The video is reviewed and the performance of the healthcare workers has been evaluated in this study. For this, the video is analysed for its respective positive and negative issues identified and discussed further on them with the support of literatures provided. The goal of this video is to deliver chest compressions to cardiac arrest patient, as he is unconscious and not responding to the healthcare workers.
It was noted that the patient is not his sense and required the medical treatment urgently. The nurses and doctors have done this part very smoothly. The nurse immediately called the team and the doctor to treat the patient, and also dictate the condition of patient to the team while treating. This is one of the positive things identified initially in the evidence. After that, it is recommended to perform cardiopulmonary resuscitation (CPR) if any patient is unconscious and not breathing. This was also done by the medical staff in the video scenario, which is appreciable. However, it was noted that compressions appeared inadequately on multiple occasions (e.g. at 50 seconds, 2 minutes 48 seconds, etc time of video). Although it is recommended to pause the compressions by 5-10 seconds while pre-shock and post-shock given to the patient. According to ARC guidelines, CPR should be given to a patient with minimum interruptions. Only to check the response or breathing of patient, it can be paused for few seconds. It is recommended to provide chest compression to a patient at a rate of approximately 100-120/min (Perkins et al., 2015). Also, compression to ventilation ratio should be in ratio of 30:2, which means compressions are only paused to allow for ventilation. According to the latest CPR guidelines, chest compressions are recommended to do first and then rescue breathing.
Moreover, depth of compression was found to be slow in the video after 2minutes and 48seconds. It is recommended to make compression depth between 2-2.4 inches for adults and children. According to Kwon (2019) depth of compression of at least 5cm is necessary to generate a cardiac output. They have identified the importance of compression depth during cardiac arrest. During CPR and after a return of spontaneous circulation (ROSC), when cardiac arrest found in any patient, they should be given combination of both basic and advanced airway and ventilation facilities (Newell et al., 2018). According to a study, survival from cardiac arrest found a statistically significant relationship between ROSC and compression depth. Compression with 6cm have greater significance with ROSC as compare to the compressions of 5cm (Graham et al., 2015). Moreover, DRSABC mnemonic refers to initial steps taken for recovery- Danger: To check for danger or hazards; Responsiveness: If a patient is unresponsive then to check for response; Send: Send for help; Airway: Open up the airways; Breathing: To check breathing of patient; CPR: Chest compressions given to the patient in case of unresponsiveness; Defibrillation: To attach automated external defibrillator (AED) while compressions (Marshall, 2017).
It is noted that one of the medical staff nurses is not in proper nursing clothes and have not taken necessary precautions while handling the patient. However, risk of transmission of disease while giving CPR is low, still it is recommended to take preventive measures while handling the CPR patients. Moreover, the positive side shows that all nurse has worn gloves in their hands to avoid disease transmission. Also, they work as a team, which is recommended while delivering CPR. Although, the major criteria to be considered while providing CPR is about pre and post shocks given to the patient, compression rate, depth of chest compression, and fraction (Harari et al., 2020).
In the media clip provided, it is clearly seen that oxygen is provided to the patient by help of bag-mask device. It has been used in correct way; the holding and the working of the instrument is perfect. It is recommended in the literatures to hold the bag mask with one hand using thumb and index finger and rest of the fingers are used to hold the chin of patient, to ensure no gap between the mask and face (Harari et al., 2020). Oxygen is provided within every two CPR. However, one thing has been seen in the video that oxygen is provided in discontinuous manner, which is not a good sign for recovery of patient. During CPR, the patient should get maximum level of oxygen, either by mouth to mouth or by help of bag mask. After ROSC, normal oxygen and carbon dioxide targets were achieved by titrating inspired oxygen and ventilation (Newell et al., 2018).
