Media annotation part 2

  • Category:
    Nursing
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    Article
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    Undergraduate
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7Media Annotation

Bachelor of Nursing

NURS1131: Complex Care Nursing

Written assessment

Media Annotation

PART 1: MEDIA ANNOTATION TOOL

Time sequence

comments

030 seconds

  • 15 sec BARCG Guideline 3 – Recognition and First
    Aid Management of the Unconscious Person

  • 20 sec Guideline 5 – Breathing

  • 23sec PTS

  • 26sec BARCG Guideline 4- Airway

  • 30sec Guideline 7 — Automated External Defibrillation in Basic Life Support

Did not check the environment for hazard or dangers of the environment and herself and patient.

(Ensure the safety of both the person and rescuer)

Did not check the respiration rate/ chest movement/ squeeze the trapezius

First rescuer should LOOK for chest movement, LISTEN for the escape of air from nose and mouth; and FEEL the air from the mouth and nose.

Did not remove the pillow away;

It should be removed the pillow, let the patient lie flat. The tongue may block the airway.

Did not assess the airway, just commence the compression

It should be check for the airway that block by any foreign body

The first rescuer stopped the compression when respond the doctor’s question and wear gloves.

Do not waste the time to wear the gloves, compression should be commenced immediately

30seconds – 1min

  • 42 sec Guideline 5 – Breathing

  • 57 sec PNTS

  • 1min PNTS — SA

Did not count for compression

The ratio of compressions to rescue breaths is 30:2.

Delay to remove the pillow

It should be removed by first rescuer before commencing compression

The head of bed did not remove.

This situation may influence the oxygen supply, for deliver oxygen conveniently, it should be removed it.

1min – 1min30sec

  • 1min5sec BARCG Guideline 4 airway

  • 1min4sec PNTS – DM

  • 1min9sec PNTS – team

  • 1min 27sec BARCG Guideline 6 compressions

Did not tilt the jaw and head of the patient

(open the airway using the head tilt-chin lift)

Delay to unfasten clothes

It should be fasten the clothes before compression, make the patient easy to breathe.

No one count the compression

The nurse who does compression should count the number of compression to let others know what time to give ventilation.

Stop compression when talk to other medical staff

Interruptions to chest compressions should be minimised.

1min 30sec – 2min

  • 1min 50sec BARCG Guideline 6 compressions

  • 1min45sec PTS

Compression depth inadequate

It should be Compress as about 5cm

The nurse, who presses the shock button, did not move her hand away from the bed.

2min – 2min30sec

  • 2min30sec BARCG Guideline 11.4 Electrical Therapy for Adult Advanced Life Support

Did not tilt jaw and head, there is no chest movement

To open the airway, it should be lifting head and chin.

2min30sec – 3min

  • 2min48sec BARCG Guideline 11.4 Electrical Therapy for Adult Advanced Life Support

  • 2min54sec BARCG Guideline 11.5 Medications in Adult advance life support

The energy of second shock is the same as the first one;

The first shock is unsuccessful and the defibrillator can delivering the energy higher than 200J, to raise the energy to the maximum available for subsequent shocks.

There is no flush before IV drug administering;

20-30mls fluid flush must be giving before IV drug administering.

4min30sec – 5min

  • 4min40sec BARCG Guideline 11.6

Did not confirm the placement of the intubation and secure the tube.

The intubation should be make sure the position and monitor the adequacy of CPR, using wave capnography. They should secure the tube as well.

5min – 5min30sec

  • 5min11sec BARCG Guideline 11.5 Medication in Adult Advance Life Support

There is no flush before IV drug administering

20 – 30mls fluid flush must be giving before IV drug administering

5min30sec – 6min

  • 5min35sec PNTS – team

Delay to check the history and charts of the patient

Reviewing the patient’s past history and all medical charts is necessary.

6min30sec – 7min

  • 6min59sec BARCG Guideline 11.5 Medication in Adult Advance Life Support

There is no flush giving before IV drug administering

20 – 30mls fluid flush must be giving before IV drug administering

7min – 7min30sec

  • 7min26sec PNTS – comm

Delay to ask the family about the history that patient is no responsiveness.

8min – 8min30sec

  • 8min11sec BARCG Guideline 6 — Compressions

Stop the compression when change over and feel the pulse.

