Procedure for Resuscitation
Procedure for Resuscitation
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The chart below is from The Resuscitation Council UK and details what actions to take for a collapsed patient in care setting. It covers:
Safety
Checking the patient for a response
What to do if the patient responds
What to do if the patient does not respond
Each part of this chart will be covered in more detail over the next few pages.
The ABCDE Approach
In the event of finding a collapsed/sick individual:
Ensure personal safety. Wear personal protection equipment if necessary
Your first impression is important. Look at the patient in general to see whether the patient ‘looks unwell’
If the patient is responsive, perform an ABCDE assessment ensuring life-threatening problems are identified and treated; do you need to call for help?
After completing an initial ABCDE assessment, or following an intervention, reassess the patient using the ABCDE approach
If the patient is unconscious, unresponsive and is not breathing normally (occasional gasps are not normal and are a sign of cardiac arrest), start CPR
Select the photos to find out more information.
Airway
Assessment
Is the airway patent and maintained?
Can the patient speak?
Are there added noises?
Is there a see-saw movement of the chest and abdomen?
Management
Ensure that the airway is patent and maintained
Simple airway manoeuvres such as a head tilt and chin lift (in trauma use a jaw thrust)
Consider suction, airway adjuncts, position patient
Oxygen via non-rebreath mask
Breathing
Assessment
Observe:
Rate and pattern
Depth of respiration
Symmetry of chest movement
Use of accessory muscles
Colour of patient
Oxygen saturation
Management
Position of patient
Monitor and maintain oxygen saturations
Consider physiotherapy and nebulisers
Ventilate the patient using a pocket mask or bag-valve mask if insufficient rate of breathing
Circulation
Assessment
Manual pulse and BP
Capillary refill time
Urine output
Fluid balance
Temperature
Monitoring and, if available, a 12-lead ECG to allow prompt recognition of a myocardial infarction
Management
Cannulate, ensure patent IV access
Take bloods
Blood cultures and antibiotics (if required)
Fluid bolus
Disability
Assessment
Conscious level using AVPU
Blood glucose level
Pupil size and reaction
Loss of tone in limbs and face on one side (CVA) – this will require urgent treatment
Observe for signs of seizures
Management
Consider recovery position
Correct blood glucose
Control seizures
Control pain
Exposure
Assessment
Perform head-to-toe examination, front and back
Look for signs of a rash or signs of injury/bleeding
Management
Manage abnormal findings appropriately
Handover
A well-structured communication process is simple, reliable, dependable, will enable the caller to convey the important facts and urgency and will help the recipient to plan ahead.
Two examples of handover tools include:
SBAR - Situation, Background, Assessment and Recommendation
RSVP - Reason, Story, Vital signs and Plan
The use of the SBAR or the RSVP tool enables timely communication between individuals from different clinical backgrounds and hierarchies.
Select the headings below for more information about the SBAR tool.
Situation/Reason
Introduce yourself and check that you are speaking to the correct person
Identify the patient you are calling about (who and where)
State what you need advice about
Background/Story
Background information about the patient
Reason for admission
Relevant past medical history
Assessment/Vital Signs
Include specific observations and vital sign values based on the ABCDE approach
State the early warning score (NEWS)
Recommendation/Plan
State explicitly what you want the person you are calling to do
What and by when?
Don't forget to document the call (including date and time), your assessment, actions/interventions and the patient's response.
National Early Warning System (NEWS) 2
To help early detection of deteriorating patients, many hospitals use early warning scores. The score of one or more vital sign observations, or the total Early Warning Score, indicates the level of intervention required; for example, increasing the frequency of vital signs monitoring or calling the appropriate level doctor to respond in a timely manner. In the UK, the National Early Warning Score (NEWS2) [2] is an early warning system which standardises the assessment and level of response of acutely ill patients. It is a fast, efficient and consistent response which measures the degree of illness of a patient. It should be used in conjunction with your clinical judgement and therefore, if a patient has a low score but you have concerns, refer to your senior colleagues or a doctor.
Please note: your organisation may use a different early warning score system to the one presented below. Ensure that you find out what system you should be using.
NEWS2
It should be remembered that NEWS2 is an aid to good clinical judgement not a substitute for it.
Some hospitals and care settings may use a different system from NEWS2. Ensure that you find out what system your organisation is using.
Handover
Remember to include the NEWS2 score in your SBAR or RSVP when referring a patient.
Score of 3
A score of 3 for any of the observations requires urgent investigation and referral.
SpO2 Scale 2
Remember that SpO2 Scale 2 is to be used when a clinical decision is made that it is appropriate for that patient and should be documented by the doctors.
Case Studies
John Peters is a 75-year-old man who has been admitted via his GP with acute confusion. He has no past medical history of significance.
Upon assessment, he moans when you try to wake him. The ABCDE findings are:
Airway: his head is slumped and he is snoring and gurgling
Breathing: his respiratory rate is 25 and the saturation monitor is showing saturations at 90% on room air
Circulation: he has a central pulse of 130 beats per minute. Blood pressure is 90/40 with a capillary refill time of 4 seconds
Disability: he is responding to painful stimuli, blood sugars are normal and his pupils are equal. His temperature is 38.9
Exposure: nil of note
Can you list what actions you would take?
Click the photo for appropriate actions.
Shout for help
Check his mouth and clear away secretions etc. by positioning him on his side and suction
Open airway
Check saturations and apply oxygen if trained to do so. Look for an improvement in his saturations
NEWS2 score is 15 and the appropriate doctor should be bleeped or called to review urgently using SBAR or RSVP
Prepare equipment to begin the Sepsis Six
Mrs Johnson is at local food festival, Mrs Johnson fell and grazed her knee and presented to the first-aid post. Her intial observations show her NEWS2 score is 0. During her time with the first responder Mrs Johnson developed chest pain. Observations are now as folllows:
Airway: airway is clear
Breathing: she feels breathless (respiration rate 25). She is not on oxygen as her saturations are 97%
Circulation: she looks pale and clammy. Her blood pressure is 160/90 and her pulse is 120
Disability: she is alert and her temperature is 36.5
Exposure: nothing that causes concern
Her NEWS2 score is 5.
Would you request an urgent review?
Think about your answer then click the photo.
YES - Her NEWS2 Score has increased by 5 and she is clinically unwell. She requires prompt assessment to identify the cause of her chest pain, be prescribed drugs including analgesia and may require urgent treatment in a cardiology department.
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