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Posted (edited) · Report post

Femoral Pulse?

Unless the international protocols are more different than I was previously led to believe, when doing CPR, a check of the pulse is done at the Carotid artery.

If Femoral is the standard in someone's protocols (not in the US, that I am aware of), please correct me.

Edited by Richard B the EMT
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Posted (edited) · Report post

@Medicone:

This is commonly known as "Pigeon Chest".

OM1822a.jpg

Actually that is known as funnel chest...or pectus excavatum

Pigeon chest is the protrusion of the breast plate...or Pectus carinatum :coool:

As far as the reason for the A/P paddles or pads in the pectus excavatum, it may be because the corrective surgery involves placing a curved bar across the chest for some time..This may impede the current from directing towards the other paddle..A/P placement may avoid the bar.

The bars are not permanent, so after a couple years of surgery and recovery, the point is moot. Recurrence is unusual after correction, but I would be curious if the procedure would make the chest wall stiffer. the chest is also wired, so this is a concern?

Edited by ccmedoc
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Posted (edited) · Report post

So I was reading up on this and found some good information and I learned allot and I have another question?

A variety of surgical procedures are available to repair pectus excavatum, here is on of three but this one brings me to another question.

The questions iswith the steel bar would that effect the placement of pads/electrodes? And that would make CPR harder right?

The Nuss Procedure: Usually restricted for adolescent patients, Cleveland Clinic thoracic surgeons use a video-assisted thoracoscopic surgery (VATS) technique to correct pectus excavatum. Through two small incisions on either side of the chest, a curved steel bar (known as the Lorenz Pectus Bar) is inserted under the sternum. Individually curved for each patient, the steel bar is used to ‘pop out’ the depression and is then fixed to the ribs on either side. A small steel, grooved plate may be used at the end of the bar to help stabilize and attach the bar to the rib. The bar is not visible from the outside and stays in place for a minimum of two years. When it is time, the bar is removed as an outpatient procedure.

Edited by sportygirl
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Posted · Report post

So after surgery for pectus excavatum (which was not the original question) then CPR may require more force but still in the same position. The pads should be place anterior/posterior if the bar is still in situ. Ideally the patient should wear a medic alert bracelet if they have any kind of procedure that would require CPR modifications such as this surgery. (Not that people always do what they should do....)

:turned:

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Posted · Report post

(Not that people always do what they should do....)

:turned:

This is true one of my friends has no right carotid and he some times dose not wear his medical alert tags that could be bad

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