EMERGENCY CARE PROCEDURES

Benefits of CPR
CARDIOPULMONARY RESUSCITATION • Compression of the chest cavity can create blood
flow
First aid procedure intended to revive a heart and lung arrest • Combined rescue breaths and chest compressions are
within 3-4 minutes, from the time the heartbeat and breathing capable of providing some oxygen
stops to prevent death or irreversible brain damage. • Immediate CPR could double or triple the chances of
survival.
Highlights of the adult CPR 2010
CABs for CPR
1. Five Links of ADULT CHAIN OF SURVIVAL
2. “Look, listen, and feel for breathing” has been CIRCULATION
removed from the algorithm • Victims must be face-up and lying flat on a firm
3. Continued emphasis has been placed on high-quality surface.
CPR To maximize internal blood flow:
4. C-A-B rather than A-B-C • Chest compressions: performed hard and fast.
5. Rate is at least 100/min and depth of at least 2 • Full chest recoil at the top of each compression.
inches • Minimize any interruptions to compressions

5 links of the Adult Chain of Survival AIRWAY

AHA ECC Adult Chain of Survival
✔ Head tilt-chin lift maneuver to open the airway of a
o Immediate Recognition of Cardiac Arrest and victim without evidence of head or neck trauma.
Early Access- The chain of survival begins with - one hand on client’s forehead, tilt head with palm
immediate recognition of cardiac arrest and rapid
using firm backward pressure
activation of EMS or an Emergency Action Plan.
o Early CPR- Early CPR with emphasis on - fingers of other hand under lower jaw; tilt jaw to
compression. bring teeth almost to occlusion.
o Rapid Defibrillation- Survival rates: highest if CPR - Tilting the head and lifting the chin will pull the
is started immediately & defibrillation is done w/in tongue away from the back of the throat and open the
3-5 mins. airway.
o Early Advance Life Support (ALS) - involves - Don’t press too hard on the soft area under the
medical procedures and medications used by chin. Doing so can block the airway.
paramedics, RNs
o Integrated Post-Cardiac Arrest Care- A bundled Jaw- thrust Maneuver
treatment strategy after cardiac arrest that allows the - use in suspected spinal cord injury.
patient’s status to return to normal or near-normal. - Open the airway without head extension.
- Stay at client’s head part, elbows on the ground/bed,
grasp both angles of the lower jaw, lift both hands
displacing the mandibles forward and tilting head

BREATHING
• Rescue breath uses your own exhaled air to force
oxygen into the lungs
• Give each breath in one second duration.
• Allow the victim to exhale completely between
breaths.
• It is recommended to use a barrier device
• Deliver each rescue breath over a period of 1 second.
• Give a sufficient tidal volume (by
mouth-to-mouth/mask or bag mask with or without
supplementary oxygen) to produce visible chest rise.
• Avoid rapid or forceful breaths.
 EMERGENCY CARE PROCEDURES

Ventilation w/ Bag and Mask 6. Open the Airway

• Victim must be face up, on a firm, flat surface.
• made of transparent material with 1-2 L capacity • If victim is lying face down: roll him or her over.
• When using a bag-mask device, deliver each breath • Minimize turning or twisting of the head and neck.
over a period of 1 second and provide sufficient tidal • Blockage: common cause 🡪 tongue.
volume to cause visible chest rise. • Untrained Responder: HTCL
• Trained Responder: HTCL or JTM for suspected
Mouth-to-Barrier Device Breathing SCI

• Barrier devices may not reduce the risk of infection 7. Give 2 Rescue Breaths after 30 Compressions
transmission, and some may increase resistance to air GIVE 2 SLOW RESCUE BREATHS via:
flow. 1. mouth to barrier
• 2 types: face shields and face masks. 2. bag mask technique
*DELIVER BREATHS SLOWLY*
Mouth-to-Nose Ventilation

• mouth cannot be opened, victim is in water, or STEPS for MOUTH TO BARRIER DEVICE
mouth-to-mouth seal is difficult to achieve RESUSCITATION:

