• Choose a category
• All
• Classic-Fiction

Figure 10.50 Remove caps from both mini-jet vials and administration chamber. Used with permission from Moule and Albarran (2009).

Figure 10.51 Screw mini-jet vial into administration chamber. Used with permission from Moule and Albarran (2009).

Figure 10.52 Push vial gently to ensure that medication can be administered and connect Luer Lok to intravenous device and inject entire contents. Used with permission from Moule and Albarran (2009).

Specific patient preparations

Education

Hospital staff should receive at least annual resuscitation training appropriate to their level and role. Medical and nursing staff should receive basic resuscitation training and should be encouraged to recognize patients who are at risk of having a cardiac arrest and call for appropriate help early. MEWS is a track and trigger system which alerts nurses to when a patient is deteriorating in order to initiate interventions and early referral to critical care outreach teams (DH 2000, NICE 2007). This is the most effective method of improving outcome (Jevon 2002). All medical staff should have advanced resuscitation training and senior nurses and doctors working in acute specialties (CCU, ITU, A&E) should hold a valid RCUK ALS certificate. The importance of prevention of cardiac arrest cannot be highlighted enough. Using a structured communication tool, such as Situation, Background, Assessment, Recommendation (SBAR) may help to indentify patients at risk in a timely manner (Resuscitation Council 2010b).

Procedure guideline 10.5 Cardiopulmonary resuscitation

Essential equipment

Airway management

Pocket masks with oxygen port

Self-inflating resuscitation bag with oxygen reservoir and tubing

Clear facemasks in sizes 4, 5 and 6

Oropharyngeal airways in sizes 2, 3 and 4

Yankauer suckers × 2

Endotracheal suction catheters × 10

Laryngeal mask airway (size 4) or Combitube (small)

McGill forceps

Endotracheal tubes: oral, cuffed, sizes 6, 7 and 8

Gum elastic bougie

Lubricating jelly

Laryngoscopes × 2: normal and long blades

Spare laryngoscope bulbs and batteries

1 inch ribbon gauze/tape

Scissors

Syringe: 20 mL

Clear oxygen mask with reservoir bag

Oxygen cylinders × 2 (if no wall oxygen)

Cylinder key

Circulation equipment

Intravenous cannulas: 18 gauge × 3, 14 gauge × 3

Hypodermic needles: 21 gauge × 10

Syringes: 2 mL × 6, 5 mL × 6, 10 mL × 6, 20 mL × 6

Cannula fixing dressings and tapes × 4

Seldinger wire central venous catheter kits × 2

12 gauge non-Seldinger central venous catheter × 2

Intravenous administration sets × 3

0.9% sodium chloride: 1000 mL bags × 2

Optional equipment

Extra ECG electrodes

Extra defibrillation gel pads unless using fast patch electrodes

Clock

Gloves/goggles/aprons

A sliding sheet or similar device should be available for safe handling

Medicinal products

Immediately available prefilled syringes of:

Atropine: 3 mg × 1

Amiodarone: 300 mg × 1

Adrenaline: 1 mg (1:10,000) × 4

Other readily available drugs used in CPR

Epinephrine (adrenaline): 1 mg (1:10,000) × 4

Sodium bicarbonate 8.4%: 50 mL × 1

Calcium chloride 10%: 10 mL × 2

Lidocaine: 100 mg × 2

Atropine: 1 mg × 2

0.9% sodium chloride: 10 mL ampoules × 10

Naloxone: 400 g × 2

Epinephrine/adrenaline 1:1000 × 2

Amiodarone: 150 mg × 4

Magnesium sulphate 50% solution: 2 g (4 mL) × 1

Potassium chloride 40 mmol × 1

Adenosine: 6 mg × 10

Hydrocortisone: 200 mg × 1

Glucose 10%: 500 mL × 1

Preprocedure

Action Rationale

1 Note time of arrest, if witnessed. Lack of cerebral perfusion for approximately 3–4 minutes can lead to irreversible brain damage. E

Procedure

2 Give patient precordial thump only in witnessed collapse and in cardiac monitored arrest if defibrillator not immediately available. This may restore cardiac rhythm, which will give a cardiac output. E Single precordial thump has low success rate for cardioversion of shockable rhythm (Haman et al. 2009, E).

3 Summon help. If a second nurse is available, they can call for the cardiac arrest team, bring emergency