Nursing Assignment Addressing the Issue of Cardiac Assert & Unresponsiveness
Question
Task
To prepare this nursing assignment, you need to analyse the video (https://youtu.be/ElLTHbslJZc) 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.
Answer
Introduction to Nursing Assignment:
The Australian Resuscitation Council has been working in order to address the needs and requirements of emergency services provided to the patient in time of critical conditions. It is necessary to have a standardized and uniform resuscitation technique that is used by every health care professional as well as rescuers in case of health emergencies (Guidelines, 2021). Thus, the Australian Resuscitation Council has developed certain guidelines in order to provide a fair set of discussions about every factor associated with resuscitation. These guidelines have been developed focusing on the scientific shreds of evidence and well as information that accounts for the beneficial outcomes of the strategies which can turn into the lifesaving act in case of emergency conditions. The assessment will thus focus on assessing a case study video where code blue has been used in order to address the issue of cardiac assert and unresponsiveness in the patient (Daniel Davis, 2021). The assessment will further assess the resuscitation procedure sued by the professional with the help of different guidelines provided by the Australian Resuscitation Council.
Review:
The case video focuses on displaying the protocol and procedure the health care organization follows during emergency medical conditions. In the initial phase of the video, the nurse enters and checks for the responsiveness of the patient, and as she observes that the patient is unconscious and not breathing, she immediately called for Code Blue (Daniel Davis, 2021). Code blue within a health care setting is used to explain the emergency condition of cardiopulmonary Resuscitation or CPR (Porter et al., 2020). Thus, as soon as the nurses assessed that the patient is under cardiac arrest and needs medical assistance in order to save his life, the nurses called a code blue and asked for an energy team or code professionally to assist her with CPR and breathing assistance. As Code Blue was called, the Code Registered Nursed for Code Blue immediately reached the to the patient in order to assist him with compression and breathing. The moment, the nurse called for Code Blue, she started providing the patient with continuous compression, and later after the RN reached, the patient was primarily monitored and assessed while the compression was continuously delivered (Daniel Davis, 2021).
The ventilation and the compression of the patient were immediately assessed in order to assess the condition of the patient. the Registered nurse after assessing the ventilation administered Pressor (1 ml of epinephrine) to the patient. pressor such as epinephrin has been administered with the help of intravenous injection and they are generally used in a case where a patient sustains cardiac arrest. It functions by increasing mean arterial blood pressure (Sicherer & Simons, 2017). After administration of pressure, the patient was provided with respiratory therapy as he was unconscious and unable to breathe. The patient was delivered with synchronous ventilation of 1: 10 ratio and suction as he was witnessing increased secretion in the airways. Later the registered nurses provided the patient with an oropharyngeal airway. It is used in the care of medical conditions where it is necessary to open or maintain the airways of the suffering patient. the functions as it inhibits the tongue to block the epiglottis which usually prohibits the patient from breathing (Cortese et al., 2020). After which the patient was connected to End-Tidal CO2. An End-Tidal CO2 of the EtCO2 monitoring is known to be a non-invasive technique that is generally used to measure and monitor the maximal concentration of carbon dioxide or the partial pressures at the end of exhalation during breathing (Gouel-Chéron et al., 2017).
After the procedure of ventilation was carried out, the oxygen saturation level of the patient was monitored. After the role of the registered nurse was completed, the Code doctor assisted the professionals with the code blue, where he initially assessed the compression provided to the patient. After which he recommended the administration of 40 units of pressor. Later the shockable or ROSC was monitored and it was found to be a case of shockable. Thus, the patient was provided with shock in order to help him review the condition of cardiac arrest. After few deep and continuous compressions and slow ventilation, the oxygen saturation level increased and the patient was brought back to stable condition (Daniel Davis, 2021).
The procedure that was carried out in a wrong manner and what should be followed according to the ARC guidelines:
It was found that the registered nurses used synchronous ventilation of 1: 10 ratios, though according to the ARC guidelines 8- Cardiopulmonary Resuscitation (CPR), it is necessary that the compression and ventilation ratio should be 30:2 (ARC Guideline 8, 2021). The ratio indicates the in case of a patient with cardiac arrest in emergency cases, two breaths or ventilation should be provided to the patient after every 30 compressions. It was found that in the case video, the registered nurse recommended providing ventilation after every 10 compressions. It is necessary to maintain and stabilize a steady heart rhythm which is constant for both double as well as single-rescuer methods. In the case of additional rescuers, it is necessary to take a turn and provide continuous ventilation and compression to the patient without any break or gap (Manrique et al., 2020). Thus, it was found that three rescuers were working with coordination in order to deliver a continuous compression along with slow ventilation to the suffering patient.