• USE: E-C Clamp technique

STEPS OF CPR • Hyperextend patient’s head use: HTCL
• Take a normal breath
1. Approach Safely • Place lips over one-way valve of the device
• “The scene is safe. Stand Clear!...” • Blow until the chest rises; take about 1 second
• Allow chest to fall
2. Check for Responsiveness and Normal Breathing • Repeat (1 second per breath; 1 second interval)
• 3-5 seconds
• Gently shake the shoulders and ask loudly, “HEY! 8. Continue CPR for a total of 5 cycles at 30:2,
HEY! ARE YOU OK?” (TWICE) while SCANNING Compression to Ventilation Ratio.
THE CHEST for NORMAL BREATHING
• “Patient is unresponsive and breathless…” During Chest Compression:
• Do not bend elbows
3. Shout for Help • Hands facing northward
• “HELP! CALL 911! ACTIVATE EMS and GET • Arms of rescuer: perpendicular to client’s sternum-
THE A.E.D.” “PUSH DOWN”
• In-hospital Scenario: • HEEL OVER THE STERNUM
- “HELP, Activate the code and get an AED!” • When possible, change CPR operator every 2
- IF YOU OR SOMEONE ELSE HAS CALLED minutes
THE EMERGENCY RESPONSE NUMBER, • 5 cycles = within 2 minutes
KNEEL AT THE VICTIM’S SIDE NEAR • 1 cycle= in less than 18 seconds
THE HEAD, AND START CPR.
9. Reassess for breathing and pulse
4. Check Carotid Pulse
Pulse Check: 5 - 10 secs A. If breathless and pulseless:
A. Repeat another 5 cycles for 2 minutes at
5. Give 30 compressions 30:2 ratio
• Place the heel of one hand @ the center of the chest B. If with pulse but no breathing:
• Place other hand on top - Provide ventilation at 1 every 5-6 seconds
• Interlock/interlace fingers for 2 minutes
• Compress the chest C. If with spontaneous pulse and breathing:
a. Rate of at least 100/min - Place on recovery position
b. Depth of at least 2 inches
 EMERGENCY CARE PROCEDURES

CPR: Recovery Position:

Uninjured Patient

1. Kneel beside the victim; make sure both legs are

straight. Place the arm nearest to you out at a right
angle to the body, elbow bent palm up
2. Bring far arm across chest; hold back of hand against
victim’s cheek nearest you. With your other hand,
grasp far leg just above knee and pull up
3. Keeping victim’s hand pressed against the cheek, pull
on far leg to roll victim towards you. Adjust the
upper leg so both the hip and the knee are bent at
right angles

Injured Patient
1. Kneel beside the victim. Place the victim’s closest
arm above the head and the furthest arm across the
chest. Bend the victim’s nearest leg at the knee. WHEN TO STOP CPR
2. Place your hand under the hollow of the victim’s
neck to help stabilize. Roll patient towards you so
S – Spontaneous breathing and pulse is present
that the head rests on the extended arm.
3. Bend legs at the knees to stabilize the victim. T – Team (EMS) arrives
O – Over-exhaustion of the rescuer
CPR P – physician declares the patient
S – Scene is unsafe
*NOTE:
Attach and use AED as soon as it is available COMPLICATIONS OF CPR

If AED arrives:
F – Fractured ribs
• Stop CPR,
• Place the patches L – Lacerated Liver
• Follow voice prompt of the AED. A – Atelectasis (punctured lungs)
G – Gastric Distention
***If SHOCK is advised, stay clear***
• After defibrillating, continue CPR for 5 cycles again.
 EMERGENCY CARE PROCEDURES

INFANT CPR

INFANT CPR (0 – 12 months)

1. Tap the infant’s foot and shout

“Baby, baby are you OK?” while
scanning chest for movement.
2. If the infant is unconscious, call for
help.
3. Place the infant on a table or on a
firm, flat surface.
4. Check for the brachial pulse.
5. Place 3 fingers directly at the center
of the chest (nipple line).
6. Raise your index finger so that the
middle and index fingers are a
width below the nipple line.
7. Compress for approx. 1 ½ inches or
4 cm.
8. If the patient is not breathing prepare
for artificial respirations.
9. Seal infant’s nose and mouth using Care of a Patient On a Ventilator
BVM.
10. Deliver 2 gentle puffs of air at 1
second interval.
11. Reassess the infant after 5 cycles. Respiratory volume and capacity (normal values)
 EMERGENCY CARE PROCEDURES
1. Tidal volume (TV): amount of air moved in and out Disorders which may require MV
of lungs with normal quiet respiration (500 mL)
⦿ Gas Exchange disorders
2. Inspiratory reserve volume (IRV): amount of air
that can be forcibly inhaled over the tidal volume - Severe RTI
(2100 -3100 mL) - Pulmonary emboli
3. Expiratory reserve volume (ERV): air that can be - ARDS
forced out over tidal volume (1000mL) - Pulmonary trauma
4. Residual volume: volume of air remaining in lungs - Pulmonary arrest
after forced expiration (1100 mL)
⦿ Extra-pulmonary disorders
5. Vital capacity: TV + IRV +ERB (4500 ml)
6. Dead space volume: amount of air remaining in - Guillain-Barre syndrome
passageways (150mL) - Flail chest
- Other musculoskeletal disorders
- Post –surgical cases

