Home / Index Page

The equipment we'll need

Roles around the patient

Main CPR / AED Protocol

Page 3 - CPR for adults

Page 4 - chest
compression
technique

Page 5 - chest
compressions
and critical
concepts

Page 6 - head tilt
and chin lift

Page 7 - mouth to
mouth breathing

Page 8 - mouth to
mask breathing

Page 9 - mouth to
mask ventilation -
compressions

Page 10 - the
summarized protocol /
algorithm

Page 11 - patient
assessment

Page 12 - open airway

Page 13 - cycles of
compressions and
breathes

Two Person CPR
Checklist

 

 

 

 


Phase 1: Run a sloppy code! I know, doesn't sound pretty but just grab your team and walk through it. Find out where you're at. Find out, in an unimtimidating way, what you know, what you don't know, and what needs some sharpening. Take the opportunity to review what you've discovered and replay it in your mind, review the videos, read your way through the BLS links, focus on quality CPR, review equipment, review roles, how to use the AEDs (two kinds - the Zoll AED (BPC) and Cardiac Science AED (APC) - there's videos of how to use each at the AED link), review the meds you might need, until you're convinced you know how to rectify trouble spots. See how we did this makeshift "dry run" in March.

Then, on another day, hopefully no more than a week or two (or maybe
even withing a few days) from the first time ...

Phase 2: Rehearse another one, and another one, and another one. Try different roles around the patient. Let different people initiate it. Maybe it'll be smoother or faster than the first 2 or 3 you've run. Maybe it won't. But who cares? If you'rre gaining confidence in running it and our MA's and nurses are more comfortable with it, then that's what's important. Review drugs, review timing of giving meds, when to give respirations only. etc.


Phase 3: you've arrived. You've got this internalized. Your team is now comfortable enough to pretty much perform any role from giving directions to recording, to feeling confident regardless of whether they're in charge of the airway, the AED, collecting all the necessary gear, etc. If they never reach that point, you have, and direct others in their positions.

 

An email Jeff sent Dr. Brancio that outlines the first phase:

Phase 1 - getting familiar with where we're at / what everyone
knows (including clinicians :-):

4-23-09

Corinna --

 
we just completed a super mini- impromptu mock code
here at BPC (Pla, Andrea and myself). I caught them completely
off guard and they were great sports :-) Here's kind of how it went:
 
I prefaced it by saying
 
"folks we're going to be trying to do  little emergency preparedness"
 
response: "what's that mean?"
 
Like if someone collapsed, unconscious, cardiac arrest...
 
the goal today is not high tech ACLS  but to know what resources we have, where they are and who's gonna do what
 
so we the three of us, reviewed where "crash box" was, where' the ambu bag, 02,saline, IV stuff, pocket mask, AED.
 
I said if we started with just the 3 of us who would do what? (rhetorically)
 
1) clinician would probably be running it so I was pretending  I was talking to the
the patient (a face and heart drawn on the paper on the exam table).pt was 
determined to be unresponsive..
 
2) now that we've established pt is down, no pulse, not breathing, Pla today was the designated person to call 911 and grab the triage nurse and IV stand (there's saline and tubing in the crash kit) AFTER she grabbed the AED and the crash box - andrea was with me at pt's side..
after ambu bag pulled from crash box
 
 
....since pt was unconscious Pla left to call 911 and get
those other things...cpr initiated
 
3) Andrea was in charge of Airway
 
4) Pla started the AED while I did compressions and Andrea controlled airway
 
some neat questions arose right away - small amount of confusion around compression ratios, breathing ratios, to how much of the equipment can we open (e.g. the paddles are a little different on the AED) without making them obsolete had to look at the paddles a little long to get familiar with them -- (maybe we can have an open one at both sites to see how these are applied)
 
we reviewed the 30:2 compression to breathing ratio for adults
15:2 for children and infants
5 cycles of 30:2 (or approximately 2 minutes of cpr)
 
So things I see that people need to hold in hand (and i'll put this together)
are a paper or guide of the BLS protocol (very simple)
 
maybe a diagram of the ABC's, designating people that given day who's going to do what
 
What I'm picturing: getting clinicians comfortable with initiating and running the
mock code, slowly phasing up the "acuity": start by just getting folks
comfortable with places and resources, on up to....
 
Goal: all staff feeling comfortable with tasks surrounding a code, at any position
and knowing / feeling comfortable with BLS until the ambulance gets here.
 
I know some of that's a little vague but I see how this could be simple, un-intimidating,and gratifying for people knowing there's simple straight forward steps for each person / in each role.
 
any thoughts at this point Corinna? Like you have nothing else going on. :-)
 
 
-j