• Choose a category
• All
• Classic-Fiction

By Root 2097 0

ventilation but, as it is widely acknowledged that there is reluctance by some people in spite of the lack of evidence, an allowance has been made for them to only perform chest compressions (Resuscitation Council 2010b). The recommended length for each breath is now 1 second (Resuscitation Council 2010b). When cardiac arrest occurs in hospital, the Resuscitation Council recommends the use of adjuncts such as the pocket mask or the bag mask unit. These can be used to avoid direct person-to-person contact and some devices may reduce the risk of cross-infection between patient and rescuer (Resuscitation Council 2010b). In 2005, in recognition of the concern about providing mouth-to-mouth resuscitation, the guidelines changed and the BLS algorithm now starts with chest compressions and then proceeds to two breaths (Resuscitation Council 2010b).

One of the most easily learnt aids is the ‘mouth-to-facemask’ method (Figure 10.29) in which a ventilation mask with a one-way valve and an oxygen attachment port is used. The mask directs the patient’s exhaled air and any fluid away from the rescuer and the oxygen port allows attachment of oxygen with enrichment up to 45%.

Figure 10.29 Mask with one-way valve over patient’s nose and mouth and rescuer giving breath. Used with permission from Moule and Albarran (2009).

If the operator is skilled in airway management, an Ambu-bag and mask may be used. When the bag is attached to oxygen, high levels, of up to 85%, can be obtained. However, it should be emphasized that to manipulate the head tilt, and hold on a facemask while squeezing a bag is a procedure that requires practice and is most safely achieved by two people, one holding the mask and one squeezing the bag (Hodgetts and Castle 1999, Resuscitation Council 2010b) (Figure 10.30).

Figure 10.30 Two people using Ambu-bag and mask. Used with permission from Moule and Albarran (2009).

The most effective method of airway management is to use an endotracheal tube, thus enabling the application of 100% oxygen (Resuscitation Council 2010b, Robertson et al. 1998). This method of airway management is included in the advanced life support (ALS) algorithm.

Circulation

Circulation is assessed by looking for any signs of movement, including swallowing or breathing. If trained to do so, a check should also be made for the carotid pulse (Figure 10.31) for up to 10 seconds. If no circulation is detected, it must be maintained by compressions. The correct place to compress is in the centre of the lower half of the sternum (Figure 10.32). The rescuer should position themselves vertically above the patient with arms straight and elbows locked. The sternum should be pressed down to depress it by 5–6 cm. This should be repeated at a rate of about 100–120 times a minute. After 30 compressions two rescue breaths are given, continuing compressions and rescue breaths in a ratio of 30:2 (Resuscitation Council 2010b). There is evidence that chest compressions are often interrupted and that this is associated with a reduction in the chance of survival. New ALS guidelines (Resuscitation Council 2010b) suggest an increased emphasis on the importance of minimal interuption in high quality chest compressions throughout any ALS intervention. Therefore, chest compressions are now continued while a defibrillator is charging, which will minimize the preshock pause. It is therefore imperative that interruptions to chest compressions are minimized by effective co-ordination between rescuers (Eftestol et al. 2002, van Alem et al. 2003, Resuscitation Council 2010b).

Figure 10.31 Carotid pulse check.

Figure 10.32 Correct positioning of hands for external compressions.

Legal and professional issues

All members of the healthcare professions who attempt resuscitation will be expected to employ the highest professional standard of care, in line with their level of training. In general, there are two means by which the risk of personal liability may be minimized. The first is by good practice and the second is by taking out adequate indemnity insurance (NMC