Complications from Mechanical Ventilation

o CardioVascular – HPN, Tachyarrhythmias

o Pulmonary- Baro trauma, atelectasis
o Gastrointestinal- stress ulcers
o Neurologic- increased ICP
o Acid-base disturbance
o Psychological - anxiety
o Equipment failure

Types of Ventilators

o Negative pressure ventilators

o Volume cycled ventilator
o Pressure cycled ventilator
o High frequency ventilators

Mechanical Ventilators
Adjuncts to mechanical ventilation
⦿ Artificially controls or supports breathing efforts of a o PEEP – for pts. With acute restrictive lung disease or
patient who is suffering from respiratory failure. intra throracic bleeding.
⦿ Helps prevent alveolar collapse by supplying o CPAP – for pts. With decreased FRC, fluid filled
adjunctive therapies alveoli, atelectasis, post-operatively
⦿ The goal is to maintain alveolar ventilation, correct o Adverse effect: Baro Trauma – caused by too high
hypoxemia and maximize O2 transport when client pressure settings
cannot sustain spontaneous and effective respirations. Nursing care Goals for patients on Mechanical Ventilation

✔ Clear, patent airway

✔ Maintenance of respiratory volume, pressure and
oxygen exchange
✔ Adequate nutrition
✔ Maintenance of normal electrolytes and serum
osmolality
✔ Maintenance of communication
✔ Prevention of complications from immobility and
disturbed mucus membranes.
✔ Management of anxiety

Nursing Care
 EMERGENCY CARE PROCEDURES
1. Note ETT position. Monitor cuff pressure - For respirator –hooked patients with self
2. Restrain only if needed breathing capacity already requiring a zero
3. Administer sedatives prn.( To keep patient calm) back-up rate
4. Auscultate breath sounds o PEEP (Positive End Expiratory Pressure)
5. Monitor ventilator settings - a maintenance of at least 5 cm H2O to
6. Change tubings prn. prevent reverse atelectasis.
7. Perform CPT as needed - Side effects include < cardiac output due to
8. Monitor ABG, O 2 sat. , V/S increased positive intra-thoracic pressure.
9. Asses position change
10. Provide alternate communication measures Normal Standards in Control
11. Suctioning prn.
12. Respond to alarms o Tidal volume – Kg.BW X 10
o Sigh Volume – tidal volume X 2
Puritan-Bennett 7200 Ventilatory System o Peak Flow (O2 content in L/min) – initially set at
40-60 (adults) and lower for infants and children
o Combines improved microprocessor technology with o the higher the PF the faster and shorter the
an advanced pneumatic system to achieve reliable inspiration; the lower the PF, the slower and
and accurate gas delivery and patient monitoring. longer the inspiration.
o It can mix air and oxygen, warm and humidify the o Pressure Limit – plus 10-20 PH20 of reading on
mixed gas. manometer( regulates pressure to prevent
o It provides breath of predetermined tidal volume, baro-trauma)
peak inspiratory flow, wave form and oxygen
composition(mandatory breath)
Problems with pressure
o It can allow a patient to inspire gas having a
predetermined oxygen consumption from a demand • High pressure – caused by any obstruction in tubings
system. or patient.
• Low Pressure – caused by leaks of oxygen in the
system.
Features of the Keyboard Panel o PEEP Control - 5-10 or less than 5
o The Patient Data (green background) o Humidifier temp. control to prevent overheating of
the humidifier
- provides information on breath types,
o Fio2 – usually starts from 40-50 then regulated
pressures, volumes, rates
o The Ventilator Settings (Blue background)
- used by the operator to select ventilatory Set-up Procedure for MV Series 7200
settings by a 2 or 3-step entry sequence
⦿ Attach tubes without proximal line.
o The Ventilator Status (Grey background)
⦿ Fill humidifier with water to desired level
- reports the operating condition and the alarm
⦿ Switch power on at the side of the machine
status. ⦿ Set Tidal Volume at 0.5 and press enter
⦿ Set the RR back-up rate and press enter.
Terms To change RR – press clear, change number then
press enter
o CMV ( Controlled Mandatory Ventilation) ⦿ Manipulate the PEEP knob – turn clockwise to
- for respirator fully dependent persons e.g. increase and counterclockwise to decrease.
comatose needing a back-up rate of 16-20 ⦿ Select Mode and press enter (CMV, SIMV, CPAP)
RR
o SIMV (Synchronized Intermittent Mandatory For Suctioning with MV
Ventilation)
- For respirator partially dependent persons
e.g. with few spontaneous respirations o select suction button and press enter. (There is an
needing a back-up rate of < 16 RR automatic 100% O2 flow)
o Proceed with normal suctioning procedure

