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ACLS Respiratory

ACLS Respiratory Arrest Case

You assess your patient and find that they are unconscious and not breathing what do you do? Alert Emergency Response System and get AED. Tell them the patient is unconscious and not breathing.
You’ve alerted the Emergency response system and an AED is on the way. What’s your next step? Check carotid pulse for 5-10 seconds
You’ve checked for a pulse and found that the patient has a pulse but is still not breathing. What is your next step? Start rescue breathing at a rate of 1 breath every 5-6 seconds to equal 10- to 12 breaths per minute using a bag mask or advanced airway device. Recheck for pulse every 2 minutes.
Discuss the varied ventilation rates depending on situation or device in use. During cardiac arrest :Bag mask 2 ventilations after every 30 compressions or any advanced airway 1 ventilation every 6 – 8 seconds for a total of 8-10 breaths per minute. Respiratory arrest: 1 ventilation every 5-6 seconds
How should breaths delivered to your patient look? Each breath should take one second and produce visible chest rise. Deliver approximately 600ml per breath. Do not hyperventilate.
The ACLS team has arrived. What is the next step? Airway. Support patent airway. Suction if needed. Determine if advanced is required. Confirm proper vents to CPR. Confirm proper placement of airway. Ausculation, O2 sat, cyanosis, monitor with continuous capnography. Make sure airway is secured.
Your patient has capnography and patent airway. What is the next step? Assess breathing. Give 100% o2 to Cardiac Arrest pt. Titrate to 94% by pulse ox for others. Check clinical criteria for adequacy – chest rise, cyanosis, O2 sat, capnography
Your patient has O2 sating > 94% chest rise, good color, adequate capnography. Now what? Assess circulation. Check rhythm, Check BP Get IV/IO access, Give medications and fluids as indicated
Your patient is still unresponsive although breathing is being adequately supported and circulation is adequate. What do you do now? Differential diagnosis – search for, find, and treat reversible causes
Why is it so important to avoid excessive ventilation? Excessive ventilation increases intrathoracic pressure impeding venous return to the heart and cardiac output. It also can lead to gastric inflation which could lead to vomiting and aspiration of gastric contents.
What is the most common cause of a blocked airway and how is it addressed? relaxation of the throat muscles – Use head tilt chin lift or jaw thrust maneuver if trauma is suspected
What if the jaw thrust maneuver is ineffective for a trauma patient? Airway takes priority
Which patients should receive a OPA or NPA? only those who are unconscious without gag or cough reflex when airway support is required, during bag mask ventilations, or in an intubated patient to facilitate suctioning and and prevent biting and occluding the ET tube
What is the procedure if your patient was known to be choking and is now unresponsive? check the mouth for foreign object and remove if possible. If not start CPR and check for the possibility of removing foreign object each time you open the airway to give breaths
Name six Basic Airway skills. Head tilt- chin lift, jaw thrust, Mouth to mouth, mouth to nose, mouth to barrier device, bag mask
What is the E C technique? use of the thumb and first finger to make a C to clamp the mask to the patient and the remaining fingers make an E to lift the jaw
Describe the procedure for insertion of an OPA. clear the mouth and pharynx with suction, select proper size (tip at corner of mouth and flange at angle of jaw), insert upside down rotate to proper position as the OPA reaches the posterior wall of the pharynx, check not to push the tongue back
Which patients are good candidates for NPO? Ok for conscious or semiconscious when indicated, OPA is difficult or dangerous such as gag reflex, tismus, mouth trauma, wired jaws, or in neurologically impaired with poor pharyngeal tone
Explain the technique for insertion of a NPA. Select proper size (from tip of nose to earlobe and approximate size of smallest finger – no blanching of nostril) Lubricate with water soluable lubricant, Insert perpendicular to plane of face, Try other nostril if one doesn’t work.
What safety concerns are associated with NPA? Nasal irritation can cause bleeding – clots into trachea, suctioning may be needed, too large may enter esophagus leading to gastric inflation, may cause laryngospasm and vomiting, possible placement into cranial cavity with facial fracture
Discuss the use of soft vs rigid suction catheters. Soft are for in place airways, aspiration of thin secretions in the oro- or nasopharnx. Rigid are for the oropharynx and thick secretions
Describe the process of suctioning an ET tube. Provide 100% oxygen, suction for 10 seconds or less, provide 100% oxygen
How do ventilations differ if and advanced airway is in place? the rate of compressions to ventilations is no longer 30 to 2. Ventilations do not interrupt compressions and are provided at 1 breath every 6 – 8 seconds (8-10) unless the patient has a pulse then the rate is 5-6 seconds (10-12 breaths per minute)
What do you do if the patient needs airway assistance and spinal injury is suspected? Have a team member stabilize the head in a neutral position during airway manipulation. Do not use an immobilization device.
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