Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
CPR and First Aid Review e-Module CPR and First Aid OBJECTIVES After reviewing this content, the learner will be able to: • Describe clinical responsibilities during a code • Demonstrate proper sequence and technique of chest compressions and ventilation • Describe the new CPR guidelines according to AHA • Discuss how to help the conscious and unconscious patient/victim with a Foreign Body Airway Obstruction (FBAO) • Describe the policy and procedure for maintaining the code cart • Review Basic First Aid for the patient in restraints 2 e-Module CPR and First Aid New sequence for CPR!! • Are you aware there are new 2010 AHA Guidelines for CPR? • If you approach a patient/victim who appears to be unresponsive, first: – Check the patient for responsiveness • – Gently shake the patient and ask: “Are you OK??” Check for signs of breathing (normal breathing) • If no signs of normal breathing: – CALL FOR HELP and have someone get the AED (Automated External Defibrillator)! – CALL A CODE!!! » Know your emergency number to call-SITE SPECIFIC • Check carotid pulse for no longer than 10 seconds • If no pulse and no breathing, start CPR, beginning with Chest Compressions 3 e-Module CPR and First Aid CIRCULATION-CHEST COMPRESSIONS • Chest compressions should be initiated within 10 seconds of recognition of arrest • 30 compressions!! • Compressions need to be given at a rate of at least 100/min, with complete chest recoil between compressions • Compression depths vary: • Adults: At least 2 inches • Children: At least 1/3 the depth of the chest (approx. 2 inches) • Infants: At least 1/3 the depth of the chest (approx. 1 ½ inches) 4 e-Module CPR and First Aid AIRWAY & BREATHING • Open airway – Head-tilt-chin lift • Give 2 breaths – After 30 compressions, give 2 breaths – Watch for chest rise and fall after each breath. • Use an Ambu bag/Bag-Valve Mask (BVM). 5 e-Module CPR and First Aid Remember! • If the person has a pulse, perform rescue breathing only. • When doing CPR, press hard and fast allowing full chest recoil Click here for a quick review: • http://www.youtube.com/watch?v=obVQSQf3nrY&feature=related 6 e-Module CPR and First Aid Remember… 7 e-Module CPR and First Aid TYPES OF MECHANICAL AIRWAYS 8 e-Module CPR and First Aid Maintaining a patent airway may require an: • Oral Pharyngeal Airway (OPA) 9 e-Module CPR and First Aid • Nasopharyngeal Airway (NPA) 10 e-Module CPR and First Aid • Laryngeal Mask Airway (LMA) 11 e-Module CPR and First Aid FOREIGN BODY AIRWAY OBSTRUCTION 12 e-Module CPR and First Aid FBAO (foreign body airway obstruction) • Universal sign for choking • If patient able to cough, let them clear their own airway. • If patient is unable to cough, perform the Heimlich maneuver (aka Abdominal thrusts): 13 e-Module CPR and First Aid UNCONSCIOUS FBAO • If the object does not dislodge and the person looses consciousness, assist them to the floor • Assess responsiveness • Open airway and look for obstruction – DO NOT DO A BLIND FINGER SWEEP!! – Only attempt to remove object if you can see it. • Assess breathing and circulation: – If no pulse and no breathing, begin CPR starting with 30 chest compressions – Give 2 breaths – Assess circulation (pulse) • Repeat cycle: – look in airway for foreign object, – 30 compressions – 2 breaths For a 2 minute video demonstration, click here: http://www.mahalo.com/how-to-perform-the-heimlichmaneuver 14 e-Module CPR and First Aid Code Cart • Know location of the unit’s code equipment • Outer contents include: – Monitor/defibrillator – Electrodes and pacer/defib pads – Compression board – Ambu bag – Oxygen tank (filled) – Sharps container (not filled) – Respiratory box – Code documentation forms – Code cart check sheets 15 e-Module CPR and First Aid Code Cart • Inner contents include: – Medications – Needles, syringes – Angiocaths, IV starter kits, • IV tubing, IV fluid – Intracardiac needle – Gauze, tape, alcohol preps – Additional respiratory supplies – Suction regulator, • suction catheters, • connective tubing – NG tubes, connectors – Central lines and central line kit – Cut down tray 16 e-Module CPR and First Aid Code Cart Nursing: • Performs code cart check every 24 hours (q shift in some sites) • Ensures breakaway lock is intact and outer contents present • Documents date, lock intact, and signature on check sheet • Unplugs defibrillator and tests to ensure proper functioning (refer to site specific policy) • Opens code cart monthly and checks for correct supplies and expiration dates. If laryngoscopes are in cart, they are tested for proper functioning and batteries present. 