o CPAP ( Continuous Positive Airway Pressure) Using the Humidifier

 EMERGENCY CARE PROCEDURES
⦿ Sterile, distilled, mineral water, boiled water are 1. Set the temperature below body temperature
acceptable for the machine
⦿ Do not use NSS or Tap water
⦿ Humidifier water is ideally changed every 8 hours Manipulating for Automatic Ambu-Bagging
⦿ To Change fluid, bypass and change within 5
minutes. ⦿ Choose CPAP button or reduce RR to 1 or Zero
⦿ Press enter
Weaning Patients from a Ventilator ⦿ Press Manual ventilation every after 5 seconds

⦿ Assess patient’s readiness for weaning

⦿ Select appropriate method (Start with CMV, shift to
SIMV, then shift to CPAP) while monitoring blood
gasses and allowing the vital signs to normalize;
evaluate progress.
⦿ To adjust FiO2 – press the % O2 button, choose the
number (60-100) then press enter
⦿ During weaning, if CPAP is not tolerated shift back
to SIMV or CMV
⦿ Extubation
⦿ Continue monitoring, assessing and evaluating
progress.

Weaning Parameters:

⦿ Hemodynamic stability (V/S, CVP, Cap. WP)

⦿ PaO2 is over 70-80 mmHg
⦿ PaCO2 = normal (35-45 mmHg)
⦿ Acceptable general respiratory status (12-25)
⦿ Correction of underlying problem
⦿ Patient is calm and responsive

Trouble shooting for MV alarms

⦿ High pressure Limit (should not be more than 60)

1. Check the patient
2. Check the tubes for obstruction
3. Check the settings of the ventilator for high
pressure limit.
4. Decrease PEEP if indicated (5-15 limit)

⦿ Low inspiratory pressure

1. Check the patient
2. Check the tubes for leaks, holes or loose
connections.
3. If using an oxygen tank, levels of 40PSI and
below should have a change of tank to
maintain FiO2

⦿ I:E Ratio (normally 1:2)

1. Check the patient
2. Patients with ARDS, PTB, Pneumothorax
and COPD require low pressure limit
⦿ Humidifier Temperature
 EMERGENCY CARE PROCEDURES
ECG/Defibrillation Team Member
THE RESUSCITATION TEAM • Sync vs. unsynchronized shocks
• Pad/paddle placement
Goals of the Resuscitation Team • Safety precautions
• Indications/complications of transcutaneous pacing
• Reestablish spontaneous circulation and respiration • Problem-solving equipment failure
• Preserve function in vital organs during resuscitation