Interruption of the compression should be minimized.

8min30sec – 9min

  • 8min34sec BARCG Guideline 11.5 Medication in Adult Advance Life Support

There is no flush before IV drug administering

20 – 30mls fluid flush must be giving before IV drug administering

PART TWO: BASIC LIFE SUPPORT GUIDELINES

Basic Life Support is defined as a level in medical care that is normally used for victims of life threatening injuries and illnesses until the patients are in a position to obtain full medical care. Australian Resuscitation Council (2010) provides that basic life support can be administered by a medical personnel who include trained emergency paramedics and medical technicians as well as a qualify witness. Countries usually have well designed guidelines on how basic life support can be administered and are normally formulated by medical professional in these countries (Hallstrom et al, 2000). These guidelines normally outline how conditions such as cardiac arrest, drowning and chocking can be managed before seeking medical care. In Australia, the Australian and New Zealand Committee on Resuscitation (ANZCOR) (2010) gives guideline 3 that enables a nurses and other health professional to manage an unconscious person before administering any form of medication. The guideline states the following care on managing an unconscious person:

a) The health profession at all time should ensure that there is no any kind of eminent danger to the patient and himself or herself (Hallstrom et al, 2000). The health professional or the rescuer should ensure a safe surrounding right after arriving at the scene in order to avoid further accidents to himself or even the patient.

b) The patient need to be in a comfortable position and therefore, the health professional should assist the patient to the ground and position the patient to the side. Additionally, it is the duty of the health profession to practically ensure that the patient’s airway is open.

c) In any case of bleeding, it is the duty of the rescuer or the health profession to stop any bleeding and regularly check on the patient’s condition.

ANZCOR further provides DRABCD (Danger, Response, Shout/summon, Airway, Breathing, CPR and Defibrillation) which is used on an unconscious person by health professional upon first arrival. Australian Resuscitation Council (2010) provides that The DRABCD approach includes looking out for danger at the accident scene, checking for responsiveness, opening the airway, giving cardiac compressions and breaths and finally attaching an automated defibrillator (Idris et al, 2015).

Checking for Dangers

Idris et al (2015) explains that the bystander should check for any dangers, which may have caused the patient to collapse, and that which could further endanger the lives of both the rescuer /health professional. For example, if a patient has been electrocuted the rescuer must make sure that the power source has been switched of so as to make sure that the rescuer/health professional does not get electrocuted too. Idris et al (2015) maintain that, this is crucial as it ensure there are no new fatalities.

Check for response

According to Idris et al (2015), it is important for the health professional to check for responsiveness of the unconscious patient. This allow to out rule any eventually since unconsciousness may be a sign of cardiac arrest. The patient responsiveness is checked by way of shaking and shouting to the patient and observing whether the patients is responding. If the patient is unresponsive then the patient has a cardiac arrest and the health professional should call an ambulance right away. If the unresponsiveness is caused by an airway obstruction, then the health professional should commence resuscitation right away 1 minute before calling the ambulance (Idris et al, 2015).

Airway and Breathing

(Mathur and Leong, (2013) maintains that, the health professional should assess the breathing and airway of the patient by visually inspecting the airway, chin lift maneuvering and tilting the patient’s head to check for any sign of breathing. The head is a very sensitive part of human body due to the brain and therefore this need to be the first part for examination (Hallstrom et al, 2000). Further, respiratory inspection should secondly take place by way of visually looking at the chest movement and carefully listening for upper airway sounds. Usually, when a patient collapses there is a presence of deep breaths a minute after the collapse. According to Mathur and Leong (2013) the breaths may be mistaken for adequate breathing if the rescuer is untrained. If no breathing is present, then the rescuer should immediately conduct a Cardiopulmonary resuscitation (CPR). If the patient is breathing adequately, then the rescuer should turn the patient on her or his side and maintain this recovery position until the emergency services or the ambulance arrives (Koster et al, 2010).

Cardiopulmonary resuscitation (CPR)

According to Koster et al (2010), Cardiopulmonary resuscitation is also known as the rescue breathing. It involves the health professional or rescuer giving two breaths followed by thirty chest compressions for about one second each. (Koster et al, 2010) maintains that, there are three method of administrating breath to an unconscious patient that is, mouth to mouth, mouth to nose, and mouth to mask methods. Breath administering is done by kneeling beside the patient’s head, tilting the patient head upward, pulling the patients chin upwards and then administering two breaths at a time.

