Download CPR and First Aid

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
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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
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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)
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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).
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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
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CPR and First Aid
Remember…
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CPR and First Aid
TYPES OF MECHANICAL AIRWAYS
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CPR and First Aid
Maintaining a patent airway may require an:
• Oral Pharyngeal Airway (OPA)
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CPR and First Aid
• Nasopharyngeal Airway (NPA)
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CPR and First Aid
• Laryngeal Mask Airway (LMA)
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CPR and First Aid
FOREIGN BODY AIRWAY OBSTRUCTION
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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):
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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
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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
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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
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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.
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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
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CPR and First Aid
Basic First Aid
For the Patient in Restraints
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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
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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
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CPR and First Aid
Cuts and Abrasions
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Control of Bleeding
-including a self inflicted injury
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CPR and First Aid
Nosebleeds
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Sprains and Strains
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Impaled Objects
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First Aid for Fainting
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First Aid for the Attempted Hanging Patient
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RESTRAINTS
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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
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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
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Restraint Dangers!
•
•
Application and
monitoring must be done
by persons deemed
competent
Essential for safety!
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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
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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!
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(Credit to www.charleydmiller.com)
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CPR and First Aid
Excited Delirium Syndrome
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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
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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
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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
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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.
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