Chest compressions is provided at right place in the media, that is on the lower half of sternum. High quality chest compressions are provided, which will eventually produce better outcomes (Lakomek et al., 2020). Only, the depth of the compressions is to be noted to provide more deeply. Approximately, compressions were given at such rate that it reaches to one-third of the chest level. Rate of compression is also counted to be slow as compare to the standard rate. It is shown in the literature to provide 100 to 120 compressions each minute, that is almost 2 compressions/second (Gauna et al., 2016). The nurses in this video have monitored heart rhythms through pads, which is a standard part of ALS. They have used external defibrillator to monitor the rhythms during shocks given to the patient. Another positive point shown in this video is the placing of defibrillator. Right electrode should be placed at right of sternum and apical paddle in mid-axillary way, which is correctly done by the nurses in this media source. It is also seen that no one is touching the patient while delivering the shock, which is also correct. Shock strategy used in this video is good, that is at 180, 140 rate of rhythms, and one pre-shock and one post-shock. Oxygen defibrillators are also crucial to use and precautions must be taken while using this equipment. Oxygen mask must be placed at least 1cm away from the patient’s chest during defibrillation.
According to the recent guidelines of CPR, chest pushing should be at rate of 100-120/min, compression should be of 5-6cm, complete chest recoiling to relax the chest, no or minimum interruptions during compressions and avoid hyperventilation. These are the guidelines which must be followed during treatment with CPR (Kwon, 2019). Hospitals and medical staff play important role in providing care to the patient having cardiac arrest. When brain cells stop working and damage frequently, then the individual is not in the condition to even respond. At this time, quickly CPR should be given to the person to make their brain cells start working and bring consciousness. Quality of CPR is a key to enhance the survival rate of patient from cardiac arrest. This technique is about to provide chest compression to the patient with adequate rate and depth by skilled healthcare workers. Oxygen levels should be maintained by help of oxygen bags or oxygen transferred by mouth. Heart rate should be monitored by a device called as external defibrillator (Gauna et al., 2016). In this video, the overall quality of compressions delivered to the patients is quite good, but several modifications are suggested in the video, like the depth of chest compression is less. Too slow, too shallow, and interrupted chest compressions are recommended to avoid in future. High quality chest compression can save an individual’s life. It is the best possible way to treat an unconscious patient, even when you don’t know what you need to do. Compressions, airway and breathing are to be trained among all healthcare professionals as an essential part to treat any patient.
According to ALS and BLS guidelines, the practices followed in this video for treating the cardiac arrest patient is correct. However, in this study, there are few modifications and corrections are suggested for future purposes. It is also recommended to provide training for treatment using CPR and only skilled workers are allowed to do this technique.
Gauna, S. R., González-Otero, D. M., Ruiz, J., & Russell, J. K. (2016). Feedback on the rate and depth of chest compressions during cardiopulmonary resuscitation using only accelerometers. Plos One,11(3). doi: 10.1371/journal.pone.0150139
Graham, R., McCoy, M. A., Schultz, A. M. (2015). Committee on the treatment of cardiac arrest: Current status and future directions. National Academic Press (US): Washington (DC).
Harari, Y., Riemer, R., Jaffe, E., Wacht, O., & Bitan, Y. (2020). Paramedic equipment bags: How their position during out-of-hospital cardiopulmonary resuscitation (CPR) affect paramedic ergonomics and performance. Applied Ergonomics,82, 102977. doi: 10.1016/j.apergo.2019.102977
Kwon, O. Y. (2019). The changes in cardiopulmonary resuscitation guidelines: From 2000 to the present. Journal of exercise rehabilitation, 15(6), 738–746. Doi: 10.12965/jer.1938656.328
Lakomek, F., Lukas, R., Brinkrolf, P., Mennewisch, A., Steinsiek, N., Gutendorf, P., . . . Bohn, A. (2020). Correction: Real-time feedback improves chest compression quality in out-of-hospital cardiac arrest: A prospective cohort study. Plos One,15(4). doi: 10.1371/journal.pone.0232672
Marshall, S. D. (2016). Helping experts and expert teams perform under duress: An agenda for cognitive aid research. Anaesthesia,72(3), 289-295. doi:10.1111/anae.13707
Newell, C., Grier, S., & Soar, J. (2018). Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation. Critical Care,22(1). doi:10.1186/s13054-018-2121-y
Perkins, G. D., Travers, A. H., Berg, R. A., Castren, M., Considine, J., Escalante, R. (2015). Part 3: Adult basic life support and automated external defibrillation. International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations, 95: e43-e69.
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