Health Care Assignment: Analysing Cardiac Arrest Scenario
Question
Task: Instructions for Health Care Assignment The review of evidence requires you to review the video of a cardiac arrest scenario from several years ago. The guidelines for management of cardiac arrest have changed in the intervening period.
The BLS/ ALS video link: https://www.youtube.com/watch?v=ElLTHbslJZc You need to analyse the video and identify practices that are in line and not in line with the ARC guidelines. Where practice is not in line with the guideline you should identify what the participants should be doing differently. You also need to consider best practice evidence for nontechnical skills in emergency situations and using that evidence critique the performance in the video against that evidence again noting what the participants should be doing if demonstrating evidenced based practice. For all the discussion you need to link to the ARC guidelines specifically and identify the research to provide evidence to support your comments.
Answer
Introduction:
As per the research on health care assignment, the ARC or the Australian Resuscitation Council has developed a certain protocol to be addressed during diverse clinical emergencies which has a significant outcome in minimizing the threat of morbidity and mortality in patients. These guidelines have an important part in addressing the nursing facilities with guided protocol to assist a patient in time of emergency health deterioration. It explains the necessity of having a common protocol and standard for resuscitation measures which are to be used equally in every health care setting as well as an incident when resuscitation is necessary. Evidence-based practices and strategies which have been found as a lifesaving step in time of emergency shave been included within the ARC guidelines which tend to minimize the rate of death due to critical health deterioration of sudden health complication such as cardiac arrest. The following case study assessment will be carried out using the case study video provided to assess the emergencycondition as well as the relevant ARC guidelines that are best suitable to bring back the patient into a normal state.
Discussion
The case study video focuses on a scenario in a health care emergency setting where a patientsustains a sudden fall in his health stability due to a certain health complication and it also represents the role of nurses and a collaborative team in assisting the patient to bring back in life (Daniel Davis, 2021). The case scenario starts with the entry of a nurse to a patient's room and after the nurse calls the patent, and tries to wake him up, she identifies unresponsiveness and unconsciousness in the patient. it was found by the nurse that the patient was not breathing and was found that his heart rate was deteriorating, and thus, she calls Code BLUE immediately and starts providing CPR. Calling code blue explains the occurrence of the condition of cardiac arrest and the need for cardiopulmonary resuscitation or CPR (Chan, Berg & Nadkarni, 2020). As soon as the call for Code Blue reached the professionals, a team of code professionals reached the setting immediately to assist the nurse with providingemergency support. Thus, the team startedmonitoring the patients’ vital signs and continuously providedcompression to the patient to maintain the pumping of the heart.
As the vital signs of the patient as monitored, it was found that the patient needed immediate compression and ventilation, thus the CPR was continued and the registered nurse administered the patient with 1 ml of epinephrine (pressor). The intravenous injection was used to providepressure to the patient as it is used to assist a patient undergoing cardiac arrest to relax the muscle and increase mean arterial blood pressure (Belletti et al., 2020). The patient was then assisted with respiratory therapy as his oxygen saturationlevel was falling and was found to sustain difficulty breathing in oxygen. Thus, the registered nurse guided the nurse to provide him with 1:10 synchronous ventilation which was also assisted by suction to clear his airways which were getting blocked due to increased production of mucus (Daniel Davis, 2021). As the airways were getting blocked and suction wasprovided, to support better clearing of the airways and opening it to maintain the significantairflow, oropharyngeal airways was considered. It has a main role in managing the airways from getting blocked which oftencausesdifficulty in inhaling a significant amount of air.
As the ventilation was provided, the patient was further connected to the End-Tidal CO2, which is a non-invasive procedure useful in monitoring and assessing the concentration of CO2 in the patient or the partial pressure that occurs during exhalation (Gouel-Chéron et al., 2017). The code doctor later arrived to assist the code team and rived his guidanceregarding the patient’s ventilation and compressions (Daniel Davis, 2021). The Code doctor supervised the administration of 40 units of pressor which was earlier provided as 1ml of pressor by the registered nurse. Also, it was found after anassessment of ROSC that the patient was sustaining a condition of shockable, thus he was delivered with shock therapy to assist his heart to beat and recover from the state of arrest. It later assisted the patient to come back in normal condition with a stable oxygen saturation level. Thus, it was found that the Code Blue team significantly assisting the patient in getting back to a normal state from deterioration due to cardiac arrest.
