Mock Code by Anastasia Graham Adult II Clinical R. Mirabella 1/16/18 H_____I_____R_____R_____EGuidelines of AHA ACLSIn 2015, the AHA ACLS guidelines research shows that high-quality CPR improves survival from cardiac arrest. High-quality CPR includes an adequate rate of chest compressions of adequate rate and depth, allowing full chest recoil between compressions, minimizing interruptions in chest compressions, and avoiding excessive ventilation. In 2017, AHA guidelines state whenever an advanced airway is inserted during CPR for Cardiac Arrest, providers should perform continuous compressions with positive-pressure ventilation delivered without pausing chest compressions.
The provider is to deliver 1 breath every 6 seconds while continuous chest compressions are being performed. The compression-to-ventilation ratio continues to be 30:2 for adults in cardiac arrest.Medications During codeMorphineAction decrease pain when pain is not resolved with nitroglycerinUse 2-4 mg of morphine given IV push every five to 15 minutes.Nursing Implication: monitor reaction to the medication. Pain level should be assessedblood pressureRespiratory status, along with pulse oximetry.
Additional side effects which can occur after giving morphine include dizziness, nausea, dry mouth, drowsiness, and headache. Caution should be used when administering morphine to patients with right-sided heart failure or patients with inferior MI, as hypotension may occur and can be severe. If possible, a 12-lead ECG should be obtained to rule out an inferior MI.OxygenAction improve oxygenation of the ischemic heart tissue.Use Oxygen can be administered through a nasal cannula or mask. According to the AHA, oxygen levels equal to or greater than 94 percent are usually acceptableNursing Implication Be aware that oxygen can only be delivered through a low flow nasal cannula up to six liters per minute.
High flow nasal cannulas, which may be used in a hospital setting, can deliver much higher flow rates depending on the manufacturer. Simple masks and non-rebreather masks are additional options used to administer higher levels of oxygen.NitroglycerineAction It causes arterial and venous dilatation, which decreases the workload of the heart and reduces myocardial oxygen demand.use it may be given in the form of sublingual tablets at a dose of 0.
3 mg to 0.4 mg every five minutes for up to three dosesNursing Implication Nitroglycerin should not be given to patients with a systolic blood pressure of less than 90 mm Hg. AspirinAction Aspirin is used to prevent further clot formation by decreasing platelet aggregationUse 160 to 325 mg of aspirin should be administeredNursing Implication the aspirin should be chewed to allow for faster absorption. Some possible contraindications to aspirin therapy include a bleeding disorder, active peptic ulcer disease, and hepatic disease.Cardiovascular Code. “The chance of survival to hospital discharge has been reported to be more than double among patients who received CPR within the first minute after a collapse, as compared with those who received CPR after 1 minute, “(Attin 2014). The current generation of nursing students has been raised with technology. Technology-based training appeals to most of the student body.
This includes cardiopulmonary resuscitation training. Response to cardiac arrest can delay from lack of training and is a common issue. Being able to intervene in a timely manner can have a direct impact on the patient’s survival. The saying to remember with cardiopulmonary resuscitation is that time is muscle. To enhance the timing of response to a new nursing, an integration of technology in nursing education is crucial to enhance teaching. The goal in the pilot study for “Animation Shows Promise in Initiating Timely Cardiopulmonary Resuscitation” was to investigate if integrating the technology-based education into the classroom will have a positive effect on nursing students’ response time to cardiac arrest, including initiation of chest compression. The sample consisted of 31 senior-year, bachelor degree nursing students (all students were previously BLS certified) who were randomized into experimental and control groups prior to practicing in a high-fidelity simulation laboratory.
The experimental group was educated, by discussion and animation, about the importance of starting cardiopulmonary resuscitation upon recognizing an unresponsive patient. Afterward, a discussion session allowed students in the experimental group to gain more in-depth knowledge about the most recent changes in the cardiac resuscitation guidelines from the American Heart Association. A linear mixed model was run to investigate differences in time of response between the experimental and control groups while controlling for differences in those with additional degrees, prior code experience, and basic life support certification.
As a result to the experimental group receiving animation education on top of the basic American Heart Association ALCS training, the experimental group’s response time of recognition of deteriorating conditions and initiating timely cardiopulmonary resuscitation was increased compared with the control group. “The median response time for the control group was 42.75 seconds, with a range of 16 to 101 seconds, and for the experimental group was 7.6 seconds, with a range of 1.7 to 13.8 seconds” (Attin 2014). The results demonstrated the efficacy of combined teaching modalities for timely cardiopulmonary resuscitation. The nurse is able to intervene in a timely manner can have a direct impact on the patient’s survival.
This study showed, that when teaching safe practice for cardiopulmonary resuscitation, providing opportunities for repetitious practice during the time of deteriorating condition for a patient is crucial. The animation showed promise to initiate a timely CPR in this study, and it can be used to integrate learning opportunities in a safe environment where students have the opportunity for repetitious performance with no out consequences to an actual live patient. According to the study done, it is concluded that teaching by an animation about proper and timely resuscitation technique may decrease the chance of error during the chaotic and stressful time of cardiac arrest.
AHA has increased their focus on animations and hands-on experience since the study. ReferencesATTIN, M. P., WINSLOW, K. M., & SMITH, T. P.
(2014). Animation Shows Promise in Initiating Timely Cardiopulmonary Resuscitation: Results of a Pilot Study (Vols. Issue: Volume 32(4), April 2014, p 166–171). Wolters Kluwer Health Lippincott Williams & Wilkins. DOI: 10.1097/CIN.
0000000000000038O’Connor, R. 2. (n.d.). 2012 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Acute Coronary Syndromes.
Circulation. 2010. http://circ.ahajournals.org/content/122/18_suppl_3/S787.full Accessed January 2018.
Resuscitation and Emergency Cardiovascular Care – Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality. (2017). Retrieved from American Heart Association: ECCguidlines.heart.org