A Review Of The Effectiveness Of CPR In A Case Scenario Based On Anzcor Guidelines

A cardiac arrest is the sudden loss in heart function caused by an electrical fault. The heart’s pumping mechanism is interrupted, and the body is deprive of oxygen and blood. This condition usually comes with a lack of breath and consciousness. This situation is extremely deadly with a high death rate. Only 10% of Australia’s 20,000 cardiac patients survive each year. The Victor Chong Cardiac Research Institute conducted a study that confirms this. Emergency care must be provided immediately and appropriately to prevent death and morbidity. The survival rate and the neural outcome are higher when cardiopulmonary resuscitation is performed properly and promptly. This includes defibrillation as well as quality care following an arrest. I watched the YouTube video, and compared what was done with the ANZCOR guidelines that we studied in class. The team clearly had both strengths and weaknesses. This paper will look at their practice, using the guidelines and existing research.

The video begins as a nurse enters a hospital ward in order to administer medication. As she approaches, she notices the patient does not respond. She calls him and says that he’s not breathing. She then touches the patient to confirm that he’s not just sleeping, but is actually unconscious. When she examines the patient, she determines whether there are any obvious causes of unconsciousness. She followed the 2016 ANZCOR Guidelines on Basic Life Support by confirming the unconsciousness and assessing the immediate danger.

First mistake: The nurse checks to see if a patient is still breathing before calling for help. The national guidelines recommend that all personnel, whether trained or not, should first call for assistance before starting CPR. The reason for this is that the CPR exercise requires a lot of different activities, which can’t be done by just one person. Nehme & Andrew carried out a study that found improved outcomes when first responders called for help immediately. The nurse fails to check the airway prior to assessing breathing. She should first have looked for solids or visible secretions in the mouth and removed them, before opening the airway with the head tilt chin lift maneuver. Newel claims that a simple head-tilt and chin-lift maneuver can help restore airway patentness. The return of normal circulation is also facilitated. It is important to assess breathing after opening up the airway.

The nurse is using the wrong technique for checking breathing. She only looks at his neck, then touches it to determine that he’s not breathing. Kaihula Sawe’s (Kaihulaet.al.,2018) recommendation to look, listen, feel and check for breathing signals is contrary to what the woman did. It’s best to look at the chest and listen with your ear close to your nose. Not all breathing patterns are effective. They are seen in patients during the early stages.

Cardiopulmonary resuscitation must be initiated immediately if normal breathing is not present. In the video, unfortunately, the first nurse is seen going to her team rather than starting the proper procedures. The nurses arrive and one checks the radial heartbeat while the other takes the BVM. After six breaths, they take a break. They never give chest pressure during the resuscitation. CPR should be performed in a 30:2 ratio, starting with chest compressions followed by breaths. Recent protocols do not include checking the pulse. Johnson and Pearson found that both laypeople and trained medics have difficulty identifying a pulse when resuscitating a patient (Johnson and Pearson, 2018). Rescuers should focus on giving breaths and chest compressions before wasting any time trying to locate a pulse.

CPR should include chest compressions. This is based on research. The compressions mimic the heart’s pumping action by increasing intrathoracic blood pressure. This pushes the oxygenated blood into the tissues. When performing compressions, place the rescuer to the right (if the patient is right handed) and the compression hands at the middle or nipple of the sternum. The compressions must be rapid and intense, with 100-120 compressions a minute. The compressions must be at least 2 inches deep with minimal interruptions. (Ewy, 2016,) The rescue breaths must be administered by a team member using the bag-valve and mask after each 30 compressions. As you inflate air, look for chest lift. If there is no rise in the chest, it’s time to reevaluate the patency. This cycle of compression breathing should be continued with minimal interruptions and at most lasting no more than 10 second.

I was surprised to learn that the team relies heavily on defibrillation in order to revive the patient. They immediately analyze the heart rhythm after arriving. Defibrillation should be used after the initial CPR cycle. In accordance with the most current guidelines, compressions must be stopped. Pads placed on chest are used to assess the heartbeat. In this situation, it happened after the six first breaths. However, the correct analysis of rhythm was done and they identified when to shock. Following the initial shock, they then make a new mistake and analyze and shock for a 2nd and 3rd time. After a few minutes of unsuccessful practice, they bring the pads back. It is correct to continue CPR for at least two minutes after the initial defibrillation before re-entering shock and analysis. The patient should recover until both shock and analysis are performed.

The video also shows a wrongful drug use. Unknown amounts of epinephrine were administered after the 4th shock. National guidelines say that this timing is incorrect. Nolan says the first dosage of adrenalin is to be administered following successful first CPR and defibrillation. The leader fails to mention that the correct dose of adrenalin is 1mg. They should have given the second dose after two successful CPRs if they were using adrenalin regularly. The mistake is to give amiodarone right after the dose of adrenalin. Amiodarone can be used in a resuscitation situation. In fact, the dose was 300mg according to the European Resuscitation Council. This is given to the patient when their heart rhythm was shockable. They didn’t take into account the fact that this drug is only given after three consecutive sets of CPR with defibrillation. However, the routes were correct.

The team does not attempt to determine what is likely the cause of the cardiac arrest. In order to prevent future incidents and manage the arrest, it is protocol to determine the cause. Jimenez says that the first thing to do is determine if the admission reason was the cause of cardiac arrest, then consider other factors. The body’s temperature is measured in order to exclude hypothermia. A glucose test is performed at the bedside, as hypoglycemia causes arrests. Pulse Oximetry should be performed to verify that oxygen partial pressure is over 90. Other gases found in the arterial system can also be analyzed. The lungs are listened to and the chest is observed to see if it rises in symmetry during ventilation. Naloxone is an opioid antagonist that can reverse the condition if it was caused due to opioid toxins. Blood electrolyte tests should have evaluated the imbalance of potassium.

A poor procedure prevents the team from providing post-resuscitation support. I only see the team reevaluating the patient’s pulse. This is not present at the end. After several CPR/defibrillation cycles, the pulse usually appears. The adequacy is assessed and the spontaneous breathing and airway are further evaluated. In the majority of cases, oxygen is administered to the patient and they are moved into the intensive care unit. The ICU treatment of patients who have suffered a cardiac arrest has been shown to improve their outcomes. The electrocardiogram (12 leads) is used to monitor the heart’s physiological state in the ICU. Moreover, the CO2 level and oxygen saturation are monitored constantly. Blood glucose and room temperature are closely monitored.

The video shows a team with poor leadership. The roles of the team members are not clearly defined on site. Some members will stand around and impede the work of others. For example, two people may want to perform defibrillation simultaneously. The team has poor communication. The team is not communicating well. One of the two decides at some point to leave before stabilizing the patients. The events are not recorded and no drugs are administered. This group doesn’t have any teambuilding experience and hasn’t been exposed to their own guidelines. The video shows how a lack of coordination in resuscitation leads to a higher risk of deviation from the standard guidelines.

Cardio-pulmonary resuscitation can save lives when done correctly. Both laypeople and medical professionals can benefit from this. This prevents not only death but other conditions related to oxygen deprivation. The practice should be regulated to ensure the best possible procedures are followed. For effective emergency medical care, these procedures should also be taught in schools and to medical practitioners. Simulations, team-building exercises, and leadership training can improve resuscitation skills.

Citing

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