Chest compression rate

[Kaisu]

I am looking for your ideas regarding the rate of chest compressions during CPR. We are all taught to do compressions at a rate of 100/minute. My understanding is that this is optimal for allowing filling of the chambers and creating enough pressure to push the blood forward.

Now my question -

After delivering a patient to the ED with CPR in progress, I have watched numerous residents, techs, etc take their turn on the chest and pump away at rates close to double this. I have looked at the attending in charge to see if he will correct this and I have yet to see on Doc, ED nurse, ANYOME, correct the CPR rate. I have uneasily murmured to the attending that I am concerned about the compression rate to no avail.

I don't want to step on toes but I do want my patient to get every chance they can. Is there a reason these people push so much faster in the hospital than we do in the field? I am going to question my Medical Director about this, but he tosses crap out of left field at anyone asking these sorts of questions. It would really help me before I ask him to have as much information as possible. I will grow cojones and confront if required but I would really like to know I have a clue before I do that.

PS.. these patients are generally intubated, thus, shouldn't the rate , if anything, be slower than faster?

edited for PS

Edited January 30, 2010 by CrapMagnet

[nypamedic43]

American Heart and Red Cross both teach the 30/2 or 100/min. If you do that, then you have done your job. Unfortunately, once you turn care over, you cant direct how ED staff care for them or continue or discontinue efforts. Once a person is intubated the 30/2 goes out the window and the 100 compressions/min and breaths of 10-12/min comes into play.

I understand that you want as much info as you can get, but busy ED staff will probably not see it that way. Doing the best that you can do for your patient while they are in your care is really all you can do. If you can walk away from the ED, knowing that, then questioning ED staff about why they do it differently should be a non-issue.

[mobey]

This answer is simpler than you may think. The increase in rate is due to the adrenaline the compressor is feeding off of while doing compressions.

I have 3 CPR rules

Rule#1 NO Dr does CPR

Rule#2 Time the compressions every 5min or so.

Rule#3 Switch out compressors often based on how many people you have available.

As for asking questions........ Well..... you will get used to being treated with hostility when confronting/questioning ER staff. That does not mean you should not do it.

If you want what is best for the pt, work them at the scene and involve competent ALS providers, with multiple compressors.

[AnthonyM83]

Rule#1 NO Dr does CPR

That's just silly to have as a rule. I've had some good doctors that provided great CPR coaching to my trainees in the ER as they helped out with compressions. In general, rules like this are silly, as they can be made for all positions (medics about EMTs, RN's about medics, medics about RN's, RN's about MD's, etc etc)

[mobey]

That's just silly to have as a rule. I've had some good doctors that provided great CPR coaching to my trainees in the ER as they helped out with compressions. In general, rules like this are silly, as they can be made for all positions (medics about EMTs, RN's about medics, medics about RN's, RN's about MD's, etc etc)

Yeah try not to take it too seriously.

They are no generic EMS rules. These "rules" are specific to my area/experience.

Rural GP's out here, working in the smalltown ER, are famous for inappropriate bagging rates/volumes, and ineffective CPR.

[Kaisu]

Doing the best that you can do for your patient while they are in your care is really all you can do. If you can walk away from the ED, knowing that, then questioning ED staff about why they do it differently should be a non-issue.

That is exactly the reason I posted this. I wanted to know if there is something I am missing.

[kohlerrf]

I am looking for your ideas regarding the rate of chest compressions during CPR. We are all taught to do compressions at a rate of 100/minute. My understanding is that this is optimal for allowing filling of the chambers and creating enough pressure to push the blood forward.

Now my question -

After delivering a patient to the ED with CPR in progress, I have watched numerous residents, techs, etc take their turn on the chest and pump away at rates close to double this. I have looked at the attending in charge to see if he will correct this and I have yet to see on Doc, ED nurse, ANYOME, correct the CPR rate. I have uneasily murmured to the attending that I am concerned about the compression rate to no avail.

I don't want to step on toes but I do want my patient to get every chance they can. Is there a reason these people push so much faster in the hospital than we do in the field? I am going to question my Medical Director about this, but he tosses crap out of left field at anyone asking these sorts of questions. It would really help me before I ask him to have as much information as possible. I will grow cojones and confront if required but I would really like to know I have a clue before I do that.

PS.. these patients are generally intubated, thus, shouldn't the rate , if anything, be slower than faster?

edited for PS

Feel free to step on toes! I have rarely seen an MD in the Er that can manage a code better than a Paramedic and interestingly enough the MD's and nurses in the local ER's realize it as well and often take second chair.

[joesph]

to my knowledge nurses and other staff take the same course and use the same criteria for cpr as everybody else. That being said I wonder if the ER staff are using info on there monitors combined with education and experience to give them criteria to go outside the standard rates and techniques. Question on the patient you witness did all of the ER staff increase the rate of compressions or just one or two. If it is the later I would say that they were just too amped up.

The perfect song to time your compressions by is ironicaly 'another one bites the dust' by queen.

[Kiwiology]

We are taught 100/min and a vent rate of 8 using a bag mask, we're also getting the MRx with QCPR to enable us to get the right number and depth of compressions.

[DwayneEMTP]

...I understand that you want as much info as you can get, but busy ED staff will probably not see it that way. Doing the best that you can do for your patient while they are in your care is really all you can do. If you can walk away from the ED, knowing that, then questioning ED staff about why they do it differently should be a non-issue.

Disagree completely. I often make suggestions to the ER staff of arrests I bring in, asking for deeper compression, slower vents, etc. Some take it well, others don't. But as long as my monitor is still hooked up and my partner is still ventilating I feel an ethical need to continue to advocate for my patient. I've never had a Dr. become offended because I attempted to keep CPR running 'my' way until I was completely clear of the pt.

I've delivered to a really busy ER, and even now, with a tiny ER, busy is still relative. It's very common that I review cases that I've delivered with the docs, and when it's slow often glove up and help with pts that I'm not responsible for. I think it's a great educational resource, as well as allowing the staff and I to get to know each other, our limits, expectations.

Walking away self satisfied is important for sure, but advocating for your patient is vital as well...todays pt, as well as tomorows.

Dwayne

Edit. Sorry, I got sidetracked. I also believe that the rate is secondary to adrenaline. I find that this is more of a problem with vents in head pts than with compressions. I sometimes have to argue to slow things down, despite allowing them to watch my ETCO2 with head injuries.

Edited January 31, 2010 by DwayneEMTP