Critical Tasks of Resuscitation Vascular Access/Meds Team Member

1. Airway management • Sites of first choice for vascular access in cardiac
2. Chest compressions arrest
3. ECG monitoring and defibrillation • IV fluids of choice
4. Vascular access and medication administration • In cardiac arrest:
– Follow each drug with 20-mL fluid bolus
Team Leader Responsibilities • Know drugs that can be given by IV, ET, and IO
• Assesses patient routes
• Orders emergency care according to protocols
• Considers reasons for cardiac arrest
• Supervises team members Support Roles
• Evaluates adequate chest compressions
• Ensures patient receives 100% oxygen • Management of supplies
• Evaluates adequacy of ventilation • Assistance with procedures
• Ensures safe defibrillation • Documentation of the resuscitation effort
• Ensures correct choice and placement of vascular • Liaison functions
access • Crowd control
• Confirms position of advanced airway
• Ensures correct drug, dose, route given
• Ensures safety of team
• Problem-solves Code Organization
• Decides when to terminate resuscitation efforts
Phase I—Anticipation
Airway Team Member
• Analyze initial data
• Manual airway maneuvers • Assemble resuscitation team
• Oral airway • Identify team leader
• Nasal airway • Assign critical resuscitation tasks
• Oxygen delivery devices • Prepare/check equipment
• Suctioning • Position team leader and team members
• Cricoid pressure
• Advanced airway placement Phase II—Entry
• If within scope of practice
• Team leader identified
CPR Team Member – Begins to obtain information
– Ensures safe transfer of patient to
• The ACLS or BLS team member responsible for CPR resuscitation bed
must: – Instructs team members to obtain ABCD
– Know how to properly perform CPR information and relay to team leader in
– Provide chest compressions of adequate rate, ABCD sequence
force, and depth in the correct location
 EMERGENCY CARE PROCEDURES
Phase III—Resuscitation

• Focuses on the ABCDs of resuscitation

• Team leader directs team through the various
resuscitation protocols

Phase IV—Maintenance

• Efforts of resuscitation team should be focused on:

– Anticipating changes in the patient’s
condition
– Repeated reevaluation of the patient’s ABCs
– Stabilizing vital signs
– Securing tubes and lines
– Troubleshooting any problem areas
– Preparing the patient for transport/transfer

Phase V—Family Notification

• Update family members frequently

• Relay results of resuscitation effort promptly to
family
• Enlist assistance of a social worker or clergy as
needed

Phase VI—Transfer

• Responsibility to the patient continues until patient

care is transferred to a team of equal or greater
expertise

Phase VII—Critique
• Team leader responsibility
• Critique provides:
– Opportunity to express grieving
– Opportunity for education (“teachable
moment”)
– Feedback to hospital and prehospital
personnel regarding efforts of team
 EMERGENCY CARE PROCEDURES
Indications:
Electrical Therapy ⚫
⚫ Standard treatment for Ventricular Fibrillation (VF)
Effective Defibrillation and Safety Pulseless Ventricular Tachycardia (VT)

Mechanism of Action

“Countershock” ● Defibrillation involves the use of electrode paddles or

patch to deliver the electric current through the
⚫
⚫ Precordial Thump client’s heart.

⚫
⚫
AED (Automated External Defibrillator)
Defibrillation How does Defibrillation work (Purpose)?

⚫ Cardioversion
AICD (Automated Implantable Cardioverter
Defibrillator)
● The purpose of the delivered current is to temporarily
depolarize critical mass of the myocardial cells when
beating irregularly so that if successful, the non
ventricular pacemaker will resume the control of the
Principles of Early Defibrillation heart’s electrical activities restoring the patient’s
(intrinsic) normal rhythm.
⚫ Most frequent initial rhythm in a sudden cardiac

⚫ arrest is Ventricular Fibrillation (VF)

⚫ The most effective treatment for VF is Defibrillation

The success of defibrillation diminishes according to
CPR before and after is better (2005 AHA Guidelines for
CPR or ECC)

⚫ VF converts asystole within few minutes

the time
If a patient with sudden cardiac arrest from VF is without
treatment for 5 minutes or longer, the outcome may improve if
CPR is performed prior to defibrillation.
Defibrillation can be accomplished:
❖ Effective chest compressions help deliver blood to
⚫
⚫ Precordial Thump the coronary arteries and brain.
❖ It is also important to perform CPR after
⚫ External Countershock using defibrillator