According to the ARC guidelines 4- airways, it is necessary that when clearing the airway of a patient suffering from airway blockage or excessive secession, the mouth should be open (ARC Guideline 4, 2021). It was fairly maintained in the case of the video assessment where the registered nurses as soon as witnessed increases secretion, were asked to clear the airways with the help of oropharyngeal airway which is generally used to clear or open airways blockage. Though the ARC guidelines 4- airways also state that while proceeding with airways clearing and opening, it is necessary that the head of the patient should be turned downward to some extent in order to allow drainage of any foreign or obvious material within the airways such as vomit, blood, food or other secretions (ARC Guideline 4, 2021). It was found that in the case of the video assessment, the patient’s head was not turned downward and was kept in the exact resting position while the airways were cleared using the oropharyngeal airway procedure. Thus, it would have been a significant step to adjust the head of the patient sightly downwards in order to help drain out any blockage or material that was present within the airways (Lee, Button & Tannenbaum, 2017). The ARC guidelines 4- airways also state that in case of any unconscious and unresponsive patient, the airways should be open with the help of a head-tilt-chin lift position as it helps in opening and clearing the airways in the case where resuscitation is provided (ARC Guideline 4, 2021). It was found in the video assessment that; the patient was not assisted with any positioning for the process of clearing the airways by the registered nurses during resuscitation.
It was also observed that as soon as the patient was found unconscious and unresponsive, the nurses stated providing compression to the patient as called for a code blue. According to ARC guidelines 8- Cardiopulmonary Resuscitation (CPR), as soon as the patient is found unconscious and not breathing in a normal pattern, the rescuer or the nurses should start providing CPR to the patient in order to minimize the threat of any further complications (ARC Guideline 8, 2021). It is also stated by ARC guidelines 8- Cardiopulmonary Resuscitation (CPR), that bystander CPR explaining continuous delivery of compression should be actively encouraged in case of such a patient in order to assist them with beating heart. The factor was fairly maintained in the case of the patient demonstrated in the video as he was continuously addressed by the bystander CPR (Bouland et al., 2017).
Conclusion:
In order to conclude, it can be thus stated that the assessment helped in understanding and assessing the effectiveness of medical assistance in emergency cases. It provided an overview of having the ability of critical think skills in nursing professionals. The assessment demonstrated an in-depth understanding of how the ARC guidelines are necessary in order to ensure that a fair protocol for emergency treatment with CPR and ventilation is provided to the patient who has witnessed cardiac arrest. The ARC guidelines not only assist with the protocol to be followed during Cardiac arrest but several other health issues in which immediate nursing assistance and emergency treatment are provided. Thus, it is relevantly explained that the ARC guidelines can be effective enough to safeguard the lives of the patient as well as prevent them from dying. It also explains the role of nurses and other professionals in teamwork in case of emergencies such as Code blue, where the patient needs the assistance of cardiopulmonary resuscitation.
References:
Guidelines, A. (2021). Guidelines. Resus.org.au. Retrieved 5 April 2021, from https://resus.org.au/guidelines/.
Daniel Davis. (2021). Code Blue - ER - The Right Stuff - 4 of 4 [Video]. Retrieved 5 April 2021, from https://www.youtube.com/watch?v=ElLTHbslJZc.
Porter, J. E., Peck, B., McNabb, T. J., & Missen, K. (2020). A review of Code Blue activations in a single Regional Australian Healthcare Service: A retrospective descriptive study of RISKMAN data. Journal of clinical nursing, 29(1-2), 221-227.
Gouel-Chéron, A., De Chaisemartin, L., Jönsson, F., Nicaise-Roland, P., Granger, V., Sabahov, A., ... & NASA Study Group. (2017). Low end-tidal CO2 as a real-time severity marker of intra-anaesthetic acute hypersensitivity reactions. BJA: British Journal of Anaesthesia, 119(5), 908-917.
Cortese, M., Pigato, G., Casiraghi, G., Ferrari, M., Bianco, E., & Maddalone, M. (2020). Evaluation of the Oropharyngeal Airway Space in Class II Malocclusion Treated with Mandibular Activator: A Retrospective Study. J. Contemp. Dent. Pract, 21, 666-672.
Sicherer, S. H., & Simons, F. E. R. (2017). Epinephrine for first-aid management of anaphylaxis. Pediatrics, 139(3).
Bouland, A. J., Halliday, M. H., Comer, A. C., Levy, M. J., Seaman, K. G., & Lawner, B. J. (2017). Evaluating barriers to bystander CPR among laypersons before and after compression-only CPR training. Prehospital Emergency Care, 21(5), 662-669.
Lee, A. L., Button, B. M., & Tannenbaum, E. L. (2017). Airway-clearance techniques in children and adolescents with chronic suppurative lung disease and bronchiectasis. Frontiers in pediatrics, 5, 2.
Manrique, G., González, A., Iguiñiz, M., Grau, A., Toledo, B., García, M., & López-Herce, J. (2020). Quality of chest compressions during pediatric resuscitation with 15: 2 and 30: 2 compressions-to-ventilation ratio in a simulated scenario. Scientific reports, 10(1), 1-7.
ARC Guideline 8. (2021). Secureservercdn.net. Retrieved 5 April 2021, from https://secureservercdn.net/198.71.190.10/777.066.myftpupload.com/download/section_8/anzcor-guideline-8-cpr-jan16.pdf.
ARC Guideline 4. (2021). Secureservercdn.net. Retrieved 5 April 2021, from https://secureservercdn.net/198.71.190.10/777.066.myftpupload.com/download/section_4/anzcor-guideline-4-airway-jan16.pdf.
