The first time I did CPR

was while working at Stanford’s ER. It was nerve-wracking. The guy in front of me was naked, bloody, and fully hooked up to the monitor. The trauma room was a little hectic as usual. Stanford is a teaching hospital so whenever a trauma patient rolls in, residents (aka doctors in training) will eagerly flock to the trauma room hoping to jump in and get some experience. I was lined up to do CPR right behind the ER tech that was currently hammering down on the patient’s chest. We cycle through ER techs every two minutes of CPR and it was finally my turn. 

Alright, you got this. One hand over the other, fingers intertwined, push down two inches for proper pump, let the chest recoil all the way, heart re-fills with blood, then push again. Memorized from the textbook - easy!

A crisis nurse was trying to get an IV in the patient’s arm opposite of me, one of my favorite nurses was holding C-Spine at the head of the bed, and the attending (head doctor) was at the end of the bed, shouting out orders.  

"Hey Steven, faster CPR bud," says the attending.

Shit, too slow. FUCK. We’re totally gonna lose this guy because of me. I started to panic and then from across the gurney I hear:

"Ah ha ha ha stayin alive, stayin alive," sings the crisis nurse. 

"Yeah Steven, ah ha ha ha stayin alive, stayin alive,” the other nurse joins in.

We all started to softly sing the chorus and IT WORKED. Singing that damn Bee Gees song actually fucking worked. It wasn't just some made up thing in The Office (and this was years before I ever watched that show). It was my first time doing CPR and I never did it again without that song in my head.

"Ah ha ha ha stayin alive, stayin alive."

 "Every two minutes we stop CPR to check for pulses and switch out. It's like a free cross-fit workout. You get in there, start CPR, everyones really supported and after two minutes you walk away dripping balls of sweat, high-fiving, and tagging in the next mother fucker."

 In the ER, when we know a patient is coming in for cardiac arrest, we get prepped and stretched. If you've never done CPR, you don't realize how exhausting it is. The ER will get a call ahead of time from EMTs or paramedics letting us know CPR is being done in the ambulance: "62 year old female found down in (insert nursing facility name here). CPR is in progress and we’re 7 min out."


We then go to prepare the room. Inside we usually have a couple ER techs, one attending, a nurse who will be charting, a couple nurses to start an IV and/or give drugs, and a respiratory therapist. (if it’s a teaching hospital there will also be lots of residents).
 
The bed is raised to a height where everyone can comfortably work, usually right above my waistline. A step stool will be on the side of the bed to make sure you get high and above the patient's heart while you do CPR. Make sure your elbows are locked, your shoulders are above the patient’s chest, and don’t be afraid to break some ribs as you push through their sternum. After every 2 minutes we do a pulse check. No pulse? Cycle to the next ER tech and continue CPR. 

Honestly, it's always kind of a shock when someone does come back. It doesn't normally happen - it's not easy to get a pulse back. The profile of most patients coming in are old and decrepit, or old/middle age and overweight (not exactly the healthiest). Once in a while, there's someone healthy and younger who just drops dead, unexpectedly. It's pretty fucked up and sad when it happens, but we don't see that as often as the grandma in the nursing facility who's been dehydrated for 3 weeks because no one's feeding her water (seriously).

Typically, CPR lasts at least 20 minutes as soon as they get there, but it depends on how long the paramedics have already been trying. Doing CPR for more than 40 minutes is just crazy. There's a pretty small window when CPR can work to get a pulse back. Otherwise we're just doing more harm than good. 

Majority of family members coming in are begging us, "please, do anything to keep them alive." And it's sad, especially for the patient. Most of them are already at the end of their life and it just seems cruel to continue bruising and crushing their chest with CPR. Not to mention the myriad of other things being jammed into their body to try to keep them alive: IV’s, IO’s, central lines, intubations, etc. All these things take a huge toll on the body. Sometimes it seems better to just let them go (but more thoughts on that another time).

20 minutes of CPR pass. One more pulse check. I shake my head. Nurse feels for the femoral artery, "no pulse." Doctor calls time of death.

I think it’s hard for ER workers to process just how sad it is when a patient dies. We get used to it. Especially if the patient already has underlying health issues and isn’t doing well to start with. We see it often enough to understand when it’s their time. It’s sad but it’s also just part of life. We all take off our gloves, walk out the room and before the next patient comes in for CPR, we stretch and take a little break. Our minds are already wandering off from what just happened. “So what’d you guys bring for lunch?”

Did you know that CPR requires 100-120 compressions per minute? Songs, like this one, that have 100-120 beats per minute are good to remember.

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