2011 CPR & Code Blue Procedures Adult and Child Support Staff: Example Mental Health Assistants, Radiology Techs, Surgical Techs, CMA, Monitor Techs NA’s,OT/PT/Speech @ WCHOB

Objectives After completing this self-learning packet the reader will be able to: 1. List responsibilities when initiating and/or assisting during a Code Blue. 2. Identify the procedure for ensuring code cart readiness as well as code cart security following a Code Blue. 3. Apply the American Heart Association's performance guidelines to case scenarios requiring: -Adult one rescuer CPR -Adult and Child Foreign Body Airway Obstruction (FBAO) Management -Child one rescuer CPR

A B C or C A B New Guidelines Again? In November 2010 the International Resuscitation Organization released new CPR guidelines. The new guidelines are based upon review of research related to Patient Outcomes and performance of CPR. The CPR procedures in this packet reflect the most recently published guidelines. There are different guidelines for those responding as Health Care Professionals (HCP) vs. the lay rescuer- This program identifies the CPR procedures for those responding to cardiac arrest situations as Non Nurse support staff.

So, what did the research show? To increase success in resuscitation outcomes* more emphasis needs to be placed on starting and maintaining well done CPR compressions. Early Defibrillation in witnessed cardiac arrests is a key to improving survival. *Patient survival to hospital discharge with the ability for at least some independent functioning

So, what did the research show? Compressions are the key! Compressions need to be hard - at least 2 inches in depth. Fast - at least 100 per minute. Started as soon as the cardiac arrest is recognized. Maintained with minimal interruption.

So, what does the research show? Ventilation - More is NOT better! We tend to over ventilate in volume and rate when doing CPR! When a patient is in cardiac arrest, there is less blood flowing so less air is needed. Too much is NOT good! Hyperventilation is Harmful! Hyperventilation (giving more air than is needed) causes decreased cardiac output. Forceful or excessively large breaths given by rescuers can cause distention in the stomach. Not only can this cause vomiting and aspiration, it can restrict lung movement as it elevates the diaphragm.

So, what else did the research say? “Hands Only CPR” is performing compression only CPR. This is intended for untrained or minimally trained bystanders who come upon the victim of a sudden, witnessed cardiac arrest. “Hands only CPR” is easier for non trained bystanders to remember. “Hands Only CPR” is NOT intended for Medical personnel in the course of their duties Infant or child victims Cardiac arrest due to respiratory arrest (ex: drowning) Victims of unwitnessed cardiac arrest

Initial Steps of Adult CPR No longer will we be doing the A, B, Cs. To emphasize initiation of early compressions, the steps are now C-A-B: C - compressions A - airway B - breathing

Steps for Adult CPR for Support Personnel Assess unresponsiveness and overview for absence of normal breathing. Call for help and a defibrillator. If patient is unresponsive and has no signs of normal breathing, begin CPR compressions. After 30 compressions, open airway and give 2 breaths. Continue CPR at a ratio of 30 compressions to 2 breaths.

Steps for Adult CPR for Support Personnel 1. Assess unresponsiveness and overview/observe for normal breathing. Tap victim, shout out, “Are you ok?” while simultaneously looking for any signs of normal breathing. Validate DNR status.

Steps for Adult CPR for Support Personnel Assess unresponsiveness and overview/observe for normal breathing - DO NOT take the time to open the airway. DO NOT Look, Listen and Feel for breathing. Abnormal breathing is frequently mistaken as presence of respirations. Cardiac arrest victims may present or initially have a short period of seizure like activity or agonal gasps-this should not be identified as normal breathing.

Steps for Adult CPR for Support Personnel 2. Call for help and the defibrillator- do not leave the patient. Note the time for recording on the code blue documentation form. If there is no telephone in the immediate area and no one could hear your call for help, you should leave the patient briefly to call the Code Blue. In any of the Kaleida Hospitals, direct helpers to call 7911 and inform the operator of your location and Code Blue. The Code Cart with defibrillator is essential.

Steps for Adult CPR for Support Personnel 3.Begin Chest Compressions to maintain forward blood flow Lower half of sternum Push Hard & Fast At least 2 inches in depth At least a rate of 100 per minute Allow full re-expansion (or recoil) of chest wall between compressions Avoid the xiphoid process and ribs Place bed board under patient to facilitate chest compressions.

Steps for Adult CPR for Support Personnel Compressions - why complete re-expansion of the chest? Maintaining pressure on the chest and heart during compressions can cause compressions to be less effective for the patient as blood flow is actually decreased.

Steps for Adult CPR for Support Personnel 4. Following the first 30 chest compressions, begin rescue breathing. Deliver 2 breaths. Use head-tilt/chin-lift position to maintain open airway position-do NOT pause to check for breathing! If the chest does not rise with ventilation attempt, reposition the head, make a better seal and try again. Healthcare workers in employment situation should always have available and use a barrier device to deliver mouth to mouth ventilations. Deliver only enough air to cause a visible chest rise - more is NOT better. Deliver each breath over only 1 second.

