The initial management sequence

A respiratory or cardiac arrest may occur at any time and any place within the healthcare environment. Though these may be unproblematic, complications can exist, such as the patient who is:

• in a wheelchair with a bilateral amputation of their legs;

• prone on the operating table mid procedure;

• collapsed whilst on the toilet and has become wedged between the toilet and the cubicle wall;

• on the treadmill during an exercise test in the cardiology department;

• found hanging from the fire escape following a suicide attempt.

Or it may be a member of staff who has arrested in the hospital canteen.

In responding to any situation it is imperative that first responders ensure their own safety. Only then can they begin to deal with the situation. The following issues need to be considered.

Assessment of the patient

Assess the patient in the position in which you find them for responsiveness, breathing and circulation. Ensure that the patient is for active resuscitation and does not have a 'do not attempt resuscitation' (DNAR) order placed on them.

Call for appropriate help

Activate any emergency buzzer in the department to ensure a quick response from your colleagues. Generally, there will always be other staff members around, allowing one or two people to deal with the patient whilst other members of the team dial the cardiac arrest number and fetch the emergency equipment to the patient. The person who makes the call for the cardiac arrest team should ensure that they dial the correct number. It is important to be clear and calm when talking to the operator. All staff should also be aware of where the nearest cardiac arrest trolley and defibrillator are located.

Get the patient into a supine position suitable for resuscitation to commence. If the patient is in bed, it is not absolutely essential for the headboard to be removed before airway management may commence.

Ensure that the mattress type is suitable for performing resuscitation. There are some mattresses that are unsuitable when chest compressions are being performed on a patient, such as an air mattress that will need to be deflated in the appropriate manner.

Arrested patient

Two-person basic resuscitation should commence and the arrival of the cardiac arrest team should be anticipated, as highlighted in Chapter 5. Remember that by the time the team arrives, the following should be occurring.

• Airway management being performed with either a pocket mask or bag-valve-mask, ideally with oxygen attached.

• Chest compressions being performed at the appropriate rate and depth and in co-ordination with airway management.

• Reasonable space around the patient to allow safe working of the team.

• Cardiac arrest equipment at the patient's bedside, particularly the defibrillator, which may already have been used if staff are appropriately trained.

• Cardiac monitoring has been established.

• Intravenous access may have been established or any existing access confirmed to be in working order.

• The patient's notes and drug chart immediately available.

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