This assignment is concerned with the analysis of the quality of performance and practices deviating from the predefined set of Australian Resuscitation Council (ACR) in the scenario depicted in the identified YouTube video the Code Blue gone well. Based on the bulk of preexisting literature, strengths and weaknesses of the practice will be identified—both technical and non technical in nature. After extracting the shortcomings and drawbacks, recommendations will be presented for improving the performance. Conclusion section, in the end, will attempt to enclose whole textual activity within the single paragraph. In a nutshell, this assignment will provide the reader with the evidence- based knowledge about standard practices involved in resuscitation process and how shortcomings can be identified and improved in the light of Australian Resuscitation Council (ARC).
The selected video for analyzing the quality of resuscitation practice is the Code Blue gone well in which scenario for the resuscitation for female patient is depicted (Video link is presented at the reference page). At the start of the video, a nurse attends female patient—Tommy—upon her light call; she reports chest tightness and breathing difficulty. The nurse measures her vital signs using stethoscope at the back of the patient; soon another nurse joins and provides the background information of the patient that she acquired the shortness of breath after surgery and experienced asthma symptoms in the past as well. Soon a team of four more female nurses rush the place and one of them measures her pulse and finds that the patient is not pulsating; after knowing this, she orders them to start compressions. One of the nurses takes the register and notes her vital symptoms down on paper. One nurse starts compressing the patient after taking her to the straight position whereas the other one prepares epinephrine solution for her that is an effective vasopressor. Patient is then left at rest for 10 seconds; her pulse is checked and again pressure is applied. Patient demonstrated no pulse at the moment; the nurse in- charge appears and asks for the patient’s current situation. She orders to prepare 300 ml of amiodarone and defibrillate at 200 Joules and one milligram of epinephrine. After 3 seconds, pulse was checked and it was felt successfully.
Inferential analysis of the video:
The Australian Resuscitation Council is a voluntary body that is responsible for the coordination of major classes involved in the education and practice of resuscitation. It is sponsored by the New Zealand and Australian College of Anesthetics. This council offers simplicity and advancement in the resuscitation of techniques in order to foster the well being of individuals passing from critical stage of their lives. For that matter, resuscitation terminologies and techniques are presented in the most comprehensive and understandable way. These guidelines are formulated after interpretive analysis of available literature in the relevant field and are published after collaborative agreement of all the members of organization.
Due to the accepted reliability of ARC, its resuscitation guidelines will be used as a benchmark to verify the quality of performance in the identified media. Additionally, a bulk of relevant peer reviewed high quality literature will be added to support the ideas.
After analyzing the video, following strengths were identified:
Collaboration of team members
Instant action in response to the directions
Successful completion of resuscitation
Although the team members carried the process to support the survival of patient
Team lead arrived at the end of operation
Amiodarone was not given during initial intervention along with the external pacing
CPR was carried intermittently—delay was recorded more than 10 seconds
Nurse is only using her arm pressure to resuscitate
The accepted method of Cardiopulmonary Resuscitation
It is an accepted life saving technique for the individuals whose heart beat stops due to some respiratory issues or excitation failure; hence it is specifically useful in emergency situation. Now the question arises how can this practice be carried successfully? Or who can carry this practice? Is it necessary to be trained professional for executing CPR? The answer is unexpectedly simple; anyone either he is untrained bystander or trained medical professional may carry Cardiopulmonary resuscitation (CPR) starting with the chest compression (ARC, 2017).
The standard method of Cardiopulmonary resuscitation starts from the pre- assessment about the person and his surroundings. It is first assured that environment where person would be resuscitated is safe for the practice and person is conscious or not, if the person is unconscious he is asked loudly about his condition (ARC, 2017). If he does not respond, he needs assistance in terms of Cardiopulmonary resuscitation. It is done using hands with the full force over the chest of patient.
First, patient is put on his back over a firm surface; nurse should exactly kneel next to his shoulder and neck; heel of the one hand is placed over the individual’s chest between the nipples; the other hand is placed at the top of first hand, elbows are placed straight to the shoulders exactly above the hand (Lim et. al., 2010). The upper body weight is utilized for exerting substantial pressure on the chest through compression at about 5 centimeters (2 inches approximately) but it must not be greater than 2.4 inches i.e., 6 centimeters approximately. There must be 100 to 120 compressions within one minute and continue till the person starts breathing.
The basic rationale behind compressing the chest and executing Cardiopulmonary Resuscitation (CPR) is that it allows the oxygen to enter the lungs and mix into the blood which is then pumped by the heart to various body organs—including brain. If brain lives, the trauma can be avoided. It is quite crucial to keep the oxygenated blood moving into the heart without any internal or external interruption (Morrison et. al., 2010). Any pause or delay in the compression of more than 5 seconds may disrupt the flow of blood within the body and resuscitation may fail. As in the given video, practice was delayed for 10 seconds (Morrison et. al., 2010).
