CPR and First Aid Review

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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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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

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)

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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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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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Remember…

e-Module CPR and First Aid

TYPES OF MECHANICAL AIRWAYS

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Maintaining a patent airway may require an:

• Oral Pharyngeal Airway (OPA)

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• Nasopharyngeal Airway (NPA)

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• Laryngeal Mask Airway (LMA)

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FOREIGN BODY AIRWAY OBSTRUCTION

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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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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-heimlich-maneuver

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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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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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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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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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Basic First Aid

For the Patient in Restraints

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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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Cuts and Abrasions

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Control of Bleeding -including a self inflicted injury

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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!

Credit to: McGill Molson Medical Informatics Project, McGill University Faculty of MedicineMMMI@mcgill.ca

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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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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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Excited Delirium Syndrome

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Excited Delirium Syndrome: Persons At Risk

• Fairly consistent profile • Need to recognize persons at risk

– Bizarre, violent, aggressive behavior – Overheating/excessive sweating or very

dry • 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 – Unbelievable strength – Undistracted by pain

• Broken bones, damaged limbs

– Irrational physical behavior – Hyperactivity – “Bug Eyes”

• These persons are likely to – Fight – Flee – Able to overpower personnel

and law enforcement

e-Module CPR and First Aid

• 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

Excited Delirium Syndrome: Scenario

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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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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.