While conducting compressions, ANZCOR (2010) states that the following guidelines should be followed:

a) it is imperative that all health professionals or rescuers to conduct chest compressions for all unresponsive patients and those not breathing properly.

b) Interruptions to chest compressions should be avoided or minimized at all given points. Nonetheless, if interruptions are unavoidable then they should not last for more than twenty seconds.

c) Chest compressions should be done at the lower half of the sternum. The health professional should place the heel of the hand at the centre of the chest with the other hand on top and commence compressions.

d) Rescuers should perform about a hundred to one twenty compressions per ny given minute.

Circulation

Koster et al (2010) according to circulation should be ascertained by palpitation of pulse in order to check a cardiac arrest. If no pulse is noticed, then external chest compressions should be commenced immediately. External cardiac compressions (ECC) should be done when rescue breathing proves futile. Australian Resuscitation Council (2010) provides that the patient should be laid on a firm mattress or a backboard which enables the patient to lay flat. The compressions should be done on the lower side of the sternum for at least four to five cm in adult. Further, it is necessary that, total chest recoil should be allowed for each chest compression. Australian Resuscitation Council (2010) provides, a well-trained health profession should perform an external cardiac compression. The external cardiac compression should be performed at the rate of 100 per minute. External cardiac compressions should be done for thirty minutes. If the patient does not respond to the Cardiopulmonary resuscitation, then advanced life support measures should be provided (Mathur and Leong, 2013).

DEFIBRILLATION

According to Mathur and Leong (2013), defibrillation is an electrical method that is used to treat ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Non-shock able rhythms include pulseless electrical Activity. Australian Resuscitation Council (2010) provides that the main key points to be followed during defibrillation include:

a) Interruptions when carrying out chest compressions should be minimized. Interruptions results from a decrease in coronary perfusion pressure.

b) After each shock, CPR should be done for at least two minutes and assessment of circulation should be done.

c) During CPR doctors recommend other treatments such as intravenous therapy, advanced airway management and medication therapy.

d) Intravenous Therapy (IV) should be administered as soon as possible.

e) In order to facilitate effective drug delivery, the limb should be elevated for about 10 to 20 seconds with a 20ml to 30ml Intravenous flush after the medication.

f) Fluids should be administered if only the health professionals suspect hypervolemia.

g) When administering IV, the health professional should insert a peripheral cannula into a large vein in the peripheral vein for better IV access. The IV drug should be followed with a 30ml Sodium Chloride 0.9%IV flush.

Considering the guidelines above, the health professional did not follow the laid procedures used in basic life support emergencies.

Conclusion

In conclusion it is critical to note that, to ensure health professionals and rescuers achieve optimal outcome from a patient, various skills are necessary. Australian Resuscitation Council (2010) provides that, it is important to have critical thinking. Here, the rescuer is expected to provide rational thinking on the various facts presented. Secondly, it is imperative for the health profession to have problem solving skills. This will enable the health professionals to identify various solutions to the various issues arising using the available resources. Communication is another important skill. Finally, it is important to deploy team dynamics. Here it will be important to integrate and coordinate all team members working towards a defined goal.

Reference

Australian Resuscitation Council, New Zealand Resuscitation Council. Guideline 11.7: Post-resuscitation therapy in adult advanced life support. 2010. Available from: http://www.resus.org.au/policy/guidelines/section_11/guideline-11-7dec10.pdf. Accessed 15th May 2016.

Australian Resuscitation Council. Guideline 11.1. Introduction to advanced life support. 2010. Available from: http://www.resus.org.au/policy/guidelines/section_11/guideline-11-1dec10.pdf .Accessed 15th May 2016.

Hallstrom A, et al (May 2000). «Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation». N. Engl. J. Med. 342 (21): 1546–53.

Idris, H et al. Chest Compression Rates and Survival Following Out-of-Hospital Cardiac Arrest. Critical Care Medicine. 2015; 43(4): 840-848.

.. 2010; 81(1): 48-70ResuscitationKoster, R et al. Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.

. 2013; 3 (6):327-330. Trends in Anaesthesia and Critical Care. Mathur, D & Leong, S. Perimortem caesarean section: A review of the anaesthetist’s nightmare