Staring eyes in CPR

[akflightmedic]

makes me think of the story in the book "EMERGENCY" by jerome hoffman of the guy that they claimed came back to "life" everytime they started CPR and "died" everytime they stopped. Evidently he would open his eyes and blink everytime they started CPR back up, then revert to the partial closed of death. He stated everybody in the ER thought he was looking at them...was there awareness there? Who knows, but freaky indeed.

BTW - if you haven't read the book it's a decent read. True incidents that are funny, sad, etc but best because all are true.

Interesting...that was in a book? I recall someone here posting a thread on this very thing and they claimed it was their call. How common is this occurrence?

[Echoburger]

Speaking of "breaking ribs" while doing CPR. Does the "crackling", or as Dust described it, "popping", of the ribs usually occur as soon as you start compressions or does the cracking/popping only occur after several rounds of CPR and stress on the chest?

Also...in a previous post, I asked about CPR while moving. I've never actually seen the option where a person "rides" the rails and uses both arms...however, I have seen the one arm technique where the compressor just walks on the side of the stretcher and uses their strong arm to compress with one hand. Is that okay? It seems like the one hand technique would be easier, but you'd have to push harder though.

[Aussieaid]

Studies have shown that there is actually more instances of broken ribs (~30%) than fractured sternum (~14%). The risk of breaking anything depends totally on the patient and also on the person performing CPR a lot more than the technique. Although poor technique is going to increase the risk. A strong male doing the correct technique on a frail old lady is more than likely going to break something. The older the person the more likely they are going to end up with fractures. It seem females also receive more rib fractures than males as well. If a person is in poor health or has underlying problems they are also going to be at high risk. Think of the older people with osteoarthritis. Hard to not break something or else you are really probably doing ineffective CPR.

I am used to doing CPR on children more and they have very elastic rib cages but you can still break them occasionally. I have noticed that children often receive over enthusiastic CPR so it is lucky that they generally are more compliant. (I have seen 2 handed CPR used on a child less than 2 years old by a large male - adrenaline overcoming training). The last person I did CPR on was a 60 something year old homeless male in very poor health and I could feel the ribs breaking and the bones crunching Not an experience I am going to forget easily.

I don't have very strong arms so I will get on the gurney if we are moving or up on the side of the bed to be able to do more effective CPR. What position you use depends on the individual but it is more important to recognize what works best for you. For an adult (pt) the 2 handed technique is going to be much more effective. If you think about it they are switching out people at the 2 minute mark because of decreased effectiveness and tiring so using one arm is going to tire you and decrease the effectiveness faster. Logistically wise it is probably easier for a large person to walk beside the gurney than climb on it though. Usually it is only for a short distance at least so something is better than nothing.

The breaking or "cracking", "popping" can occur at any stage as it depends on all the aforementioned factors. The longer you do it though the more risk of breaking as you are repeatedly causing stress and trauma to the area.

This is a link to one of the studies I mentioned.

[Lone Star]

Well when I look in Lone Stars eyes .... oh sorry off topic.

*pours cold water on tniuqs, then whacks him with a rolled up newspaper*

Bad puppy!!

[Dustdevil]

Interesting...that was in a book? I recall someone here posting a thread on this very thing and they claimed it was their call. How common is this occurrence?

You mean for someone to claim someone else's experience as their own?

Pretty common in this biz, I'd say.

[fireflymedic]

Interesting...that was in a book? I recall someone here posting a thread on this very thing and they claimed it was their call. How common is this occurrence?

My apologies - the book is called Emergency by Mark Brown M.D. It is a collection of stories from physicians and nurses in the ER from across the country, so I would say it was pretty easy for someone to take the work and call it their own. The actual story was written by Jerome Hoffman M.D. To be fair to whoever posted this comment as you say, it's possible they were the medic caring for the patient as they state the paramedics brought him in like that in the middle of life and death, not choosing which side he wanted to be on. Persistent V-Fib was his rhythm never changing and a two hour code when they finally called it quits and let the man die.

As far as how common that phenomenon is - the doctor stated in the story he had been a physician 20 years in a busy urban ER and had never seen it before. I've never heard of it, but that doesn't mean it's not happened elsewhere. This is the only case I've ever heard of. I guess theoretically if you were perfusing the brain well enough via CPR you could improve level of consciousness. I am only guessing at this point though. Would definitely be an eerie position to be in.

As far as how common is it for someone to take a story and turn it to their own - dust stated best - extremely frequently. I've seen it more than a few times on this board and others.

[tniuqs]

My apologies - the book is called Emergency by Mark Brown M.D. It is a collection of stories from physicians and nurses in the ER from across the country, so I would say it was pretty easy for someone to take the work and call it their own. The actual story was written by Jerome Hoffman M.D. To be fair to whoever posted this comment as you say, it's possible they were the medic caring for the patient as they state the paramedics brought him in like that in the middle of life and death, not choosing which side he wanted to be on. Persistent V-Fib was his rhythm never changing and a two hour code when they finally called it quits and let the man die.

As far as how common that phenomenon is - the doctor stated in the story he had been a physician 20 years in a busy urban ER and had never seen it before. I've never heard of it, but that doesn't mean it's not happened elsewhere. This is the only case I've ever heard of. I guess theoretically if you were perfusing the brain well enough via CPR you could improve level of consciousness. I am only guessing at this point though. Would definitely be an eerie position to be in.

As far as how common is it for someone to take a story and turn it to their own - dust stated best - extremely frequently. I've seen it more than a few times on this board and others.

Yea a few have "borrowed a few of my stories too" oh well shit happens, when TV writers get a drift of things then its BS personified, that annoyed me a TV series based in Jasper National Park, and heck for the life of me I can't remember the name of the TV series. About Wardens in a fictious National Park anyway Bruce Greenwood, an actor I met on a little known movie called Striker's Mountain (oh and my 2.5 minutes of fame as an extra) well after that filming ended we took him on a ride along with us ... funny how attending a rescue became part of another twisted episode.

Anyways so off topic.

But no word of a lie, had a patient on the the old THUMPER, and this years ago he was awake and grabbed bloody my arm in ER scared the ever loving crap out of me! We would turn it off and he was flat, turn it on and he was a GCS of 14. Had family come in and said goodbyes after about an hour as he was complaining about the pain, heck every drug under the sun even had cardiology float a temp pacer but no capture.

In this biz and just when you think you have seen it all, you get a wake up, maybe thats the way its supposed to be ?

cheers

Edited October 15, 2009 by tniuqs

[Dustdevil]

Yeah, I had one in 1979 that was conscious during CPR, but immediately lost consciousness when CPR was stopped. On and off for a very long time. Crazy.

[fireflymedic]

I would really struggle with that one - knowing they are conscious and talking to you and as soon as you stop they will be dead. How do you explain that to them? "I'm sorry but we're going to stop because we can't continue this forever, and you will die." I believe that would be even more difficult for the family as they know if you continued that the person would be alive and push you to keep going. I know we speak many time of the cruelty of doing CPR to certain populations (the very old, end stages of terminal disease, etc) but would you react differently if they were able to communicate with you? I can deal with open eyes during CPR as I know there is no one there, but to experience someone literally "coming back to life" and then dying again would be troubling. Very few calls in my career have haunted me, but that is one that I will be the first to say would. Interesting topic we got started.

[Dustdevil]

Well, he didn't talk to us. He wasn't exactly lucid. But he would open his eyes and move his head and extremities during CPR, then almost immediately stop whenever compressions stopped. It's been thirty years, so I don't remember the fine details too vividly. I seem to remember the code lasted a couple of hours.