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Assessing and responding to sudden deterioration in the adult
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
The cessation of breathing and heartbeat in a person is a natural process of dying (Resuscitation Council 2021b). For a person who experiences sudden cardiac or respiratory arrest, cardiopulmonary resuscitation (CPR) can be effective in improving the chances of recovery for the person who is deteriorating. In some situations, however, due to gradual deterioration, CPR cannot be effective and may be detrimental to the individual’s wishes or failing health condition. People who, due to their condition, will not benefit from resuscitation attempts may have a ‘Do not attempt resuscitation’ (DNAR) request signed. The British Medical Association, Resuscitation Council and Royal College of Nursing offer practitioner guidelines relating to how these decisions are made and by whom. Decision frameworks and consideration of healthcare team views should be used to assist in planning the best outcome. These decisions, however, are complex and require a great deal of knowledge and skills to ensure the optimum outcome for the person is achieved. Senior clinicians should be involved in these processes and assist and guide junior healthcare practitioners to develop their own decision-making skills. The individual’s best interests should be paramount in any decision-making process regarding CPR and DNAR.
Shock Management
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Resuscitation strategies are complex and must be tailored to the needs of the individual patient. It is the trauma team leader’s role to collect, digest and interpret all the information, overlaid by experience, in order to maximize the chance of a bleeding patient surviving. It must be remembered that permissive hypotension is neither a treatment nor a substitute for definitive surgical haemorrhage control.
Ethical, professional and legal requirements to involve older adults in decisions about their care
Published in Helen Taylor, Ian Stuart-Hamilton, Assessing the Nursing and Care Needs of Older Adults, 2021
DNAR orders are one aspect of caring for older adults that might cause healthcare professionals to experience ethical dilemmas. On the one hand it is morally wrong to prolong suffering, yet morally right to protect and promote life. Yet it must be acknowledged that in the event of cardiac or respiratory arrest, for some individuals, particularly the terminally ill and the aged reaching the end of their natural life, resuscitation may not be appropriate. There will also be some people who do not wish to be resuscitated in the event of cardiopulmonary arrest, preferring to exercise their right in law to ‘die with dignity’.
Effect of Wearing N95 Mask on the Quality of Chest Compressions in Prehospital Emergency Personnel: A Cross-over Study
Published in Prehospital Emergency Care, 2023
Liang Chen, Yang Shen, Shuangmei Liu, Yanyan Cao, Zhe Zhu
Out-of-hospital cardiac arrest is a leading cause of global mortality (1). Cardiopulmonary resuscitation (CPR) is an important emergency technique for saving patients from cardiac arrest and is something that prehospital emergency personnel must be proficient in. CPR training is generally based on simulated scenarios, using simulators for practice. Because novel coronaviruses such as COVID-19 can be transmitted via respiratory droplets and aerosols, and because of the general susceptibility of the population, the latest American Heart Association (AHA) guidelines require rescuers to wear personal protective equipment (PPE) when performing CPR (2). Because of the high-risk scenario of respiratory exposure in prehospital emergencies, rescuers need to wear N95 masks. N95 masks may lead to discomfort for medical personnel due to better airtightness, resulting in increased breathing resistance and greater physical exertion for users during strenuous exercise (3–5). Early, high-quality chest compressions are critical to the implementation of CPR and are essential for circulatory recovery and survival after cardiac arrest (6). Previous studies have shown that the quality of chest compressions of medical staff using PPE is significantly decreased (7). This trial was planned to determine whether wearing N95 masks influenced the performance of chest compressions by prehospital emergency personnel and the rescuer's condition when compared to surgical masks.
Cardio-pulmonary-resuscitation for people who use a wheelchair and/or have an atypical chest shape: an educational intervention
Published in Disability and Rehabilitation, 2023
Elisha M. Deegan, Annette Saunders, Nathan J. Wilson, Damhnat McCann
Globally, an estimated 15% of the total population have a disability, with 1.1–1.9 million people experiencing significant difficulties with independent function [1]. In Australia, 18.3% of the total population have a reported disability [2]. People with complex disabilities, many of whom use wheelchairs, are at very high risk of experiencing changes to their body shape and anatomical structure [3]. In addition, people with a disability who experience a limitation, or total inability, to change body positions readily, often have distortion to their body shape with atypical chest shapes a predictable outcome [4]. No endorsed policies, procedures, or guidelines currently exist to supplement the learning of cardiopulmonary resuscitation (CPR)—heart compression and airway management—or basic life support (BLS)—CPR plus first aid and choking management—for caregivers of someone with an atypical body shape and/or for people who are wheelchair users. This represents a major gap in knowledge and practice that places people with disability at an added disadvantage if the need arises for CPR. This study reports on the results of a small-scale educational intervention to supplement disability-specific content specific to people who use a wheelchair and/or have an atypical chest shape in an existing CPR training program.
Transferring nursing home residents to emergency departments by emergency physician-staffed emergency medical services: missed opportunities to avoid inappropriate care?
Published in Acta Clinica Belgica, 2023
Sabine E. E. Lemoyne, Peter Van Bogaert, Paul Calle, Kristien Wouters, Dennis Deblick, Hanne Herbots, Kg. Monsieurs
In Belgium, more than 75% of the NH residents are heavily dependent on care. More than half of them die within 24 months of NH stay [26]. Literature data show that DNR orders with written treatment restrictions often are not available, even for patients with severe life-limiting illness [27–29]. This increases the risk of futile resuscitation as discussed below [30–33]. The NH staff should make the DNR status available for every patient at the time of the EMS intervention [2]. When the NH staff pays more attention to the patient’s wishes regarding medical treatment, less avoidable transfers occur [34,35]. Conversations about advance directives are often perceived as difficult by health-care professionals and many GPs find it hard to identify the ‘right time’ to discuss directives [2]. It is, however, essential for this conversation between the patient and the GP or another treating physician to take place.