Problem 5 - Clinical Nursing Skills and Techniques

Question

A visitor suffers a cardiac arrest, and resuscitation is begun. The nurse would be correct doing CPR and operating an AED if which of the following sequence of steps were followed? 1 Check for a pulse, provide chest compressions until the AED arrives, attach the AED, open the airway, provide two breaths if needed. 2 Wait for the AED, open the airway, provide two breaths if needed, check for a pulse, and attach the AED if no pulse. 3 Call for help, get the AED, open the airway, provide two breaths if needed, check for a pulse, continue compressions if no pulse is present, attach the AED. 4 Provide two breaths, check for a pulse, call for the AED, provide chest compressions until the AED arrives, attach the AED.

Step-by-Step Solution

Answer

The correct sequence is: Call for help, get the AED, open the airway, provide two breaths if needed, check for a pulse, continue compressions if no pulse is present, attach the AED.

Step 1: Identify Critical Actions After Determining No Pulse

Based on the Cardiac Arrest protocol, if there is no pulse, provide chest compressions immediately. This is critical to maintain blood circulation.

Step 2: Prepare for Defibrillation

Call for the AED as soon as possible because defibrillation is a key step in addressing cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia.

Step 3: Open the Airway and Provide Breaths if Necessary

Ensure the airway is open and provide two rescue breaths if trained and necessary, particularly if the arrest is due to a situation like drowning. These steps are to be followed if the chest compressions are not effective or as part of advanced care.

Step 4: Attach and Operate the AED

Once the AED arrives, immediately attach it and follow the instructions provided by the device. It may prompt further action like a shock or continue with CPR.

Key Concepts

Cardiac Arrest Protocol

When someone experiences a cardiac arrest, their heart suddenly stops beating effectively, causing blood flow to critical organs to cease. The first step in this emergency is to recognize the need for immediate action. According to the cardiac arrest protocol, you should begin CPR right away if there is no detectable pulse.

Start by checking for responsiveness and breathing. If the person is unresponsive and not breathing or only gasping, it is crucial to call for emergency services and an Automated External Defibrillator (AED) if available. Begin chest compressions without delay.

• Recognize cardiac arrest by assessing responsiveness and breathing.
• Call for emergency help and an AED.
• Immediately start chest compressions if no pulse.

This protocol is designed to enhance the chances of survival by maintaining blood circulation and preparing for possible defibrillation.

Chest Compressions

Chest compressions are a vital component of CPR. They help to keep blood circulating to the brain and other vital organs until advanced medical help arrives. For effective chest compressions:

• Place the heel of your hand on the center of the person's chest, between the nipples.
• Place the other hand on top and interlock your fingers.
• Perform compressions at a rate of 100 to 120 per minute.
• Push down hard and fast, compressing the chest 2 inches deep in adults.

Allow the chest to fully recoil between compressions. Recoiling lets the heart refill with blood, which is crucial for effective resuscitation. Compressions should continue without interruption until the AED is ready to be used or emergency medical personnel take over.

Airway Management

Proper airway management ensures that the person can breathe effectively if possible. Open the airway using the head-tilt-chin-lift maneuver. Here’s how you do it:

• Place one hand on the forehead and gently tilt the head back.
• Use the fingers of your other hand to lift the chin upwards, creating an open airway.

Once the airway is open, check for breathing again. If the person isn’t breathing, you can provide rescue breaths if trained to do so. Deliver two breaths, each lasting about one second, watching for chest rise.
Remember, inadequate or improper airway management can compromise respiratory efforts and hinder effective resuscitation. Airway management is particularly crucial in cases of drowning or asphyxiation.

Defibrillation Steps

Defibrillation is the process of delivering a controlled electrical shock to the heart. This shock can help restore a regular heartbeat in certain types of cardiac arrest, such as ventricular fibrillation. As soon as the AED arrives, switch it on and follow the spoken instructions. The steps usually include:

• Attaching the AED pads to the person's bare chest.
• Ensuring no one is touching the person during analysis.
• Following the AED prompts, which may advise a shock or the continuation of CPR.

If a shock is advised, make sure everyone stands clear of the patient before pressing the shock button. The AED will guide subsequent actions, which often include more cycles of CPR. Using an AED significantly increases survival odds when integrated promptly within the cardiac arrest protocol.