The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [388]
Training should be provided in the use of AEDs but if there is no trained individual present when a cardiac arrest occurs, the Resuscitation Council (UK) advises that an untrained individual should attempt AED defibrillation. The administration of a defibrillatory shock should not be delayed by waiting for more highly trained personnel to arrive. The same principle should apply to individuals whose period of qualification has expired (Resuscitation Council 2010b).
Placement of paddles or self-adhesive electrodes
The right paddle or electrode should be placed to the right of the sternum below the clavicle and the left paddle vertically in the midaxillary line approximately level with the position V6 used in electrocardiogram (ECG) monitoring (see Figure 10.34).
Figure 10.34 Placement of defibrillation pads attached to defibrillator on patient’s chest.
Safe defibrillation practice
Defibrillation in an environment where high flows of oxygen are present could represent a danger to patients and rescuers. It is therefore essential to ensure that oxygen tubing and equipment are moved away from the chest when defibrillation is performed. Using adhesive electrodes to deliver the shock as opposed to paddles may also minimize the danger (Resuscitation Council 2010b).
A pocket mask with oxygen port (Figure 10.35) may be used as an adjunct to administer mouth-to-mask ventilation for a patient with respiratory arrest. The patient should be in the supine position with the head in the sniffing position (head tilt, chin lift – see Figure 10.27). Apply the mask to the patient’s face using the thumbs of both hands. Lift the jaw into the mask with the remaining fingers by exerting pressure behind the angles of the jaw (jaw thrust). Blow through the inspiratory valve and watch the chest rise. Stop inflation and allow the chest to fall before blowing in the second breath.
Figure 10.35 Pocket mask with oxygen port.
A self-inflating resuscitation bag with oxygen reservoir and tubing (Figure 10.36) may be used to administer high inspired oxygen concentrations to a patient and can be connected to a facemask, laryngeal mask or tracheal mask. As the bag is squeezed, the contents are delivered to the patient’s lungs and on release, the expired gas is diverted to the atmosphere via a one-way valve and the bag then refills automatically via an inlet at the opposite end. Used alone, the bag-valve apparatus ventilates the patient’s lungs with ambient air only (FiO2: 0.21), which can be increased to around 45% by attaching oxygen tubing and increasing the flow to 5–6 L/min directly to the bag adjacent to the air intake. If a reservoir system is attached and the oxygen flow is increased to 10 L/min, an inspired oxygen concentration of approximately 85% can be achieved (Resuscitation Council 2010b).
Figure 10.36 Self-inflating resuscitation bag with oxygen reservoir.
An oropharyngeal or Guedel airway is a curved plastic tube, flanged and reinforced at the oral end with a flattened shape to ensure that it fits neatly between the tongue and the hard palate. It is used to overcome backward tongue displacement in an unconscious patient. Guedel airways come in sizes 2, 3 and 4, for small, medium and large adults respectively. Choosing the right size is done by measuring the Guedel airway from the corner of the mouth to the angle of the jaw/mandible, as indicated in Figure 10.37.
Figure 10.37 Measure the Guedel airway from the corner of the mouth to the angle of the jaw. Used with permission from Moule and Albarran (2009).
The technique for insertion of an oropharyngeal airway in the unconscious patient is as follows.
Open the patient’s mouth and ensure, by looking into the mouth, that there is no foreign material that may be pushed into the larynx.
Insert the airway into the mouth in the ‘upside-down’ position as far as the junction of the hard and soft palate and then rotate the airway through 180° (Figures 10.38, 10.39, 10.40). Then insert the airway until it lies in