Practical Resuscitation: Recognition and Response

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This change should be done with minimal interruption to compressions. This should be done during planned pauses in chest compression such as during rhythm assessment.

Practical Resuscitation: Recognition and Response by Pam Moule, John Albarran -

Use whatever equipment is available immediately for airway and ventilation e. Use an inspiratory time of about 1 second and give enough volume to produce a visible rise of the chest wall. Avoid rapid or forceful breaths. Add supplemental oxygen as soon as possible. There are usually good clinical reasons to avoid mouth-to-mouth ventilation in clinical settings, and it is therefore not commonly used, but there will be situations where giving mouth-to-mouth breaths could be life-saving e. If there are clinical reasons to avoid mouth-to-mouth contact, or you are unable to do this, do chest compressions until help or airway equipment arrives.

A pocket mask or bag-mask should be immediately available in all clinical areas. Tracheal intubation should be attempted only by those who are trained, competent and experienced in this skill, and can insert the tracheal tube with minimal interruption less than 5 seconds to chest compressions.

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If a supraglottic airway e. LMA device has been inserted it may also be possible to ventilate the patient without stopping chest compressions. As soon as a defibrillator arrives, apply the self-adhesive pads to the patient's chest whilst chest compressions are ongoing. The use of adhesive electrode pads will enable rapid assessment of heart rhythm compared with the use of ECG electrodes.

All other team members must now be informed to stand clear of the patient whilst the defibrillator is charged and a safety check performed.

Once the defibrillator is charged and the safety check completed, stop chest compressions, deliver the shock and restart chest compressions immediately. Do not delay restarting chest compressions to check the cardiac rhythm. Using a manual defibrillator it is possible to reduce the pause between stopping and restarting of chest compressions to less than 5 seconds. If staff cannot use a manual defibrillator, use an automated external defibrillator AED.

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Switch on the AED and follow the audio-visual prompts. All actions should be planned by the team before pausing chest compressions. If there are delays caused by difficulties in rhythm analysis or if individuals are still in contact with the patient, chest compressions are restarted whilst a decision is made what to do when compressions are next paused. Continue resuscitation until the resuscitation team arrives or the patient shows signs of life. Follow the Advanced life support algorithm. Once resuscitation is underway, and if there are sufficient staff present, prepare intravenous cannulae and drugs likely to be used by the resuscitation team e.

Use a watch or clock for timing between rhythm checks. Any interruption to CPR should be planned. Assess the cardiac rhythm about every 2 minutes. Identify one person to be responsible for handover to the resuscitation team leader. Use a structured communication tool for handover e. This diagnosis can be made only if you are confident in assessing breathing and pulse or the patient has other signs of life e. If there are any doubts about the presence of a pulse, start chest compressions and continue ventilations until more experienced help arrives. All patients in respiratory arrest will develop cardiac arrest if the respiratory arrest is not treated rapidly and effectively.

If the patient has a monitored and witnessed cardiac arrest If a patient has a monitored and witnessed cardiac arrest in the catheter laboratory, coronary care unit, a critical care area, or whilst monitored after cardiac surgery, and a manual defibrillator is rapidly available: Confirm cardiac arrest and shout for help.

Rapidly check for a rhythm change and, if appropriate check for a pulse and other signs of ROSC after each defibrillation attempt.

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Start chest compressions and continue CPR for 2 min if the third shock is unsuccessful. These initial three stacked shocks are considered as giving the first shock in the ALS algorithm. A precordial thump works only rarely. Using the ulnar edge of a tightly clenched fist, deliver a sharp impact to the lower half of the sternum from a height of about 20 cm, then retract the fist immediately to create an impulse-like stimulus.

Background notes Hospital and staff factors The exact sequence of actions after in-hospital cardiac arrest depends on several factors including: location clinical or non-clinical area; monitored or unmonitored patients skills of staff who respond number of responders equipment available hospital system for response to cardiac arrest and medical emergencies e. MET, cardiac arrest team. Location Monitored cardiac arrests are usually diagnosed rapidly. Skills of staff who respond All healthcare professionals should be able to recognise cardiac arrest, call for help, and start resuscitation.

Number of responders The single responder must ensure that help is on its way. High quality CPR The quality of chest compressions during in-hospital CPR is frequently sub-optimal and interruptions are often prolonged. Defibrillation strategy The length of the pre-shock pause i.

National Cardiac Arrest Audit All in-hospital cardiac arrests should be reviewed and audited. Accreditation is valid for 5 years from March More information on accreditation can be viewed at www. Part I. Resuscitation ;e1-e Resuscitation ;e71—e Agency NPS. Establishing a standard crash call telephone number in hospitals.

Patient Safety Alert London: National Patient Safety Agency; European Resuscitation Council Guidelines for Resuscitation Section 2 Adult basic life support and automated external defibrillation. Resuscitation ; BTS guideline for emergency oxygen use in adult patients. Thorax ;63 Suppl 6:vi RSVP: a system for communication of deterioration in hospital patients. Br J Nurs ; The teaching of a structured tool improves the clarity and content of interprofessional clinical communication. Qual Saf Health Care ; Perceptions of collapse and assessment of cardiac arrest by bystanders of out-of-hospital cardiac arrest OOHCA.

Crit Care Med Incidence, staff awareness and mortality of patients at risk on general wards. The "OBS" chart: an evidence based approach to re-design of the patient observation chart in a district general hospital setting. Postgrad Med J ; Review and performance evaluation of aggregate weighted 'track and trigger' systems. A review, and performance evaluation, of single-parameter "track and trigger" systems. Introduction of the medical emergency team MET system: a cluster-randomised controlled trial. Lancet ; Nurse-staffing levels and the quality of care in hospitals. N Engl J Med ; Hogan J.

Why don't nurses monitor the respiratory rates of patients?

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Buist M. The rapid response team paradox: why doesn't anyone call for help? Crit Care Med ; Delayed time to defibrillation after in-hospital cardiac arrest. The immediate life support course. Nolan J. Advanced life support training.