Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 37 Resuscitation

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Airway Obstruction Upper airway components include the pharynx and trachea, which can become occluded for various reasons Airway obstruction compromises air exchange and subsequent oxygenation of cells and tissues, so an unrelieved airway obstruction will lead to loss of consciousness and eventually death

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Causes of Airway Obstruction

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Airway Obstruction (cont’d) Signs of airway obstruction generally occur while the person is eating To relieve an obstruction during the worst situations, activate the emergency medical system by calling a code, summoning personnel trained in advanced life support techniques

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Universal Sign for Choking

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Signs of Partial or Complete Airway Obstruction

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Airway Obstruction (cont’d) Relieving an obstruction –Client is conscious: Heimlich maneuver is appropriate; involves subdiaphragmatic thrusts or chest thrusts oClient’s age determines how these thrusts should be performed –Client is unconscious: cardiopulmonary resuscitation (CPR) is considered appropriate

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Airway Obstruction (cont’d) Relieving an obstruction (cont’d) –For infants (children younger than 1 year), the nurse supports the baby over his or her forearm, holding the infant prone with the head downward; the heel of one hand is then used to administer 5 back slaps between the shoulder blades oA finger sweep is performed only if the nurse notices an obstructing object

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Airway Obstruction (cont’d) Relieving an obstruction (cont’d) –For all clients older than 1 year of age, the nurse gives a series of 5 quick subdiaphragmatic upward thrusts slightly above the navel to increase intrathoracic pressure, equivalent to a cough

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Assisting an Infant With an Obstruction

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Giving Subdiaphragmatic Thrusts

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Survival Early recognition and access to emergency services: if the client is not breathing, coughing, or moving, it is essential to activate the emergency medical response system –Resuscitation team: a group of people who have been trained and certified in advanced cardiac life support (ACLS) techniques

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Differences in CPR Among Infants, Children, and Adults

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Survival (cont’d) Early cardiopulmonary resuscitation: ABCDs of CPR are Airway, Breathing, Circulation, and Defibrillation –Open the airway to restore ventilation oHead tilt/chin lift technique, jaw-thrust maneuver, and recovery position

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Survival (cont’d) Early cardiopulmonary resuscitation (cont’d) –Perform rescue breathing, the process of ventilating the lungs oMouth-to-mouth breathing oMouth-to-nose breathing oMouth-to-stoma breathing

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Mouth-to-Mouth Breathing

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Survival (cont’d) Promote circulation: assess circulation to determine whether or not chest compressions are necessary –Chest compression promotes circulation in 2 ways: increases pressure in the ventricles and promotes systemic blood flow –Correct placement of the hands and the body is essential during chest compressions

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessing the Carotid Artery

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Correct Hand and Body Positions

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Survival (cont’d) Early defibrillation: an automated external defibrillator (AED) is a portable, battery- operated device that analyzes heart rhythms and delivers an electrical shock to restore a functional heartbeat

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Algorithm for Resuscitation

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Survival (cont’d) Early defibrillation (cont’d): –Attaching the electrode pads –Analyzing the rhythm –Administering a shock –Continuing CPR without defibrillation

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Automated External Defibrillator (Refer to Figure 37-9 in the textbook.)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Survival (cont’d) Early advanced life support: emergency medical support personnel such as paramedics provide early advanced life support; they are trained in techniques for inserting endotracheal tubes and administering supplemental oxygen

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Recovery When there is evidence of circulation and breathing, rescuers place the victim in a recovery position Internal self-evaluation provides a means to improve similar resuscitation efforts in the future

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Discontinuing Resuscitation Decision to stop resuscitation efforts often is based on the time that elapsed before resuscitation began, the length of time that resuscitation has continued without any change in the victim’s condition, the age and diagnosis of the victim, objective data, and electrolyte studies

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Implications Nursing diagnoses relevant in a resuscitation situation: –Ineffective airway clearance –Impaired spontaneous ventilation –Impaired gas exchange –Decreased cardiac output –Ineffective cardiopulmonary tissue perfusion