COALINGA STATE HOSPITAL. Effective Date: August 31, 2006

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1 COALINGA STATE HOSPITAL NURSING POLICY AND PROCEDURE MANUAL SECTION Emergency Procedures POLICY NUMBER: 702 Effective Date: August 31, 2006 SUBJECT: CARDIOPULMONARY RESUSCITATION (CPR) 1. PURPOSE: To provide nursing staff with current and appropriate guidelines for the provision of CPR, which will provide oxygenated blood to the brain until appropriate, definitive medical treatment can restore normal heart and breathing function. 2. POLICY: 1. CPR shall be taught using, American Heart Association (AHA) standards. 2. Length of certification shall be two years. 3. Gloves and barrier devices shall be utilized while performing CPR. 4. All medical emergencies shall be responded to in a prompt and competent manner by all available nursing staff. 5. The most qualified staff person is in charge regardless of Civil Service Classification until relieved by a still more qualified person or the paramedics. 6. All appropriate emergency medical equipment, supplies, and emergency drugs shall be brought to the scene of an emergency. 3. DEFINITION: Cardiopulmonary Resuscitation (CPR) - the attempt to restore spontaneous circulation using the techniques of compression and pulmonary ventilation. -1-

2 4. GENERAL INFORMATION: An emergency situation where CPR may prevent death includes: heart attacks, drowning, electrocution, suffocation, drug intoxication, trauma, or any situation where there is an absence of pulse and or respiration. UTILIZE THE FOUR LINKS TO THE CHAIN OF SURVIVAL: 1. Early access: Immediately call 7119 to activate the EMS (Emergency Medical System) for a Individual in need of CPR. If more than one staff member is present, one should be sent to call If only one staff member is present they should call 7119 before initiating CPR. 2. Early CPR: CPR is more effective when started immediately after the victim s collapse. 3. Early defibrillation: Early defibrillation is the link in the chain of survival most likely to improve survival rates. Thus, no link in the chain of survival should delay defibrillation. 4. Early advanced care: Early ACLS provided by trained personnel at the scene is critical in the management of cardiac arrest. ACLS provides advanced ventilatory support, establishes intravenous access, administers drugs, controls arrhythmias, and stabilizes the victim for transport. 5. ASSESSMENT: 1. Assess for early warning signs of a cardiac arrest: -Chest discomfort not relieved by rest (lasting 10 minutes) or relieved by NTG. -Sweating, nausea, SOB, or a feeling of weakness. -Be alert that the discomfort may not be severe and the person may not have all of the symptoms. The person may be in denial. 2. If the Individual has collapsed or is found on the floor, assess the scene for hazards (e.g. fumes, smoke, etc) before approaching the victim to ensure your safety. -Check victim for responsiveness. -Call 7119 if no response. -Assess victim using ABCD (Airway-Breathing-Circulation-Defibrillation) rule: Airway must be cleared. Breath for the victim utilizing a breathing device if not breathing. -Assess for carotid pulse, if none begin chest compressions. -2-

3 3. Assess for presence of wounds or injuries that may require a modification in the usual method of performing CPR such as severe bleeding, trauma, and injuries to the mouth. 6. OUTCOME CRITERIA: To maintain adequate ventilation and circulation until more advanced life support arrives. 7. PRECAUTIONS: Personal protective equipment is to be used per Infection Control Policy. 8. COMPETENCY/TRAINING: Required per A.D. BARRIER DEVICES: Location, Advantages and Disadvantages Type of Device Location Advantages Disadvantages Pocket Mask Grounds presence Ease of use Increased tidal volume Delivers approx. 16% oxygen content. Bag Valve Mask (Ambu Bag) Crash Cart Delivers up to 100% oxygen with supplement oxygen of at least 10L/minute Decreased tidal volume. Difficult to use. 9. EQUIPMENT: 1. Gloves 2. Breathing device A. Ambu bag is most effective in delivering a higher percentage of oxygen B. Pocket Mask 3. Defibrillator 4. Emergency Cart 1. Oxygen cylinder with extension tubing 2. Portable suction machine -3-

4 PROCEDURE CPR: A. When a victim appears unconscious determine unresponsiveness. Gently tap or shake the victim and shout, Are you okay? If no response immediately activate EMS (call 7119). B. The person who calls the EMS system should be prepared to give the following information: A. Location of the emergency (building, unit number, ect); B. The telephone number from which the call is made; C. What happened (e.g. heart attack, injury if known, or signs/symptoms observed); D. How many people need help; E. Condition of the victim F. What aid is being given; G. Any other information requested; H. Hang up only when told by the dispatcher. C. Position the victim in a supine position on a flat surface. If victim is face down, roll the victim as a unit (log roll). Support the head, and neck, avoid twisting the body. D. Open the airway using the Head-tilt Chin lift maneuver. E. Check the victim for breathing: a. Look for chest to rise and fall; b. Listen for air escaping during exhalation; c. Feel for airflow A. Time is of the essence. Brian damage can occur in 4-6 minutes. B. CALL 7119 C. The head must be higher than the feet. Airway management and rescue breathing are more easily achieved in the supine position. D. This will move the tongue away from the back of the throat and open the airway. E. the side of you check should be positioned directly above the victim s mouth with your eyes looking down the length of the body. -4-

