Week 11 Nursing

Question 1

Indications for Basic Life Support

Answer 1

▪ Unconscious
▪ Unresponsive
▪ Not breathing NORMALLY
▪ No signs of life
▪ Don’t waste time – if you are in doubt – commence CPR!

Question 2

Danger

Answer 2

▪ Is there any danger to you?
– Hazards – electrical or water
– Obstacles (chairs, tables, walking frames)
– Environment – by side of road, sharps, weapons
– Bystanders and other healthcare professionals
▪ Is there any danger to the patient?
– Environment/hazards
▪ Your personal safety and that of the resuscitation team are of primary importance.
▪ Put on gloves as soon as you can and consider other PPE as required (goggles, face mask).

Question 3

Response

Answer 3

▪ Check if the patient is responding to you.
▪ Talk and Touch
– “Open your eyes?” No response
– Need to assess central stimuli. Squeeze the shoulders (trapeze pinch) or orbital pressure, or sternal rub (depend on what is wrong with the patient and hospital policy)
▪ If no response, you need to SEND FOR HELP.

Question 4

Send For Help

Answer 4

▪ Hospital options to send for help
– Shout
– Emergency call bell
– Call the emergency phone number
– Response/Code Blue
▪ Community options to send for help
– Shout
– Call 000
– Emergency response bells

Question 5

Airway

Answer 5

▪ Care of airway takes precedence over any potential injury (inc. spinal).
▪ Assess airway and clear if needed
– Open mouth, head turned down to drain.
– Suction if immediately available
– Roll only if in community setting and fluid or obstructive matter is present.
– NO finger sweep
▪ Open airway
– Head tilt & chin lift
– Jaw thrust

Question 6

Head Tilt and Chin Lift Manoeuvre

Answer 6

Head Tilt
▪ One hand is placed on the forehead to tilt the head (not the neck) backward.

Chin Lift
▪ The chin is held up by the rescuer’s thumb and fingers by placing the thumb under the bottom lip and the middle and index finger along the jaw line.

Question 7

Jaw Thrust

Answer 7

▪ Used if spinal injury is suspected or if head tilt/chin lift not working.
▪ Locate the angle of the jaw and apply pressure behind using index or middle finger.
▪ May need to anchor thumbs in suborbital region to assist with the squeeze.

Question 8

Paediatric Considerations

Answer 8

▪ The upper airway in infants is easily obstructed because of the narrow nasal passages and trachea.
▪ Trachea is soft and pliable and may be distorted by excessive backwards head tilt.
▪ The head should be kept in a neutral position with the lower jaw supported at the point of the chin.
▪ If the neutral position does not open the airway, the head can be slightly tilted back into a ‘sniffing position’.

Question 9

Adjuncts

Answer 9

▪ Oropharyngeal (Guedel)
– Used for unconscious patients (GCS ≤ 8)
– Measure from centre of the mouth to the angle of the jaw
– Insert upside down initially and then twist into proper position when halfway inserted (adults)

▪ Nasopharyngeal
– Can be tolerated by semiconscious patients as it doesn’t initiate gag reflex
– Studies show that measuring NPAs is inaccurate, now we use a size 7 for women and a size 8 for men.

Question 10

Breathing

Answer 10

▪ Look, listen and feel for NORMAL breathing

▪ LOOK for chest movement (upper abdomen or lower chest).
▪ LISTEN for breath sounds (to the nose and mouth for breath sounds).
▪ FEEL for movement of the chest and upper abdomen for rise and fall of chest and airflow from patients nose or mouth.

▪ If the patient is not breathing normally
– START CPR
▪ Note that the DRSAB to this point should be a rapid assessment, and take approximately 30 seconds.
▪ The key to survival is efficient CPR and early defibrillation so we must not delay in getting to these steps.

Question 11

CPR

Answer 11

▪ Chest compressions should be performed on all persons who are unresponsive and not breathing normally.
▪ There should be minimal interruptions to compressions.
▪ If there is no sign of life within 10 seconds, begin chest compressions.
▪ How do compressions work?

– Allow a build-up of pressure in the aorta to maintain flow to both the heart and the brain.
– A break in compressions causes the pressure within the aorta to drop.

● Therefore eliminate as much as possible any gaps in compression

● Risks – rib/sternum fractures, pneumothorax. But acceptable given alternative of death!

Question 12

CPR Adults

Answer 12

▪ The correct hand position for chest compressions is the middle lower half of the sternum.
▪ Place the heel of one hand on the patient then place other hand on top and interlock fingers.
▪ Compress the chest
– Rate 100-120 min
– Depth at least 5-6 cm adult (1/3 depth chest)
– Equal compression : relaxation ratio
– 30 compressions/2 breaths
▪ Minimize interruptions to chest compressions (hands off time)
▪ Swap CPR operator every 2 minutes to decrease fatigue and maintain quality compressions.

Question 13

CPR Paediatrics

Answer 13

To give chest compression, use one or two hands, depending on the size of the child and your own strength.
● Place your hand on the lower half of the breastbone, which is in the centre of the chest.
● Push down to 1/3rd of the depth of the chest 30 times.
● Push fast, at a rate of 100-120 compression per minute.