Steps for Adult CPR for Support Personnel Continue CPR in cycles of 30 compressions to 2 ventilations. Pause no more often than every 5 cycles or 2 minutes for a 5 second pulse check.

Steps for Child CPR for Support Personnel For the purposes of CPR resuscitation - the guidelines identify a child as: 1 year of age to puberty

Steps for Child CPR for Support Personnel Assess unresponsiveness and overview for absence of normal breathing. Call for help and a defibrillator. If the patient is unconscious and does not have normal breathing, begin CPR compressions. After 30 compressions, Open airway and give 2 breaths. Continue CPR at a ratio of 30 compressions to 2 breaths.

Steps for Child CPR for Support Personnel 1. Assess unresponsiveness Tap victim, shout out, “Are you ok?” while simultaneously looking for any signs of normal breathing. 2. Call for help - in any of the Kaleida Hospitals, call 7911 to initiate a Code Blue. Note: if you are alone with the child - do not leave to make this call at this time!

Steps for Child CPR for Support Personnel 3. Begin Chest Compressions to maintain forward blood flow Lower half of sternum Push Hard & Fast At least 1/3 the dimension of the chest or at least 2 inches in depth At least a rate of 100 per minute Allow full re-expansion (or recoil) of chest wall between compressions Do not compress the xiphoid process or ribs Use one or two hands

Steps for Child CPR for Support Personnel 4. Following the first 30 chest compressions, begin rescue breathing. Use head-tilt/chin-lift position to maintain open airway position. Breathing-DO NOT take the time to look in the airway. DO NOT Look, Listen and Feel for breathing. Health care workers in employment situation should always have available and use a barrier device to deliver mouth to mouth ventilations. Deliver only enough air to cause a visible chest rise-more is NOT better. Deliver each breath over only 1 second.

Steps for Child CPR for Support Personnel Continue CPR in cycles of 30 compressions to 2 ventilations. If a code response has not been initiated because you are alone, call a code blue after the first 2 minute cycle of CPR. Pause no more often than every 5 cycles or 2 minutes for a 5 second pulse check.

Foreign Body Airway Obstruction (FBAO) Management is the same for adults and children Definition=sudden onset of respiratory distress or difficulty breathing with coughing, gagging, and or wheezing Mild=can cough forcefully or make some sounds Severe=victim unable to make sounds

FBAO-Conscious Adult or Child Perform Abdominal thrusts until object is expelled or victim unresponsive. Use inward, upward thrusts just above the umbilicus. For the adult victim, chest thrusts may be used for obese patients and females in the later stages of pregnancy. If 2 rescuers are present - call for help immediately (7911).

FBAO- Unconscious Adult or Child For a choking adult or child victim who becomes unresponsive: Call for help (if not done already). Start CPR chest compressions immediately (do not pause for breathing check). After 30 compressions, open the airway and look for a foreign object. If a foreign object is seen-remove it. NO blind finger sweeps! Attempt 2 breaths. Continue with cycles of compressions and breaths.

Code Blue Procedures The patient is coding and I am blue I’m not quite sure what I need to do……

Code Blue Procedures Maintaining CPR is the first Priority! Secondly, the cardiac rhythm needs to be assessed to determine if defibrillation is needed. The code cart with defibrillator needs to be brought to the side of the patient immediately.

Initiate Cardiac Monitoring If you have been taught how to initiate cardiac monitoring with the defibrillator, assist to do so as long as CPR is not interrupted. Make sure electrodes or multifunction pads are placed in the appropriate location on the chest and attached to the corresponding lead wire. The Defibrillator should be set to “monitor” and “lead II”.

Defibrillation Defibrillation is most effective when done as soon as possible. Assure your own safety by clearing away from the patient during defibrillation attempts.

Communication Staff at bedside need to clearly communicate information to the team leader. Ex. “Mr. Smith is a diabetic and he told me he was having a reaction”. Ex. “ I think she is having a seizure”.

Support Activities during a Code Blue Bring all patient records to the bedside. Open the code cart and assist with obtaining resuscitation bag, oxygen equipment, IV bags, suction equipment. Assist patient’s family as necessary. Assist other patients/visitors. If not needed for CPR - Be available and prepared to run errands - get ice for blood gases, IV pole, IV pump.

Infection Control During A Code Blue All code responders must implement /maintain standard precautions when providing care to a coding patient. All code carts at the adult sites have a supply of personnel protective equipment (gowns, masks, eye shields) for the very first responders.

Code Blue Equipment Readiness Each Unit or Department is required to complete daily check of their Code Cart each day the department is open. The daily check includes: Includes check of Defibrillator functioning

Post Code Equipment Security When stocked and ready for use: the outside of the code cart will be locked using a numbered green lock. the medication box (locked inside the code cart) will be locked with a red lock. Following the code , the cart AND medication box must be relocked. obtain blue locks from the outside of the code cart medication box. use one blue lock to secure the med box –place the locked medication box on top of the code cart. use the other blue lock (s) to assure that the outside of the cart is locked. Initial on the code blue worksheet that the relocking has been done. Remember… Red and Green = Ready and Clean Blue Lock =Restock