Patient Care.pptx

7/29/2019 Patient Care.pptx

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PATIENT CARE

Chapter 19: Medical Emergencies


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CARDIAC ARRESTSIGNS AND SYMPTOMS

Cardiac arrest is the sudden stoppage of

cardiac output and leads to permanent organ

damage or death if not treated.

Death from cardiac arrest has been reduced

significantly since the advent of

cardiopulmonary resuscitation (CPR) and

the most recent availability of automaticexternal defibrillators (AEDs).


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Patients who are experiencing cardiac arrestgenerally complain of crushing chest pain

often described as feeling as though an

elephant is standing on the victims chest.

The pain may also radiate down the left arm


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CARDIOPULMONARY RESUSCITATION

The radiologic technologist should be familiarwith an institutions protocol for cardiacemergencies.

On realization that a patient has sufferedcardiac arrest, the appropriate alert shouldbe initiated before the beginning of CPR.

Because cerebral function is generallyimpaired if the brain is deprived of oxygen formore than 4 to 6 minutes.


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CPR must be initiated immediately onverifying hat cardiopulmonary distress exists,

but these procedures absolutely must be

performed only after determining that true

cardiopulmonary distress exists.

CPR provides external support for circulation

and respiration and consist of three primary

aspects the ABCs: airway, breathing and

circulation.


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ONE PERSON RESCUE

1. Establish unresponsiveness by gentlyshaking and shouting at the victim. If theseactions fail to rouse the person then call for

help and proceed with CPR. 2. Position the patient on his or her back on a

hard surface to facilitate CPR. A radiographictable is suitable. If the patient is lying on astretcher, then the backboard fromemergency cart should be used.


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3. Open the airway by tilting the head back,which helps prevent the tongue from falling

back and obstructing the airway. Place on

hand on the victims forehead and apply film

backward pressure while placing the fingers

of the other hand beneath the bony part of

the chin and lifting upward. The lips should

be close together, but the mouth should notbe completely closed.


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4. Establish breathlessness by placing an earover the patients nose and mouth andlooking toward the patients chest. In thisposition, listen for breath sounds. Look for

any rise and fall in the chest and feel for flowof air from the victims nose. If no breath isapparent then proceed with rescuebreathing.

5. Perform rescue breathing by putting thepalm of the hand on the victims foreheadand using the thumb and fingers to pinch

shut the victims nostrils.


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Take a deep breath and seal your lips aroundthose of the victim or place a facemasktightly over the nose and mouth. Initially blowtwo deep breaths, each of 1 second

duration, into the patients mouth or into themask while watching to determine whetherthe chest is rising and falling. Then takeanother breath between the ventilations. Thebreaths should not be rapid or forceful. If themouth is damaged or clogged, then sealingthe victims mouth closed and sealing your

lips or the mask around the nose of the


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6. Establish circulatory inadequacy bypalpating the carotid artery. If after 5 to 10

seconds the pulse is absent, then proceed

with the closed chest compressions.

7. Perform chest compressions by

positioning yourself to one side of the patient

and placing the hands properly. This action is

done by using the hand to find the loweredge of the rib cage and running the middle

and index fingers along the lower edge to the

point where the ribs meet the sternum.


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Place the middle finger at this notch, andthen place the heel of the other hand on the

sternum next to the index finger. The heel of

the hand should rest along the length of the

sternum. The other hand is placed on top of

the first and the fingers of both are interlaced

and extended to prevent their tips from

applying inadvertent pressure on the ribs.The elbows are locked with the arms

extended directly over the patients sternum

and compression is applied straight down


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The force applied should be sufficient todepress the sternum 1 to 2 inches in an

adult. Pressure should be released after

each compression to allow the sternum to

return to its original position, but the hands

should not be lifted from the sternum. Thirty

compressions should be alternated with two

ventilations the compressions are given at arate of approximately 100 per minute.


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8. Reassess after four complete cycles ofcompression and ventilations (15:2 ratio), by

taking no more than 7 seconds to reevaluate

the patient. If breathing and pulse are still

absent, then continue CPR checking every

few minutes for the return of pulse and

breathing.


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TWO-PERSON RESCUE

The protocol for CPR with two rescuers is

similar, but each rescuer independently

performs compressions or ventilations with

periodic switches of position. One rescuer isat the victims side and performs chest

compressions. The second rescuer is at the

victims head and maintains the open airwayand provides breathing, usually mouth to

mask.


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Compressions are delivered at the rate ofapproximately 100 per minute, with cycles of

30 compressions and 2 breaths. The breaths

are given during pauses in compression and

should be of approximately 1-second

duration. When rescuers become fatigued,

an organized switch of positions should take

place.


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INFANT RESCUE

The CPR procedure for infants and childrenis basically the same as that for adults, withadjustments made in the volume of air

delivered during artificial breathing and theplacement of the hands and the depth ofdepression of the sternum during externalchest compressions. When breathing for a

pediatric victim, the volume of air should bejust enough to cause the rise and fall of thechest.


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When performing chest compressions on

infants, the index finger should be placed on

the sternum just under the point where it

intersects with the intermammary line. Usingthe second, third and fourth (or only the third

nad fourth) fingers compress the sternum to

a depth of to 1 inch at rate of 100 perminute. In


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In infants and children, two ventilations are

given after 15 compressions. For a child up

to 8 years of age, the hand placement is the

same as for an adult. The chest, however iscompressed with only one hand to a depth of

only 1 to 1 inches.


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CONSIDERATION

CPR is not indicated in all situations of

cardiac arrest. If any doubt exist as it its

appropriateness, then it should be initiated.

CPR is clearly not indicated in instances inwhich patient, the patients family, or the

patients physician has specifically requested

that resuscitation not be done. In thesecases, a do not resuscitate (DNR) order

should be clearly indicated on the patient

chart.


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AUTOMATIC EXTERNAL DEFIBRILLATION

Ventricular fibrillation is fluttering or ineffectivecardiac rhythm that results in the hearts inabilityto pump blood.

Effective ventricular rhythm must be restoredwithin a few minutes to preserve life.

The use of AEDs is one of the few times CPRcan be interrupted.

One of the most important elements ofdefibrillation is time; performing it in less than 5minutes is considered critical to survival.

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