Cardiac Arrests: Stopping To Check Pulses?

[BEorP]

You are right, checking a pulse during compressions is stupid. Don't know why I have been wasting those 5 seconds to feel if a pulse is present during compressions. Give me a break. It's one thing if I was choosing not to give Vasopressin, or choosing to give all my drugs down the tube. Show me the evidence that checking for a pulse during compressions is hurting patients. Just because they don't do research on it doesn't mean that it doesn't work.

There has been research on it and it doesn't work:

In the past sternal compression force was gauged as adequate if it generated a palpable carotid or femoral pulse. But a venous pulse may be felt during CPR in the absence of effective arterial blood flow.

_{Source: Circulation}

How could it be hurting patients? It could give you the false impression that you are doing adequate chest compressions when you are not.

[Dustdevil]

Show me the evidence that checking for a pulse during compressions is hurting patients. Just because they don't do research on it doesn't mean that it doesn't work.

Can you tell us how you are utilising the information you get from the pulse checks? Depending upon what you are doing with that information, you may or may not be doing any harm. However, if the information does not affect your treatment at all, then why bother?

[Emtgirl101]

i personaly think even though we check pulse with patient in cardiac arrest, but i think cpr should be continued unless the patient wakes up or says OW!! lol , i am stronge believer in continous cpr, keeping everything regular until u get to the hospital , even though i havent done continous i believe in it but i am scared id be wrote up for not checking fo a pulse so i do because thats how it works here were i live.

[p3medic]

I check pulses if there is a sudden spike in etCO2.

[AnthonyM83]

While pulses present might not indicate effective CPR, the lack of pulses during CPR may indicate ineffective CPR (or hypovolemia, etc).

And no, I don't have evidence of it, but if every single time CPR is done, pulses are felt...then suddenly with one patient pulses are not felt...it's common sense to attempt to problem solve.

[BEorP]

While pulses present might not indicate effective CPR, the lack of pulses during CPR may indicate ineffective CPR (or hypovolemia, etc).

But the lack of pulses could also mean nothing in terms of the quality of CPR... Why not just focus on adequate rate, depth, and recoil?

[AnthonyM83]

But the lack of pulses could also mean nothing in terms of the quality of CPR... Why not just focus on adequate rate, depth, and recoil?

Why not focus on more than just that if you have the time? It's already assumed you're watching for good rate, depth, and recoil.

Pulse check might increase your index of suspicion on faulty CPR (combined with questionable rate, depth, recoil, fitness of provider, time doing CPR, etc) and of hypovolemic state (combined with skin signs, medical history, environment, ECG rhythm, etc etc).

I try to have my fingers on the neck before CPR is stopped to do the pulse check, so how does that slow the team down?

Especially, when you have everything else taken care of.

It's one thing to take action based on a random assessment that has no evidence base and another to note several common sense findings that could add up to a big picture combined with evidence based assessments.

Edited March 27, 2009 by AnthonyM83

[BEorP]

Why not focus on more than just that if you have the time? It's already assumed you're watching for good rate, depth, and recoil.

Pulse check might increase your index of suspicion on faulty CPR (combined with questionable rate, depth, recoil, fitness of provider, time doing CPR, etc) and of hypovolemic state (combined with skin signs, medical history, environment, ECG rhythm, etc etc).

I try to have my fingers on the neck before CPR is stopped to do the pulse check, so how does that slow the team down?

Especially, when you have everything else taken care of.

It's one thing to take action based on a random assessment that has no evidence base and another to note several common sense findings that could add up to a big picture combined with evidence based assessments.

I appreciate your desire to do more assessments, but there is no sense in doing assessments that aren't truly assessing for anything meaningful. Someone could be doing perfect CPR and not generate any type of pulse and on another call there could be poor quality CPR that generates a venous pulse. By adding in this assessment we gain no information that can help us to better care for the patient.

[AnthonyM83]

I appreciate your desire to do more assessments, but there is no sense in doing assessments that aren't truly assessing for anything meaningful. Someone could be doing perfect CPR and not generate any type of pulse and on another call there could be poor quality CPR that generates a venous pulse. By adding in this assessment we gain no information that can help us to better care for the patient.

Couldn't you liken that to an O2 sat?

You could have a good have someone well-oxygenated with a good O2 sat on one call, then on another call with good poor oxygenation but even better O2 sat? BUT combine a bunch of things and it might lead give you an index of suspicion.

No pulses, might make me review the person doing CPR again...

and I might say: "Nope, he's doing a good job. We're good there."

or: "Hmmm, that's not as good CPR as it good be, gotta remember to get others to switch out with him for a few rounds"

[theotherphil]

DRABC? That's a new one on me.

Is this an Aussie thing, or am I just out of the loop?

DRABC is used in the UK as well as Aus. Danger Response Airway Breathing Circulation etc

Once cardiac arrest is confirmed with an initial pulse check, I wouldn't check again unless there's a rhythm change (and after finishing the 2 mins CPR). No pulse check straight after a shock due to myocardial stunning, although this is lessened on biphasic defibs.

edit: speeling

Edited March 27, 2009 by theotherphil