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
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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 [email protected]
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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
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• 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.