Basic Life Support Measures (Primary Survey)

BLS measures for a person in cardiopulmonary arrest include cardiopulmonary resuscitation (CPR) and early defi brillation with an automated external

Morton_Chap11.indd 137

TA B L E 1 1 - 1

Equipment Purpose

Intubation equipment Straight and curved blades Endotracheal tubes Syringes

Oropharyngeal airways Nasopharyngeal airways

• Provides adequate, patent airway, thus ensuring oxygenation of the lungs during resuscitation

• Allows the patient to be placed on mechanical ventilation • Reduces chances for gastric distention, aspiration, or vomiting • Allows for the administration of oxygen in high concentrations

• Provides route for NAVEL medications (ie, those that can be administered via endotracheal tube): naloxone, atropine, valium, epinephrine, lidocaine Oxygen tank

Manual resuscitation bag (MRB) Suctioning equipment

Suction source Suction catheters Suction tubing

• Ensures that oxygen is available if wall oxygen is unavailable • Permits delivery of breaths manually

• Clears oropharyngeal (nasopharyngeal) airway before intubation • Ensures that suctioning is available if wall suction is unavailable

IV fl uids and tubing • Improves hypotension

Nitroglycerin tubing • Prevents precipitation of IV nitroglycerin Medications (advanced cardiac life support

[ACLS] drugs as a minimum) Amiodarone Lidocaine Atropine Epinephrine Sodium bicarbonate Calcium chloride D₅₀ Adenosine Magnesium

Premixed dopamine infusion

• Used to support circulation, correct underlying dysrhythmias or electrolyte imbalances

Drip chart • Allows for rapid titration of ACLS/critical care drugs during and after resuscitation without having to perform complex calculations Blood tubes

Red—chemistries Blue—coagulation studies

Purple—hematology (complete blood count) Green—troponin

• Allows for the rapid drawing and sending of blood for analysis

Arterial blood gas (ABG) kits • Allows for rapid drawing and sending of ABGs Peripheral IV supplies • Ensures access for fl uid and IV drug administration Prefi lled fl ush syringes (normal saline) • Allows for faster fl ushing of IV lines

Needles • Allows for drawing up of medications

Decompression (cardiac) needles • Used in cardiac tamponade Clipboard with paper and pen; code sheets • Used to document the arrest

Pressure bags • Used for rapid infusion of fl uid boluses

Manual blood pressure cuff • Used to monitor effectiveness of resuscitation Gloves (latex, nonlatex, sterile) • Used for infection control

Defi brillator/transcutaneous pacemaker • Used for defi brillation, cardioversion, and temporary transcutaneous pacing

Resuscitation board • Used to create a fl at, hard surface to improve chest compressions

is being performed in the critical care unit), there is no pause for the breath; one team member pro- vides uninterrupted chest compressions, while the other administers the breaths using the MRB. A third team member checks the patient’s carotid or femoral pulses at regular intervals to determine the adequacy of compressions. If no third team member is present, CPR should not be interrupted for a pulse

check.3

Airway

The nurse assesses for an adequate airway. In an unintubated patient, the airway is opened using the head tilt–chin lift method or the jaw thrust

maneuver (Fig. 11-2). If the patient is intubated, the nurse suctions the artifi cial airway and attempts to ventilate the patient with the MRB. If spontaneous respirations do not return once a patent airway is established, then the patient must be assisted with breathing and an artifi cial airway secured if not already present.

Breathing

Oxygen is delivered as rescue breaths using an MRB. The MRB is connected to 100% high-fl ow oxygen, and either the mask portion is placed over the patient’s mouth and nose or the adapter is con- nected directly to the endotracheal or tracheostomy

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Code Management C H A P T E R 1 1 139

TA B L E 1 1 - 2

Drug Class Uses Dosages

Adenosine Antidysrhythmic Supraventricular

tachycardia, atrial fi brillation

6 mg rapid IV followed by 10 mL NS fl ush

Repeat twice with 12 mg Max. dose: 30 mg

Amiodarone Antidysrhythmic Ventricular tachycardia,

supraventricular tachycardia, atrial fi brillation, ventricular fi brillation

150–300 mg bolus, 1 mg/min for 6 h, then 0.5 mg/min for 18 h

Atropine Anticholinergic Bradycardia 0.5–1.0 mg IV

Max. dose: 3 mg

Calcium chloride Electrolyte Hyperkalemia,

hypocalcemia, calcium channel blocker toxicity

Syringe 10 mL of 10% solution (100 mg/mL), 2–4 mg/kg Dobutamine Inotrope; β₁ agonist Decreased cardiac output 5–20 μg/kg/min

Dopamine Inotrope; β₁ agonist Hypotension 5–20 μg/kg/min

Epinephrine Catecholamine Ventricular fi brillation

Pulseless ventricular tachycardia, pulseless electrical activity

Syringe 1:10,000, 1-mg bolus IV Repeat q 3–5 min

Isoproterenol Catecholamine; β agonist Ventricular tachycardia, ventricular fi brillation

Drip 0.5–5 μg/min

Lidocaine Antidysrhythmic Ventricular tachycardia,

ventricular fi brillation

Bolus 1–1.5 mg/kg Drip 20–50 μg/kg/min

Magnesium sulfate Electrolyte Torsades de pointes Drip 1–2 g/50 mL

Normal saline Nitroglycerin Coronary vasodilator Myocardial infarction, angina 5–100 μg/min

Procainamide Antidysrhythmic Ventricular tachycardia,

ventricular fi brillation

Bolus 5–10 mg/kg over 8–10 min Drip 20–30 mg/min

Sodium bicarbonate Alkalinizer Acidosis 50 mEq syringe

Normal dose is 1 mEq/kg Vasopressin Nonadrenergic, endogenous

antidiuretic hormone; vasoconstrictor

Ventricular fi brillation Pulseless ventricular

tachycardia

40 U to be substituted for the fi rst of second dose of epinephrine Verapamil Calcium channel blocker Supraventricular tachycardia 2.5–5 mg IV over 2 min

Repeat 5–10 mg in 15–30 min

F I G U R E 1 1 - 1 Delivering chest compressions. To be effective, chest compressions must be applied using

proper technique.

Morton_Chap11.indd 139

tube. The bag reservoir is squeezed to deliver breaths while observing the rise and fall of the chest wall to verify that the breaths are actually ventilat- ing the lungs. Another team member can auscultate the patient’s lung fi elds to confi rm that the delivered breaths are reaching the lungs.

RED FLAG! Chest compressions should

not be interrupted to deliver the breaths. The AHA recommends asynchronous breathing with chest compressions.

A

B

F I G U R E 1 1 - 2 A: The head tilt–chin lift maneuver is used to open

the airway in an unintubated patient. B: The jaw thrust maneuver is used without head extension if cervical spine trauma is suspected.