Question 14

Pregnant Women

Answer 14

▪ Commence CPR immediately.
▪ Once help arrives, provide positioning - left lateral pelvic tilt
▪ The pregnant woman is positioned on her back with her shoulders flat and sufficient padding under the right buttock to give an obvious pelvic tilt to the left.
▪ Rescuer can use own knees to provide the tilt until further help arrives.

Question 15

CPR – Back Board

Answer 15

▪ CPR must be performed on firm surface – backboard or floor.
▪ Some hospital beds have a ‘CPR’ button which allows for firm surface.
▪ Backboard should be taken from crash cart when arrives so compressions effective.

Question 16

CPR – Breathing (Adult)

Answer 16

▪ The cycle of CPR is 30:2 for 2 minutes (approx. 5 cycles of 30:2)
▪ At end of your 30 compressions, you need to give two (2) breaths.
▪ Place bag valve mask over nose & mouth (attached to O2).
▪ Squeeze bag gently until the chest rises (usually about 1/3 of bag).
▪ Allow chest to fall
▪ Repeat
▪ The ARC state that having one person hold the mask and one delivering ventilations is ideal where possible.

Question 17

CPR- Breathing (Pediatric)

Answer 17

Bag and mask ventilation:
Self-inflating bags ( LAERDEL AIR VIVA CIRCUITS) are available in three sizes:
● 250 ml: Newborn or small neonates ONLY
● 500 ml: Neonates-infants
● 1500 ml: Infants-adults

Mask:
Remember to choose a suitable size mask

Question 18

Defibrillation

Answer 18

▪ Defibrillator interrupts the abnormal activity in the heart to allow normal pacemaker to start.
▪ Time to defibrillation is a key factor on a person’s chance of survival.
▪ Defibrillator pads should be applied ASAP
▪ Chest compressions must continue whilst the pads are being placed.
▪ AEDs accurately assess if the patient is in a shockable rhythm (VF/VT) or a non shockable rhythm.
▪ AEDs are used in many public settings – sports clubs, shopping centres. They are designed for ease of use for all.

Question 19

Defibrillation – Automatic External Defibrillator

Answer 19

Step one
– Turn on machine
– Attach Pads (CPR continues)
Step two
– AED will analyse rhythm
– Follow it’s instructions
– It will advise if shock is advised (VF or VT)
Step three
– Stand clear, perform full safety check of
area.
▪ No one touching patient or bed and oxygen
removed from the patient

– Advise everyone when shocking patient
– Discharge shock
– Recommence CPR

NO ONE SHOULD TOUCH THE PATIENT DURING SHOCK DELIVERY

Question 20

Pad Placement

Answer 20

▪ Placed in order to ensure that a shock is delivered on the axis through the heart.
▪ Pad Placement – Anterior – Lateral.
– Right upper chest (over second ICS mid clavicular line) and left lateral chest (over 5th ICS anterior mid axillary line). Follow the diagrams on the pads.
– Dry skin and remove excess hair
– Remove medication patches
– Avoid pacemakers
– Place under breast tissue
– Anterior-posterior placement if necessary

Question 21

Defibrillation - Paediatrics

Answer 21

Age > 8 years
* Use adult AED

Age 1-8 years
* Use paediatric pads / settings if available (otherwise use adult mode)

Age < 1 year
* Use only if manufacturer instructions indicate it is safe

Question 22

Identify the need of basic life support in the community setting.

Answer 22

1. Assess the situation: Check for any potential hazards, determine the patient’s responsiveness, and activate the emergency response system, such as calling 000.
2. Initiate chest compressions: If the patient is unresponsive and not breathing, initiate chest compressions at a rate of 100 to 120 compressions per minute.
   ● Place the heel of one hand on the center of the chest (between the nipples) and place the
   other hand on top.
   ● Push down 1⁄3 rd of the depth with each compression, allowing the chest to recoil between
   compressions.
3. If trained and available, use an automated external defibrillator (AED): Follow the AED’s
   voice prompts to deliver a shock if advised by the device.
4. Continue CPR: After the shock, immediately resume chest compressions, giving 30
   compressions followed by 2 rescue breaths. If the AED is not available or the patient does
   not respond to the shock, continue chest compressions until emergency medical services
   arrive.
5. Support the patient and family members: Provide emotional support to the patient and their
   family members, as this can be a stressful situation for all involved.
   Remember to always follow the latest BLS guidelines and seek training in CPR and AED use to
   increase your confidence and competence in performing BLS in a community setting.

Question 23

Nurse’s role during BLS

Answer 23

During basic life support (BLS), the nurse plays a critical role in providing timely and
effective care to patients experiencing cardiac arrest or other life-threatening
emergencies. The nurse’s role in BLS includes the following:

● Recognizing the need for BLS and calling for emergency assistance
● Assessing the patient’s airway, breathing, and circulation
● Performing cardiopulmonary resuscitation (CPR), including chest compressions
and rescue breaths, if necessary
● Using automated external defibrillators (AEDs) to deliver an electrical shock to
the heart, if needed
● Correct placement of the defib pads
● Documenting the events and interventions performed during the resuscitation
attempt.

Overall, the nurse’s prompt recognition and response to emergency situations can
greatly improve the patient’s chances of survival and recovery.