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Measuring and monitoring vital signs
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
When assessing any person in your care, the first priorities are to check responsiveness, ensure an open airway, check breathing and maintain adequate circulation after the basic life-support algorithms (Resuscitation Council UK 2021). Systematic assessment of acutely ill people is discussed further in Chapter 14. It should be quickly established whether the person lost consciousness at any stage and appears to be deteriorating, particularly after an accident. Thus, the person and any bystanders should be asked about the incident. Witnesses to a cardiac or respiratory event can be a valuable source of information regarding a person’s condition (Resuscitation Council UK 2021) so it will be essential to gain a detailed history from Anne’s husband about exactly what he observed. The onset and duration of signs and symptoms, previous medical history and any recent illnesses are all useful to note. After taking the history, a person’s neurological status can be assessed using the GCS. This assessment provides a quantitative score for assessing eye-opening, verbal response and motor response.
Paper 3
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
When administering basic life support, what is the optimal depth for chest compressions according to the current UK Resuscitation Council Guidelines? 1–2cm2–3cm3–4cm4–5cm5–6cm
Nasogastric tube insertion
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
Position your patient correctly, by asking them to sit upright and place their chin on their chest (seeFigure B8.1). This position is the opposite of the positioning used to optimise a patient’s airway in basic life support. The purpose of this is to encourage the NGT to enter the oesophagus, and not the trachea.
Are Pediatric Manual Resuscitators Only Fit for Pediatric Use? A Comparison of Ventilation Volumes in a Moving Ambulance
Published in Prehospital Emergency Care, 2023
Gregory Sun, Susan Wojcik, Jennifer Noce, Nicholas Cochran-Caggiano, Tracie DeSantis, Steven Friedman, Derek R. Cooney, Chrisitan Knutsen
Lastly, results were broken down by certification level. EMTs are often called upon to assist with manual resuscitator ventilations while the paramedic performs additional interventions (15). Because of this, and the varied training for each clinician, it is important to assess not only the paramedic but also the EMT as both are expected to deliver adequate ventilations. It was noted that the EMTs were consistent in delivering 50% less volume than that of their paramedic counterparts. Average differences ranged from 112 ml to 249 mL, indicating a sizable and presumably clinically significant difference. These data correlated with the general observations made by the principal author while conducting the trial. To affirm these findings, the principal author ventilated the manikin after each EMT completed the trial in order to determine if there was any defect or air leak, though none were found. A potentially related finding in a study by Kurz et al. was a greater return of spontaneous circulation rate in out-of-hospital cardiac arrest cases when advanced life support clinicians were present earlier along with basic life support clinicians, implying a difference in performance (16). Further study to investigate differences in basic airway management and other elements of initial resuscitation care by advanced and basic life support clinicians is warranted.
A Novel Assessment Using a Panoramic Video Camera of Resuscitation Quality in Patients following Out-of-Hospital Cardiac Arrest
Published in Prehospital Emergency Care, 2023
Huai-Kuan Huang, Huei-Han Chen, Yu-Long Chen, Giou-Teng Yiang, Wen-Chu Chiang
The evaluation of CPR quality is even more challenging in prehospital settings compared with in-hospital settings because resuscitation may be performed by inexperienced operators in a chaotic environment. In Taiwan, commercially available quality-monitored chest pads have been used to evaluate CPR quality in prehospital settings for years (10,11). We have also used a single-angle video camera (SAC) set inside the ambulance to monitor the CPR process and evaluated the CPR quality and teamwork during en-route transportation for over 10 years (7,9,10,12). The chest pads can be used to monitor basic life support (BLS), while the SAC can partially monitor BLS, advanced life support, and teamwork during resuscitation. However, even with a combination of both devices, a comprehensive observation of the entire team’s resuscitation quality and performance to provide an all-around assessment is not possible.
Advanced Life Support for Out-of-Hospital Chest Pain: The OPALS Study†
Published in Prehospital Emergency Care, 2022
Ian G. Stiell, Justin Maloney, Jon Dreyer, Doug Munkley, Daniel W. Spaite, Marion B. Lyver, Julie E. Sinclair, George A. Wells
The study enrolled 12,168 patients: 5,788 in the 9-month basic life support phase (from October 1994 to February 1998) and 6,380 in the advanced life support phase (from April 1998 to June 2002). Of all cases, 886 had survival status ascertained by review of the Ontario Death Registry. In each community, the two phases were separated by a run-in period of 6 to 36 months to allow for training to the advance life support standards. Patients in the two phases had similar baseline characteristics and received similar in-hospital procedures; however, there was a higher proportion of patients complaining of both chest pain and shortness of breath in the basic life support phase (42.1 percent vs 38.6 percent) (Table 1). The response times to patients with chest pain were similar in the two phases, except that in the advanced life support phase, advanced life support crew responded to 59.3% of all cases, were on scene an average 3 minutes longer, and as expected, had a higher proportion of patients receiving symptom relief and intravenous medications (Table 2).