Cardiac Arrests: Stopping To Check Pulses?

[Mateo_1387]

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

_{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.

Is there a link for this source? Has there only been one study done to determine the effectiveness of pulse checks during CPR.

I am thinking it is not a bad thing to do, even though it is not a definitive assessment tool. It is like listening to breath sounds. You have patients just starting to develop pulmonary edema, yet they have clear breath sounds. Although just listening to breath sounds is not definitive in this case, listening to breath sounds may still add to the bigger picture. This is how I am viewing the pulse checks.

[BEorP]

Is there a link for this source? Has there only been one study done to determine the effectiveness of pulse checks during CPR.

I am thinking it is not a bad thing to do, even though it is not a definitive assessment tool. It is like listening to breath sounds. You have patients just starting to develop pulmonary edema, yet they have clear breath sounds. Although just listening to breath sounds is not definitive in this case, listening to breath sounds may still add to the bigger picture. This is how I am viewing the pulse checks.

http://circ.ahajournals.org/cgi/reprint/112/24_suppl/IV-19

I don't think I will ever understand the point of doing an assessment that is not meaningful.

[Camulos]

Anthony, there's no point in doing pulse checks (after your intial assessment) until you see an organized rhythm on the monitor. Why check for pulses when you see asystole?

I certainly hope none of your ECG leads are inadvertantly dislodged without you noticing. I personally prefer to treat pt's rather than monitors.

I question the validity of checking pulses during CPR to determine the effectiveness of cardiac compressions. During compressions the retrograde transmission of pressure through the venous system may give the perception of the palpation of pulses in the adjacent artery and may not be a sign of forward flow. This is the "venous pulse" that BEorP was referring too earlier. In that sense I don't know that checking for a "pulse" as a sign of adequate compressions is beneficial because I feel it is not clear what you are truly assessing.

Stay safe,

Camulos

[FL_Medic]

I agree with you 90% of the time. Although, during cardiac arrest you almost exclusively treat the monitor.

[crotchitymedic1986]

Per AHA guidelines, you are to check before you start CPR and then after the 5th round of 30 compressions. Obviously a 2-3 member team could check more often than that, and guys please realize that the crew doing CPR could be BLS with an AED only, so pulse checks would be important.

[zzyzx]

Camulous wrote, "I certainly hope none of your ECG leads are inadvertantly dislodged without you noticing. I personally prefer to treat pt's rather than monitors"

What kind of monitor are you using? It must be something ancient. LIfepak 12's won't show asystole if a lead is off. The crappy old Zoll that I'm using now will show asystole if a lead is off, but it will also say "defib pad short."

[WolfmanHarris]

Per AHA guidelines, you are to check before you start CPR and then after the 5th round of 30 compressions. Obviously a 2-3 member team could check more often than that, and guys please realize that the crew doing CPR could be BLS with an AED only, so pulse checks would be important.

I'm going to need to go looking to verify this, but apparently you're not supposed to bother checking for a pulse until the 2 minutes of CPR is completed regardless of the rhythm as NSR and even a palpable pulse might not yet be adequate CO. (I have some doubts on that as I feel like if you have a palpable carotid you must have fairly adequate CO)

I saw this to an extreme recently. VSA Pt. in the local ED, witnessed arrest. Physician performed CPR. Halfway through a cycle the pt. regained conciousness and started saying "Why-are-you-pushing-on-my-chest-?" RN asks if they should maybe stop and the Dr says, "Not yet we have to complete two minutes." Still scratching my head on that one.

[Camulos]

I agree with you 90% of the time. Although, during cardiac arrest you almost exclusively treat the monitor.

Nah I still treat pt's 100% of the time. Those damn monitors are far too hard to cannulate and intubate for me to treat them effectively - LOL.

Monitoring certainly dictates your treatment algorhythm during confirmed cardiac arrest. However should monitoring take over and negate pt assessment? I think not and believe that there is great danger in advocating there is "no point in doing pulse checks until you see an organised rhythm on the monitor" - as was suggested. In examining whether this approach is appropriate I would appreciate if anyone could answer this question. Are there any "disorganised" (your term, not mine) rhythms that can generate a pulse?

Stay safe,

Camulos

[Katiebug]

The accepted practice we have just been taught is to do one round of CPR even after converting to a perfusing rhythm. Logic is that the heart is hypoxic and is not circulating blood as it should during the first couple of minutes after conversion. The last round of CPR is an assist to the hypoxic heart until it can recover enough to do the job on its own.

Although if the patient were trying to sit up and talk to me, I would probably stop.

Edited April 2, 2009 by Katiebug

[Richard B the EMT]

...What crotchitymedic1986 said in his posting of the AHA standards.

I'm BLS, and do that, even with the SAED.