5 F. If victim is not breathing you must breath for the victim. Utilize protective breathing device. F. Give two shallow breaths. CPR PROCEDURE USING BAG-VALVE MASK DEVICE ( Ambu type): A. The mask is applied to the Individual s face with the rescuer s hand. The last two or three fingers are placed on the mandible while the remaining fingers are placed on the mask. A. The Ambu bag is preferred due to the higher oxygen delivery, 21% oxygen and increased to 100% oxygen with supplemental oxygen at 10L/min. B. You must maintain the head-tilt, keeping the anterior displacement of the mandible while finding the optimum mask fit. The bag is then compressed with the other hand or between the other hand and thigh, or by both hands of a second rescuer. Observe the rise and fall of the chest. Listen for any air leakage around the mask. B. You can connect Ambu device to oxygen with a small oxygen tank. Set at maximum flow rate at least, 10L. This assures an adequate oxygen supply in the reservoir. A. Proceed with CPR ventilation using approved technique. B. If the airway is open and the chest rises, check the carotid pulse for 5-10 seconds maintaining the head-tilt chin-lift. If pulse is present, maintain an open airway and perform rescue breathing (one breath every 5 seconds). A. One rescuer CPR has a 2 to 30, ventilation compression ratio. B. The carotid artery is the most accessible and reliable location for checking the pulse in adults. -5-

6 TECHNIQUE FOR CHEST COMPRESSIONS, ADULT CPR, ONE RESCUER: A. If the victim is not already on a hard surface, place a cardiac backboard under the victim s back. B. Begin chest compressions. Assure proper hand placement by sliding the middle and index fingers up the ribs to locate the landmark lower half of the sternum. Continue with compressions with the ratio of 30 compressions and 2 ventilations (30:2) at the rate of at least 100 compressions per minute. Compression depth 1 ½ to 2 inches. C. Check pulse and breathing after one minute. If pulse less, continue CPR with 2 breaths, followed by 30 compressions. Check pulse every few minutes. A. Activate EMS (dial 7119). D. Continue CPR until: -Victim s pulse and respiration s are restored. -Victim is turned over to certified advanced life support team. -Rescuer is exhausted. -Ordered to stop CPR by physician -6-

7 TECHNIQUE FOR CHEST COMPRESSIONS, ADULT CPR, 2 RESCUER A. The second rescuer should activate EMS (dial 7119). Give the following information: -Location of emergency (building, unit number, etc) -The telephone number from which the call is made -What happened (heart attack if known or signs/symptoms observed) -Condition of victim -What aid is being given -Any other information requested -Hang up only when told to by the dispatcher B. The first rescuer begins the ABCD s of CPR. Airway open airway and look, listen, and feel. Breathing Give two slow breaths. Circulation check for a carotid pulse. If no pulse, state no pulse start compressions. Defibrillation done by trained staff as soon as possible after appropriate equipment is on scene. C. The second rescuer commences external chest compressions at the rate of at least 100/minute, counting out loud one-and-two, three-and, four- and, fourand, five etc. A. The operator will announce a Code Blue to alert the MOC, NOD, ACNS, and HSS. B. The second rescuer assumes position at the chest in preparation to perform chest compressions. C. One rescuer is at the victim s side performing chest compressions while the other is at the head performing ventilations. D. Continue compression to ventilation ratio of 30:2. When the compressor becomes fatigued, the rescuer performing ventilations should exchange places. Stop CPR after the D. 30:2 is the new protocol per the American Heart Association for 1 or 2 person CPR. First minute to assess for pulse and breathing. Then repeat assessment every few minutes. -7-

8 E. Continue CPR until: a. Victim s respiration and pulse are restored b. Victim is turned over to ACLS trained staff c. Rescuers are exhausted d. Ordered to stop CPR by physician TECHNIQUE FOR 3 PERSON CPR: A. Follow the same procedure as Two person CPR. B. Rescuer one performs ABCD and gives two initial breaths by squeezing on the bag valve mask device. The second rescuer performs chest compressions. The third rescuer maintains the head in the correct position and holds the bag valve mask securely on the victim s face. B. The third rescuer does not change places. 10. EVALUATION: 1. While ventilations are being performed the chest should rise and air movement within -+the lungs should be auscultator. 2. While compressions are being performed a faint carotid pulse should be felt. 11. DOCUMENTATION: 1. Complete documentation should be done on both the Medical Emergency Flow Sheet CSH 7107 and the IDN note. 2. Complete Emergency Critique form. 12. CROSS REFERENCE: A.D. Medical Emergencies, A.D. Standard Precautions, NP&P Section 700 series, P&T Manual P&T Manual Emergency Medication Kits. NP&P #419 Oxygen Therapy, NP&P #610 Pulse Oximetry, NP&P #716 Monitor/Defibrillator -8-

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CPR https://youtu.be/5r7havfzxek CPR Saves Lives Cardiopulmonary Resuscitation or CPR and defibrillation within 3-5 minutes can save over 50% of cardiac arrest victims CPR followed by AED saves thousands