Emergency Measures for Life Support in the Hospital Setting Chapter 30 Emergency Measures for Life Support in the Hospital Setting

Patient-Centered Care Encourage patients to complete advance directives. Assist patients and their families in making informed decisions about end-of-life care. Advance directives can minimize disagreements among family members when the patient is physically or mentally unable to make decisions.

Safety Perform emergency procedures quickly to ensure patient’s best chance of survival. Follow current cardiopulmonary resuscitation (CPR) guidelines. Ensure that providers and bystanders do not touch patient during delivery of defibrillation. Use appropriate hand position when performing chest compressions. Use a respiratory barrier when providing artificial respirations.

Skill 30.1 Inserting an Oropharyngeal Airway Oral airways facilitate suctioning and maintain patent airway. Select appropriate airway for patient age and width and length of mouth. Only use in unresponsive patients without active gag reflex. Do not use on patients with recent oral trauma, oral surgery, or loose teeth. Prevent displacement of tongue into posterior oropharynx during insertion.

Skill 30.2 Using an Automated Electronic Defibrillator Automated electronic defibrillators (AEDs) make early defibrillation achievable. They may be fully automated or provide prompts. Become familiar with facility model. Establish absence of respirations and circulation. Turn on AED and follow prompts. Attach pads, avoiding wet areas, medication patches, implanted pacemakers, or defibrillators. Do not touch patient during analyze phase. Ensure that no one is in contact with patient when shock is to be delivered. Continue cardiopulmonary resuscitation (CPR) after shock if indicated.

Skill 30.3 Code Management First responder provides cardiopulmonary resuscitation (CPR) A—Airway: Head-tilt chin lift or jaw thrust B—Breathing: Barrier mask or bag-valve-mask C—Circulation: Chest compressions D —Defibrillation: Automated electronic defibrillator (AED) When code team arrives, give brief report. Prepare to start intravenous (IV) line if not already in place.

Skill 30.3 Code Management (cont’d) Code team performs advance life support. A—Airway: Endotracheal (ET) intubation B—Breathing: ET placement and ventilation C—Circulation: Cardiac rhythm D—Differential diagnosis: Determine cause of arrest