17 e-Module CPR and First Aid Code Cart • Whenever code cart is opened (i.e. in an emergency): – A new cart is supplied by Sterile Processing (refer to site specific policy) – RN documents new lock number, date and signature on code cart check sheet – If code cart is replaced by central sterile supply, outer contents stay on unit and are then placed on new code cart (refer to site specific policy) • Special circumstances 18 e-Module CPR and First Aid Basic First Aid For the Patient in Restraints 19 e-Module CPR and First Aid Essentials of First Aid • STAY CALM • ALWAYS CALL FOR HELP! – Activate appropriate emergency response system, as per policy – All injured patients, visitors and/or staff need to be evaluated by a member of the medical team! • SAFETY FIRST • ADHERE TO UNIVERSAL PRECAUTIONS 20 e-Module CPR and First Aid Inform the Supervisor • Always inform your immediate supervisor! • Ensure completion of incident report – Administration needs to be aware and follow up on serious incidents • Reports are ESSENTIAL! • Team members are here to back up one another – Mutual Support & Cross Monitoring 21 e-Module CPR and First Aid Cuts and Abrasions 22 e-Module CPR and First Aid Control of Bleeding -including a self inflicted injury 23 e-Module CPR and First Aid Nosebleeds 24 e-Module CPR and First Aid Sprains and Strains 25 e-Module CPR and First Aid Impaled Objects 26 e-Module CPR and First Aid First Aid for Fainting 27 e-Module CPR and First Aid First Aid for the Attempted Hanging Patient 28 e-Module CPR and First Aid RESTRAINTS 29 e-Module CPR and First Aid Facts about restraints • Restraints do not prevent patients from falling. • Restraints do not ‘protect patients from all harm’. • Restraints should not be used for position improvement • Restraints do not provide an increased sense of security for you or the patient • There are alternatives to restraints 30 e-Module CPR and First Aid Persons Wearing A Restraint: Requires Close Monitoring by the Team • What are some of the risks? • Proper security of straps is essential – Proper application – Proper size – Release/slip knot: single pull – Secured to non-mobile structures of bed, stretcher, chair 31 e-Module CPR and First Aid Restraint Dangers! • • Application and monitoring must be done by persons deemed competent Essential for safety! 32 Credit to: McGill Molson Medical Informatics Project, McGill University Faculty of [email protected] e-Module CPR and First Aid Restraint Emergencies • Choking or other medical emergencies while wearing a restraint – Always call for help immediately! – Staff must be prepared to release immediately • Release/slip knot • Scissors, if necessary – Must not hamper rescue efforts – Patient must be monitored closely for prompt intervention • Examples of medical emergencies – Patient is unable to move if they spill hot coffee on themselves – Unable to stand up or significantly change position if choking 33 e-Module CPR and First Aid Restraint Asphyxia • Occurs when a patient is unable to breathe due to some form of restraint – serious risk for death! – Positional – Mechanical Patient may be unable to change position to obtain adequate ventilation/air exchange! 34 e-Module CPR and First Aid 35 (Credit to www.charleydmiller.com) e-Module CPR and First Aid Excited Delirium Syndrome 36 e-Module CPR and First Aid Excited Delirium Syndrome: • • Fairly consistent profile Need to recognize persons at risk – – Persons At Risk • – – Bizarre, violent, aggressive behavior Overheating/excessive sweating or very dry – – – Unbelievable strength Undistracted by pain • Broken bones, damaged limbs – – – • Body may shut down perspiration attempts because extreme demand on body system – Public disrobing • Cooling attempt Extreme paranoia Incoherent shouting • Animal noises, loud pressured speech Led to many in custody deaths in law enforcement These persons also exhibit • Irrational physical behavior Hyperactivity “Bug Eyes” These persons are likely to – – – Fight Flee Able to overpower personnel and law enforcement 37 e-Module CPR and First Aid Excited Delirium Syndrome: Scenario • Person is restrained – – – – • Becomes unconscious shortly after restraint Breathing becomes shallow or labored Unexpected death can follow Resuscitation is often unsuccessful What can we do? – – – Be aware These patients require medical treatment Use careful restraint techniques and close monitoring 38 e-Module CPR and First Aid You have completed this module • It is required that you take a post assessment after completing this module. • Passing score is 100%. Complete the post assessment CPR and First Aide Review Quiz which is located on the Quia site 39 e-Module CPR and First Aid References American Heart Association. (2010). Basic life support for health care providers. American Heart Association. Experts for everyday emergencies.. Emedicinehealth. Retrieved (2010, May 15) from http://www.emedicinehealth.com/script/main/art.asp?articlekey=60041 Miller, C. D. (2002). Silent killer: Death by restraint. Brookfield WI: Crisis Prevention Institute. Molson Medical Informatics Project, M., Molson Medical Informatics Project, M., (2009). Correct Use of the Thorasic Restraint Vest. MedEdPORTAL: http://services.aamc.org/30/mededportal/servlet/s/segment/mededportal/?subid=6851 Protection and Advocacy, INC. (PAI), (2002). The Lethal hazard of prone restraint: positional asphyxiation (Publication # 7018.01). Oakland, CA: Disability Rights California. 40