⚫ AED- Automated External Defibrillator

AICD- Automated Implantable Cardioverter
defibrillation for the patient may experience a period
of asystole or pulseless electrical activity which the
Defibrillator CPR may help by converting to a more perfusing
rhythm.
Monitored Arrest ❖ However basic CPR can not convert VF to a normal
rhythm. The only way to convert VF and restore
⦿ The patient is already connected to the monitor at the normal rhythm is through defibrillation.
time of the arrest.
The need for SPEED
PRECORDIAL THUMP
● If the defibrillation is done with VF patient within 5
⦿ Perform by directly hitting the mid-sternum or center minutes of cardiac arrest, the survival rate is 50%.
of the sternum using the hypotenar aspect of the fist ● The survival rate decreases by 7 % to 10% for each
(softest side) from a height of no more than 12 minute that the patient is in VF.
inches.
AED
Defibrillation ● Portable defibrillator with microcomputer that senses
and analyzes patient’s heart rhythm and gives
⦿ Is a delicate procedure performed by a competent RN step-by-step directions on how to proceed if
wherein electrical shock or shocks of short duration defibrillation is indicated.
is/are discharged through the heart as an attempt to ● Shocks are automatically delivered with the use of
terminate death-forming dysrhythmias. adhesive pads as needed according to the machine’s
own interpretation.
 EMERGENCY CARE PROCEDURES
Purpose of Adhesive Electrode Pads
AED (Automated External Defibrillators)
⚫
⚫ ToTo transmit patient’s rhythm.
● Fully Automatic deliver the shock.
● Semi Automatic

How should it be done? Situations requiring a change in actions when using AEDs:

⚫ Attach AED only when the patient has no pulse and 1. Child <1 year old (do not use the AED)

⚫ respiration. Lying in water, move the victim first and dry the

⚫ Witnessed cardiac arrest- in the hospital with monitor chest wall.

Unwitnessed cardiac arrest – outside the hospital and 2. With AICD, (implanted pacemaker or defibrillator)
no monitor place the electrode pad away from the devices.
3. With transdermal medication patch, remove the patch
and clean the chest wall.
Witnessed Cardiac Arrest
Treat the client, not the AED machine
● Initiate CPR immediately and use an AED as soon as
possible. ⚫ Example: If the AED reads “flatline”, it may only
mean that one of the cable electrodes is disconnected
or it may read normal and the client is actually on
Unwitnessed Cardiac Arrest
⚫ VT.
Remember that AED only analyzes “rhythm”, it does
● Perform 5 cycles (2 minutes) of CPR before checking
the ECG and attempting to defibrillate. ⚫ not check the pulse.
CPR is vital and that AED’s purpose is to treat
death-forming dysrhythmias.

⚫
Unmonitored / unwitnessed using conventional

⚫ Open the pockets containing the two electrode pads. defibrillator

⚫ Expose the client’s chest.

⚫
⚫
⚫ Remove the plastic backing from the electrode pads. Assess level of responsiveness.

⚫ Press the ON button.

Listen to the computerized voice analyzing the ⚫ NoUsing
response-call 911 and get the AED
manual defibrillator, do “quick look” by

⚫ rhythm 5 to 15 seconds. simply placing the paddle on the client’s chest to

If shock is not needed, the AED will advise to
continue CPR. ⚫ quickly view the heart’s rhythm.
With lethal arrhythmias, (pulseless VT) apply the

⚫ IfCLEAR”
----------------
shock is needed, the AED will announce “STAND ⚫ conductive medium.
Turn the defibrillator on and set at the initial 200
joules, no conversion increase to 300 joules, no
message and emit a beep that changes to a

⚫ steady tone as it charges. conversion increase to 360 joules. Once 360 joules is
When the AED is fully charged, and ready to deliver
⚫ used, stay to that level.

⚫ aMake shock, it will prompt you to press the shock button. Charge the paddles by pressing the charge buttons on
sure no one is touching the patient or bed and
call out “I’M CLEAR”, YOU’RE CLEAR, ⚫ the paddle.
Press firmly against the client’s chest using 25lbs.
Note: no pulse check needed for the first 3 defibrillations.
EVERYBODY’S CLEAR, then press the shock

⚫ button.
Resume CPR 5 cycles (about 2 minutes).
 EMERGENCY CARE PROCEDURES
The current practice:
PADDLE PLACEMENT:
Monophasic
Vs
Biphasic
⚫ (For standard placement) Antero-Lateral
Right- upper sternum just below the right clavicle
Waveform
⚫ Left- nipple line and mid-axillary

⚫ Anterior / Posterior
Manage “Arching” by:
Monophasic defibrillators a. Necessary amount of gel applied

⚫ Delivers a single current of electricity that travels in

one direction between the two paddles on the
⚫ b. 25 pounds muscle pressure
Manage transthoracic resistance :
1. by paddle size (adult 8.5-12 cm diameter ; child

⚫ patient’s chest
To be effective, a large amount of electrical current is
8cm; infant 4.5 cm)

⚫ required for monophasic defibrillators.

