The Chain of Survival  Early Recognition  Early CPR  Early Defibrillation  Effective Post Resuscitation Care

Danger  To ensure safety in an emergency the rescuers must establish the area is safe for him/herself, the victim and other participants or bystanders prior to commencing CPR  Recognise that dangers can include electricity, fluid spills, toxic substances excessive clutter, crowd control, access to small area  Moving the victim &/or modifying environment may be necessary prior to commencing BLS

Response  Assess response to verbal and tactile stimuli (touch and talk)  Speak loudly and ask “can you hear me”  Give a simple command i.e. “open your eyes”  C.O.W.S – Can you hear me; Open your eyes; What’s your name; Squeeze my hand  Apply firm grasp to the shoulders and squeeze to induce a response  Rub the soles or the palms of the victim if an infant.

Send – A Call for Help  Stay with the patient

 Activate CODE BLUE EMERGENCY by depressing emergency button.  Dial 444 between 0700 – 1930 (Rton)  Dial 777 in Gladstone  Dial 88 in Mackay. Announce 3 times Code Blue and ward area  When orientating patient and family ensure significant others are aware of how to activate the emergency call system (this is Only for Rockhampton, Gladstone )

Airway Management  >Assess >clear >establish airway  Check to see if airway is clear  Don’t routinely roll patient onto their side unless in the event of obstruction with fluid i.e. blood /vomit, or in the event of a submersion (drowning)  In the hospital situation – use of suction  Remove loose dentures leave in if well fitting

 To clear - open and turn mouth slightly downward to use gravity or utilise suction  Reassess for return of responsiveness

Establishing the Airway  The manoeuvres used to establish an airway in an adult are > Head Tilt/Chin Lift

Establishing the Airway Jaw Thrust  Used if a neck injury is suspected or difficulty opening the airway occurs using the “head tilt & chin lift “ method

Airway Children & Infants Infant = less than 1 year  Head in infant maintained in NEUTRAL position with jaw support only

Child = 1 – 8 years  Head tilt chin lift  Jaw support

Airway Obstruction(choking) Recognise and Relieve Foreign Body Airway Obstruction (FBAO)  Back Blows – administer up to 5 back blows with heel of hand between shoulder blades. Goal to relieve obstruction with each blow – ceasing manoeuvre once obstruction relieved  Chest Thrusts – administered by locating the same point where compressions are delivered in CPR. Give up to 5 thrusts by pushing on chest in a similar manner but sharper and slower

Breathing  Look for movement of the upper abdomen or lower chest  Listen for the escape of air from nose and mouth

 Feel for movement of chest and upper abdo  If breathing present maintain open airway  If breathing doesn’t commence once airway is clear and open – CHEST COMPRESSIONS MUST BE COMMENCED IMMEDIATELY  Following chest compressions rescue breaths are given  The inspiratory time for each breath is 1 second/breath

Breathing  Mouth to Mask i.e. pocket mask  Ensure one way valve and good seal  Rescuer positioned behind pts head

 Inflate lungs, blowing through mouthpiece of mask – sufficient volume to achieve chest movement  Assessing respirations - turn your head and listen and feel for escape of air  If chest not rising check head tilt, chin lift and mask seal

Pocket Mask Technique Provides ventilation O2 concentration = 15 – 18% adding oxygen increases this to 40 – 50%

Circulation Cardiopulmonary Resuscitation  If the patient is unresponsive and not breathing normally CPR must commence with COMPRESSIONS  Feeling for a pulse is unreliable and should not be performed to confirm the need for resuscitation.  A health professional may check for central (i.e. carotid pulse) in an adult or brachial or femoral in the infant/child for up to 10 seconds only while checking for other signs i.e. response and breathing  Correct hand position for chest compressions is the lower half of the sternum for all age groups – this equates with the centre of the chest