Moreover, it is also important that how fast the compression must be executed and with how much interval it must be released. It is quite essential to keep the hands intact and protect them from bouncing; whole body weight must be used for resuscitation rather than mere arm pressure (Wahba et. al., 1997). This is the area where quality of Cardiopulmonary Resuscitation was interfered in the video. When superficial pressure (only of the arms) is applied to the chest, it becomes insufficient to compress internal organs and oxygenate the blood; hence, all the resuscitation activity fails if this practice is continually executed.
Moreover, Epinephrine was used by the nurse that is quite effective during Cardiopulmonary Resuscitation because it increases the blood pressure over arteries and coronary perfusion through alpha-1-adrenoceptor agonist effects. It couples with the pressure being generated through CPR and ensures patient’s survival against cardiac arrest (Long, 2017).
Amiodarone is commonly used in treating various types of irregular heart beat that are essentially dangerous and fatal in nature for example during persistent ventricular fibrillation/tachycardia. It is known as an anti- arrhythmic drug because it works by blocking intermittent or abnormal electrical signals in the heart that generate irregular heartbeat. In this way, normal heart rhythm is restored and steady and regular heartbeat is maintained (Dorian et. al., 2017). This drug is used after every two minutes of the CPR in order to gain favorable results, however, in the identified video, it was seen that nurses used this drug at the end of resuscitation activity.
The role of team leader in the successful execution of CPR practices is highly demanding. It is irrefutably significant for the team leader to remain at his position during resuscitation activity and command his team effectively. He carries or coordinates defibrillation, cannulation, intubation and drug administration; checks resuscitation status periodically for favorable prognosis and orders investigations for reassessing response to treatment (Chase, 2017). Moreover, he ensures that family of the patient is notified and documentation is being carried properly. Organizing post resuscitation care is another primordial duty of the team leader. However, in the identified video, it was seen that team leader arrives at the last moment and asks for the progress that his team has made at that moment (Smith et. al., 2010).
Suggestions for further improvement
The responsible role playing of team leader during critical care hours is highly crucial in ensuring patient’s safety; nurses must be trained enough to lead their teams effectively. Essential drugs must be administered in association with the CPR with correct time and dosages. CPR practices must be carried in line with the preexisting literature and ARC guidelines.
In a nutshell, high quality Cardiopulmonary Resuscitation contains five critical components that must be met in order to accomplish the practice successfully; minimizing the interruptions in the compression practice, providing compressions at adequate depth and rate along with the associated drugs, avoiding leaning on the patient when compression is being carried out, ensuring proper head placement and performing the resuscitation continuously. Furthermore, the role of team leader in ordering and addressing his team members during critical care is highly significant. Need of the hour is to educate the nursing professionals about updated literature and ARC guidelines so that they could be applied to enhance effectual practice.
Chase F. A. (2017). Team Communication in Emergencies: Simple Strategies for Staff. Zoll.com. Retrieved from HYPERLINK "http://www.zoll.com/codecommunicationsnewsletter/ccnl04_10/ZollTeamCommunications04_10.pdf" http://www.zoll.com/codecommunicationsnewsletter/ccnl04_10/ZollTeamCommunications04_10.pdf
Dorian, P., Cass, D., Schwartz, B. et al. (2017). Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 346, 884-90. 10.1056/NEJMoa013029
Home (2017). Australian Resuscitation Council (ARC). Retrieved from HYPERLINK "https://resus.org.au/" https://resus.org.au/
Lim, S. H., Shuster, M., Deakin C. D, Morrison L. J, et al. Part 7: CPR techniques and devices: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation., 81(1), e86–e92.
Long, B., Koyfman, A. (2017). Emergency medicine myths: Epinephrine in cardiac arrest. J Emerg Med., 52, 809–14. doi: 10.1016/j.jemermed.2016.12.020.
Lorenzini, S. (2016). Code Blue gone well. Retrieved from HYPERLINK "https://www.youtube.com/watch?v=wGrDX6II_E8&feature=youtu.be" https://www.youtube.com/watch?v=wGrDX6II_E8&feature=youtu.be
Morrison, L. J., Deakin, C. D., Morley, P. T., Callaway, C. W., Kerber, R. E., et al. (2010). Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation, 122(16 2), S345–S421.
Smith, S., Capella, J., Philp, A., et al (2010). Teamwork training improves the clinical care of trauma patients. J Surg Educ. 67(6), 439–43.
Wahba, A., Gotz, W., Birnbaum, D. E. (1991). Outcome of cardiopulmonary resuscitation following open heart surgery. Scand Cardiovasc J., 31, 147–9.
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