3 stacked shocks delivery without pause Safety is the first consideration
a. 200-300 joules
b. 200-300 joules
c. 360 maximum
⚫
⚫ DoAvoid
not use alcohol to clean the paddles.
placing the paddles near the monitoring

Biphasic defibrillators ⚫ electrodes.

⚫ DoStand
not tilt the paddles during use to avoid arching.

⚫ Pad or paddle placement is the same. However, the

discharged electrical current travels in a positive
clear from the patient and bed when

⚫ Do not position the pads over the pacemaker.

discharging the device.

direction for a specified duration and then reverses &

flows in a negative direction for the remaining time
of the electrical discharge, thus delivering 2 or double Post Defibrillation

⚫ currents of electricity.
more successful conversions ⚫
⚫ Monitor neurological status

⚫ Cardiovascular status

⚫ Respiratory status

⚫
Advantages:
Requires lower threshold of the heart muscle
allowing more successful defibrillation with smaller
Blood values

⚫ amounts if energy.
It also adjusts for differences of impedance or
Neurological status

⚫
resistance reducing the number of shocks needed.
⚫
⚫
Level of consciousness
Pupillary reactions

⚫ RECTILINEAR BIPHASIC WAVEFORM

DEFIBRILLATOR - 150-200 JOULES
⚫ Motor / Sensory
Vital signs that could indicate brain damage / IIP

⚫ BIPHASIC TRUNCATED EXPONENTIAL Respiratory

WAVEFORM (B.E.T.W.) - 120 JOULES
⚫
⚫ Breathing pattern / status
Indications:
⚫ Intubated
Breath sounds
● VENTRICULAR FIBRILLATION
● PULSELESS VENTRICULAR TACHYCARDIA Cardiovascular

⚫
⚫ Pulses

⚫ Heart sounds

⚫ Dysrhythmias
Medication drips
 EMERGENCY CARE PROCEDURES
Synchronized cardioversion AICD (Automated Implantable Cardioverter

⚫ Cardioversion- “synchronized countershock” is the

Defibrillator)

delivery of timed but direct electrical shock(s) to the

heart as an emergency or elective treatment ⚫
Priorities:

⚫ Activation status

⚫ performed by an MD or certified RN
The electrical charge is delivered to the myocardium
at the peak of R wave causing immediate
⚫ Heart rate cutoff
Number of shock(s) allowed to deliver

depolarization allowing SA node to gain control of Description:

the conduction system.
⚫
⚫ Pulse generator + Leads
Elective or emergency electrical therapy procedure is used
to treat VT with pulse that is transient or not sustained and ⚫
⚫
Weight – ½ lbs.
Size: a deck of cards
“tachydysrhythmias” if refractory or not responding to usual
mode of treatments like medications or valsalva. ⚫
⚫
Implantation: thoracotomy, sternotomy, transvenous
CAB via sternotomy

“SYNCHRONIZED” ⚫ Pulse generator

Sensor – monitor client’s EKG continuously: will
● When electrical current is discharged, it only triggers deliver countershock within 15-20 seconds can also
the client’s QRS complex to avoid accidental
electrical discharge at the repolarization phase (T ⚫ cardiovert Vtach with pulse

⚫ Combination of electrical therapy SHOCK and

Nothing will work, not until medications are used.
wave) due to the danger of converting to death
forming dysrhythmias. Medications

⚫
indications:

⚫ Tachydysrhythmias

⚫
⚫
Symptomatic
Refractory to medications
Conscious or ventricular tachycardia with pulse

⚫
What are the 4 usual ways of treating tachydysrhythmias?

⚫ Valsalva

⚫
⚫
Medications
Cardioversion
Carotid massage

⚫
Preparation:

⚫ Explain the procedure.

⚫
⚫
Obtain 12L EKG as baseline.
Connect client to pulse oximeter and BP cuff.

⚫ Connect to the monitoring leads.

Turn on the defibrillator and set for the synchronus

⚫
⚫
mode.
Sedation as ordered.

⚫
⚫
Remove dentures / jewelries.
Empty bladder.

⚫
⚫
Check the Digoxin level.
Prepare by exposing the client’s chest.

⚫ Have emergency and intubation set ready.

Obtain 12L EKG and write “pre conversion”.