Module 3: Emergency Measures for Life Support Flashcards
Life Saving Principles
Early defibrillation
-Early defibrillation or shock may quickly return the heart to normal without further deterioration of a patient’s status
Early warning signs of cardiac arrest
-Tachycardia, hypotension, tachypnea, decreasing oxygen saturation below 90% despite provision of supplemental oxygen, and a decreasing urine output of less than 50 mL in 4 hours.
Early intervention can be provided by a rapid response team (RRT).
Blue code initiation
-Each agency has a specific code or signal to summon immediate assistance in the event of a cardiac and/or respiratory arrest; the arrest situation may be referred to as a “code”
Strategies to improve survival after cardiopulmonary
arrest include:
Immediate recognition and activation of emergency medical response
Early CPR and rapid defibrillation that emphasizes high-quality chest compressions
Effective advanced cardiac life support
High-quality CPR includes:
Ensuring chest compressions of adequate rate and depth
Allowing full chest recoil between compressions
Avoiding excessive ventilation
Minimizing interruptions in chest compressions
Cardiopulmonary arrest
Follow American Heart Association (AHA)
resuscitation guidelines
Provide resuscitation in a timely manner to restore
cardiopulmonary function and avoid poor neurological
outcomes
Maintain basic life support (BLS) certification
Resuscitating Patients with Covid-19
Special tasks and guidelines exist for providing
resuscitation to patients with COVID-19, including:
Don personal protective equipment (PPE) according to local guidelines and availability before beginning CPR.
Minimize the number of clinicians performing resuscitation, use a negative-pressure room whenever possible, and keep the door to the resuscitation room closed if possible.
May use a mechanical device, if resources and expertise are available, to perform chest compressions on adults and on adolescents who meet minimum height and weight requirements.
Use a high-efficiency particulate air (HEPA) filter for bagmask ventilation (BMV) and mechanical ventilation
Postarrest Care
Postarrest care is encouraged to be delivered in a
structured pathway approach to include
Targeted temperature management to preserve neurological function
Early coronary angiography and intervention (if indicated)
Keeping mean arterial pressure above 65 mm Hg pressure
Keeping end-tidal carbon dioxide levels within normal levels
Keeping pulse oximetry above 95%
Avoidance of fever
Glucose control
Safety Guidelines
Know your patient’s baseline vital signs, history of
irregularities in cardiac rhythm, and current problems.
Know your patient’s most recent serum electrolyte
values.
When a patient has been exposed to a chemical or drug, attempt to determine the type and amount of the
substance involved.
Clear communication to all others in the room is
essential at the time of defibrillation so that everyone is
aware and does not touch the patient or the bed at the
time of shock.
Inserting an
Oropharyngeal Airway
Semicircular, rigid piece of plastic shaped to follow
the curvature of the tongue.
Allows for the passage of a suction catheter or a
fiberoptic scope through the channel of the airway
Maintains airway patency by displacing the tongue
forward and toward the oral cavity floor.
Size is correct when the flange is held parallel to the
front teeth and the end of the OPA reaches the angle
of the jaw.
Inserting an
Oropharyngeal Airway: Delegation
Delegation
The skill of inserting an OPA cannot be delegated to
assistive personnel (AP). The nurse should direct the
AP to:
* Immediately report to the nurse any signs of airway distress, vomiting, or change in level of consciousness
Oropharyngeal Airway Unexpected Outcomes
Unexpected outcomes and related interventions
Patient continually coughs and gags when OPA is
inserted.
* Do not continue inserting airway if patient begins to gag. Stimulation of gag reflex can cause vomiting and aspiration.
* Remove OPA and position patient on his or her side.
Airway obstruction not relieved.
* Obtain immediate assistance.
* Reinsert airway or determine if another form of airway is needed.
* Assess for other causes of obstruction.
Unexpected outcomes and related interventions
Patient pushes airway out of place or out of mouth.
* Reassess patient’s need for OPA.
* Do not reinsert if patient is awake or can protect his or her own airway.
Unable to insert oral airway; patient is combative, or
you are unable to open the mouth.
* Get help.
* Do not continue efforts to place OPA.
Using an Automated
External Defibrillator
Defibrillation
Administration of an electrical shock to a patient’s
chest in an attempt to terminate a lethal cardiac
arrhythmia
An automated external defibrillator (AED)
Device that allows a basic life support provider to
defibrillate.
It is attached to a patient’s chest via two adhesive
pads.
Most AEDs have a very simple three-step function
with verbal prompts to guide the responder.
AED Delegation
Delegation
Basic life support certification provides hands-on
training with an AED for laypeople, AP, and licensed
health care professionals. Most agencies using AEDs
have given the authority to use it to all basic life
support or CPR-certified personnel, including APs.
Refer to specific agency policies for use of the AED
AED Unexpected Outcomes
Unexpected outcomes and related interventions
Patient’s heart rhythm does not convert into stable
rhythm with pulse after defibrillation.
* Assess pad contact on patient’s chest wall.
* Do not touch patient during AED rhythm analysis.
* Avoid placing AED pads over medication patches,
pacemaker, or implantable defibrillator generators.
Patient’s skin has burns under AED pads.
* Assess AED pad contact on chest.
* Ensure that chest is dry before applying pads to chest.
* Apply skin care as indicated if patient is resuscitated
successfully.
Resuscitation
Management
Cardiopulmonary resuscitation (CPR)
Primary survey
* C: circulation
* A: airway
* B: breathing
* D: early defibrillation
* Notification of the resuscitation or code team
Early CPR and defibrillation delivered within the
primary survey time period will help to preserve heart
and brain function, leading to improved survivability.
Resuscitation or code team
Secondary survey
* C: rhythm analysis of cardiac rhythm)
* A: airway intubation)
* B: confirmation of airway and ventilation)
* D: differential diagnosis of the cause)
During the secondary survey, the code team will
determine the patient’s cardiac rhythm and provide
the appropriate treatment for that rhythm
Resuscitation Management - Delegation
Delegation
Most skills involved with resuscitation management
cannot be delegated to AP. However, AP who are
certified in BLS techniques can perform the basic
skills of CPR, including AED use. Most agencies
reserve the skill of manual defibrillation for licensed
personnel who are ACLS certified or have received
competency validation to perform manual
defibrillation. All other skills in the code situation are
directed by the code team leader and performed by
nurses, respiratory therapists, and other health care
professionals
Resuscitation Management - Unexpected Outcomes
Unexpected outcomes and related interventions
Patient develops skeletal injury, such as fractured ribs
or sternum or internal organ injury including lacerated
lung or liver as result of chest compressions.
* Obtain appropriate diagnostic tests to document injuries.
* Assess patient’s postarrest breathing for symmetry and pain.
* Assess for intrathoracic or intraabdominal bleeding
(hematomas, increasing abdominal girth).
Unexpected outcomes and related interventions
Patient’s CPR is unsuccessful.
* Contact chaplain services.
* Contact social worker.
* Complete postmortem care on patient.
* Notify coroner and organ procurement agency in accordance with local agency or state law.
* Provide for privacy for patient’s family to grieve and mourn loss of loved one