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Method of Compression (Adult)  Patient supine on a firm surface rescuer beside chest  Heel of hand is placed on the compression point  Fingers of hand slightly raised with other hand securely on top of the first hand  Pressure is exerted through the heel of the bottom hand  The shoulder should be vertically over the sternum and the compressing arm is kept straight  Compressions should be rhythmic with equal time for compression and relaxation  Avoid compression beyond lower edge of sternum as compression delivered too low may cause injury to internal organs &/or regurgitation  Too high – compressions ineffective

 ADULTS/LARGE CHILD 30 compressions to 2 breaths (for one or two rescuers)  SMALL CHILD OR INFANT 2 BREATHS TO 15 COMPRESSIONS WHEN 2 HEALTH CARE PROFESSIONALS PERFORMING CPR (NOTE THE IMPORTANCE OF 2 INITIAL BREATHS)  Approximately 100 – 120 compressions per minute (almost 2 compressions/second)  Compression MUST be paused to allow for ventilation allowing for 1 second /inspiration, UNTIL PATIENT INTUBATED  Minimise interruptions to chest compression for any reason – Compressor counts  Swap compressor every 2 minutes to reduce deterioration in quality due to rescuer fatigue 

(

Hand Placement Infant

Adult/Large Child

Small Child (1-8)

Infant (< 1 yr)

Method (Allow recoil)

Heel of one hand Heel of one hand or other hand on top heel of one hand other hand on top

Two fingers or Two thumbs

Depth

> 5 cms or 1/3 Approx 5 cms or depth of the chest 1/3 depth of the wall chest wall

Approx 4 cms or 1/3 depth of the chest wall

Rate

100compressions /min

100 compressions /min

100 compressions /min

One Operator

30 : 2

30 : 2

30 : 2

Two Operators Lay Person

30 : 2

30 : 2

30 : 2

Two health care Professionals

30 : 2

2 : 15 (2 initial breaths)

2 : 15 (2 initial breaths)

Resuscitation in Late Pregnancy  Pregnant (gravid) uterus causes pressure on major vessels i.e. the inferior vena cava and aorta reducing venous return to heart and cardiac output  Position patient on her back with shoulders flat and padding under right buttock to give an obvious pelvic tilt to the left  Proceed with CPR

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(Soar et al, 2010 Section 8 p 1400)

Defibrillation  D = in the basic life support algorithm refers to defibrillation and states that the defibrillator must be attached as soon as able.  All staff are assessed in the use of AED as it now forms part of BLS

Duration of CPR Interruptions to chest compressions are associated with lower survival rates. Therefore CPR should continue until  Responsiveness or normal breathing return  Impossible to continue (exhaustion)

 An qualified health professional directs for CPR to cease

Communication  Establish who is the team leader  Establish roles and responsibilities of staff during the medical emergency using clear, concise communication  Give accurate information to the Medical Officer/ Senior RN re medical emergency event

Nursing Responsibilities  Ensure there are enough staff to manage the situation  Nurse scribe should include the following documentation: time, cardiac rhythm, defibrillations, drugs administered - dose and route, observations, IV fluids  Remember to provide privacy and curtain off the other patients and ask visitors to leave the room  Allocate staff to care for other patients

Post Resuscitation Care  Consider transfer arrangement  Monitor and Maintain perfusion  Maintain oxygenation through airway management/ensuring adequate ventilation  Determine and treat the cause  Informal or formal debriefing for staff participants.

Documentation  Rockhampton •

Adult Code Blue Report and Neonate/Paediatric Code Blue Report (copy to be sent to CNC HDU)

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Variance

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Progress Notes

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Medication Chart

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RiskMan

 Mater Mackay • Cardiac Arrest Drug Record • Cardiac Arrest Evaluation Form • Specific Observation Chart • Patient Progress Notes

For further information  Clinical Policy and Procedure: Assessment and treatment of Medical Emergencies  Australian Resuscitation Council

http://www.resus.org.au/  ALS Workshops REMEMBER it is MANDATORY to ensure your CPR skills are assessed every year