Assessment of steps that was conducted in wrong as well as highlight the factors that needed to be addressed focusing in the ARC Guidelines: Throughout the case study video, it was found that the nurses were providing continuous compression to the patient until he revived back to normal and three nurses were working co-ordinately to provide compression in turns and ventilation. It was found to be one of the significant steps taken by the code team as it has been guided in the ARC guidelines that compression should be provided without making any pause along with the delivery of ventilation (Geri et al., 2017). The process is generally explained as bystander CPR where two professionals function in providing continuous CPR to the patient and are have been guided by the guidelines 8 of the ARC for Cardiopulmonary resuscitation. Initially, it was found in the case study video that the registered nurse provided the patient with a 1:10 ratio of synchronous ventilation, which is inappropriate according to the protocol of ARC guidelines. In the Guidelines 8 of the Cardiopulmonary resuscitation (CPR), a patient sustaining cardiac arrest must be provided with a compression and ventilation ratio of 30:2 which is the universal application ratio for patients with cardiopulmonary difficulties (ARC Guideline 8, 2021). The ratio of 30:2 explains that within a duration of 30 compressions 2 ventilations must be provided which was significantly low in the case of the patient she was provided with 1 ventilation in 10 compressions (Küçükceran, Ayranc? & Dündar, 2020).
As soon as the nurse identified unresponsiveness and unconscious state within the patient, she started providing compression in a continuous manner which signifies an effective step to take in case of an emergency (Zhan et al., 2017). It has also been guided by the ARC guidelines 8 for Cardiopulmonary Resuscitation (CPR) that when a patient is identified nit breathing and is unresponsive, compression should be immediately provided to the patient to support the patient with a beating heart andminimize the condition of mortality (ARC Guideline 8, 2021). It was found in the case study video that the patient's mouth was opened while condition suction to clean the airways but it was also identified that the head of the patient was not turned down. It was found to be carried out in the wrong manner as according to guideline 4 of ARC for airways (ARC Guideline 4, 2021). It has been guided in the ARC guidelines 4 that whole assisting a patient with suction, the mouth should be open but alongside the head of the patient should be turned downward. It helps in assisting the process to drain any waste material or substance that might be blocking the airways, and the position should be maintained till the airways in cleaned (ARC Guideline 4, 2021). Also, it is necessary to ensure the head-tilt-chin lift position for the patient to support with opening the airways ad clearing any blockage that might have occurred due to cardiac arrest (Jo et al., 2019). The condition was found to be lacking in the case of the case study video as the patient was not adjusted to the desired position and was kept in the exact position, he was found unconscious. Thus, the assessment provided the following issues that generally can take place in the health care emergency condition which needs to be addressed with the help of ARC guidelines.
Conclusion:
The conclusion of the assessment thus highlights the fact that medical supervision and assistance have a significant role in managing patient health and minimizing the chances of mortality. Nurses and registered nursesmust possess the critical thinking ability and critical decision-making skills to take appropriate action in times of emergency such as Code Blue. While conducting the assessment, the need and importance of ARC guidelines in the role of nursing facilities were explained which tend to function in guiding the nurses with their skills and responsibilities to addressan emergencyconditionwiththe designed protocol. It guidesthe nurses to assist a patient with cardiac arrest with proper ventilation and CPR to revive back to a normal state. Thus, it has been found from the study that apart from involving ARC guidelines in nursing role to assist the emergency, thenurse must possess the skills of working in a team to assist the patient withcomplex health need and minimize the risk of death.
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References:
ARC Guideline 4. (2021). Secureservercdn.net. Retrieved 22 April 2021, from https://secureservercdn.net/198.71.190.10/777.066.myftpupload.com/download/section_4/anzcor-guideline-4-airway-jan16.pdf.
ARC Guideline 8. (2021). Secureservercdn.net. Retrieved 22 April 2021, from https://secureservercdn.net/198.71.190.10/777.066.myftpupload.com/download/section_8/anzcor-guideline-8-cpr-jan16.pdf.
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Chan, P. S., Berg, R. A., & Nadkarni, V. M. (2020). Code blue during the COVID-19 pandemic. Circulation: Cardiovascular Quality and Outcomes, 13(5), e006779.
Daniel Davis. (2021). Code Blue - ER - The Right Stuff - 4 of 4 [Video]. Retrieved 22 April 2021, from https://www.youtube.com/watch?v=ElLTHbslJZc.
Geri, G., Fahrenbruch, C., Meischke, H., Painter, I., White, L., Rea, T. D., & Weaver, M. R. (2017). Effects of bystander CPR following an out-of-hospital cardiac arrest on hospital costs and long-term survival. Resuscitation, 115, 129-134.
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Küçükceran, K., Ayranc?, M. K., & Dündar, Z. D. (2020). Comparison of cardiopulmonary resuscitation that applied synchronous 30 compressions–2 ventilations with that applied asynchronous 110/min compression–10/min ventilation: A mannequin study. Hong Kong Journal of Emergency Medicine, 1024907920958861.
Zhan, L., Yang, L. J., Huang, Y., He, Q., & Liu, G. J. (2017). Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non?asphyxial out?of?hospital cardiac arrest. Cochrane Database of Systematic Reviews, (3).
