Friday, December 23, 2011

Medical emergency ( BLS)

Basic Life Support

· Includes the recognition of signs of sudden cardiac arrest (SCA). Heart attack, stroke, and foreign- body airway obstruction (FBAO); cardiopulmonary resuscitation; and de-fibrillation with an automated external defibrillator (AED).
Check for Response
· The rescuer should ensure the scene is safe, the rescuer should check for response.
· To check for response, tap the victim on the shoulder and ask, “Are you all right?” If the victim is responsive but is injured or needs medical assistance, leave the victim and call 911.
· Then return as soon as possible after calling for help, recheck the victim’s condition.

Activate the emergency medical services (EMS) system

· For one rescuer who finds an unresponsive adult, the rescuer should activate the EMS system (911), get an AED (if available), and return to the victim to provide CPR, and defibrillation if needed.
· If 2 or more rescuers are present, one rescuer should begin the steps of CPR while a second rescuer activates the EMS system and gets the AED.
· If the emergency occurs in a facility with an established medical response system, notify that system instead of the EMS system.
· If phoning for help, the rescuer should be prepared to the dispatcher’s questions about location, what happened, number & condition of victims, type of aid provided. ( Note: The caller should hang up only when instructed to do so by the dispatcher & should then return to the victim to provide CPR)

Open the Airway and Check Breathing

· To prepare for the CPR, place the victim on a hard surface in a face up position (supine).
· If an unresponsive victim is face down (prone), roll the victim to a supine position.
· If a hospitalized patient with an advanced airway, the health care provider may attempt CPR with the patient in a prone position.
· Healthcare Provider: should use the head tilt-chin lift maneuver to open the airway of a victim without evidence of head or neck trauma. If a healthcare provider suspects a cervical spine injury, use a jaw thrust without head extension.
· Check breathing: Determine breathlessness and maintain open airway. Place ear over mouth, observing chest. Look, listen, feel for breathing. (5-10 seconds)


Give Rescue Breaths

· Give 2 rescue breaths, each over 1 second, with enough volume to produce visible chest rise
o Mouth-to-Mouth Rescue Breathing
§ Open the victim’s airway, pinch the victim’s nose, and create an airtight mouth-to-mouth seal.
§ Give 1 breath over 1 second, take a regular breath, and give a second rescue breath over 1 second.
o Mouth-to- Barrier Devise Breathing
§ Barrier devices are available in 2 types: face shields and face mask
§ Face shields are clear plastic or silicone sheets that reduce direct contact between the victim and rescuer but do not prevent contamination of the rescuer’s side of the shield.
§ Masks used for mouth-to-mask breathing should contain a 1-way valve that directs the rescuer’s breath into the patient while diverting the patient’s exhaled air away from the rescuer.
§ If oxygen is available, healthcare providers should provide it at a minimum flow rate of 10 to 12 L/min.

o Mouth- to- Nose and Mouth- to-Stoma Ventilation
§ Mouth-to-nose ventilation is recommended if it is impossible to ventilate through the victim’s mouth.
§ A mouth-to-stoma rescue breath is recommended to a victim with a tracheal stoma who requires rescue breathing. An alternative is to create a tight seal over the stoma with a round pediatric face mask.

Pulse Check for Healthcare Providers

· Determine pulselessness, in adult feel for carotid pulse for 5-10 seconds and maintain an open airway. For infant feel for brachial pulse, maintaining head-tilt.
· For two-rescuer CPR, one person assesses while other rescuer assumes proper position for external chest compressions.


Chest Compressions

· Increases the intrathoracic pressure and directly compresses the heart.
· The victim should lie supine on a hard surface, with the rescuer kneeling the victim’s thorax.
· Correct hand placement for chest compression is crucial. The rescuer should place the heel of the hand on the lower half of the sternum, between the nipples and then place the heel of the second hand on top of the first so that the hands are overlapped and parallel.
· For adult, the rate of compression is 100 per minute at a depth of 1 ½ to 2 inches (4 -5cm), then allow the chest to return to its normal position. Perform 5 complete cycles; then reassess the victim.
· For infant, place 2 fingers on the sternum, 1 finger’s width below line and with a depth of 1/3-1/2. For neonates use chest encirclement technique.
· Recommended compression-ventilation ratio is 30:2. Give cycles of 30 compressions and 2 breaths for adults, one or two rescuers. For infant or child use 30:2 for single rescuer and 15:2 for 2 rescuers.
· Reevaluate the patient’s pulse every 2 minutes and every 5 cycles thereafter. If pulse returns but not breathing, continue with rescue breathing only.


· All BLS providers should be trained to provide defibrillation.
· Defibrillation is not recommended for infants <1 year of age.
· If shockable, resume CPR immediately for 5 cycles. Check rhythm every 5 cycles.
· Continue until ALS providers take over or victim starts to move.
· Use adult pads ages 8 and above.

to watch video on cpr and defibrillation click on this


Ethics – The branch of philosophy concerned with distinction between right and wrong based on body of knowledge

Morality – Behavior in accordance with custom or tradition

Nurse Practice Act – A series of statutes that have been enacted by each state legislature to regulate the practice of nursing in that state

Standards of care – Are guidelines that identify what the client can expect to receive in terms of nursing care

Contracts – Nurse are responsible for carrying out the terms of a contractual agreement with the employing agency and client
• Hospital staffing
• Floating

Good Samaritan Law – Encourage health care professional to assist in emergency situations without fear of being sued for the care provided

Legal risk areas
Good Samaritan Law – Encourage health care professional to assist in emergency situations without fear of being sued for the care provided

False imprisonment – Occurs when a client is not allowed to leave a health care facility when there is no legal justification to detain the client
Defamation – Is a false communication or a careless disregard for the truth that causes damage to one’s reputation

Informed Consent – Is the client’s approval to have his or her body touched by a specific individual

Client privacy – Client right to protection against unreasonable and unwarranted interference into private affairs

Confidentiality – A special relationship exist between the nurse and client , in which information discussed will not be shared with a third party
Medical records
•Client has the right to read the medical records
•Only staff members directly involved in care has legitimate access to a clients record

Patient Self determination act – Right to identify written direction about the care that they wish to receive in the event that they become incapacitated and are unable to make health care decisions
• Advanced directive
• Durable power of attorney