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All search results are from google search results. Please respect the publisher and the author for their creations if their books are copyrighted. The value of securing the airway must be balanced against the need to minimize the interruption in perfusion that results in halting CPR during airway placement. Both airway equipment terminate in the pharynx.
The main advantage of a NPA over an OPA is that it can be used in either conscious or unconscious individuals because the device does not stimulate the gag reflex.
Advanced airway equipment includes the laryngeal mask airway, laryngeal tube, esophageal-tracheal tube, and endotracheal tube. Different styles of these supraglottic airways are available. If it is within your scope of practice, you may use advanced airway equipment when appropriate and available.
OPA is used in individuals who are at risk for developing airway obstruction from the tongue or from relaxed upper airway muscle.
A properly sized and inserted OPA results in proper alignment with the glottis opening. If efforts to open the airway fail to provide and maintain a clear, unobstructed airway, then use the OPA in unconscious persons. An OPA should not be used in a conscious or semiconscious individuals, because it can stimulate gagging, vomiting, and possibly aspiration.
The key assessment to determine if an OPA can be placed is to check if the individual has an intact cough and gag reflex. If so, do not use an OPA. It is used as an alternative to an OPA in individuals who need a basic airway management adjunct. Unlike the oral airway, NPAs may be used in conscious or semiconscious individuals individuals with intact cough and gag reflex.
NPA placement can be facilitated by the use of a lubricant. Never force placement of the NPA as severe nosebleeds may occur. If it does not fit in one nare, try the other side. Use caution or avoid placing NPAs in individuals with obvious facial fractures.
Providers should suction the airway immediately if there are copious secretions, blood, or vomit. Attempts at suctioning should not exceed 10 seconds. If a change in monitoring parameters is seen, interrupt suctioning and administer oxygen until the heart rate returns to normal and until clinical condition improves.
Assist ventilation as warranted. Otherwise, an OPA may stimulate vomiting, laryngeal spasm, or aspiration. However, use carefully in individuals with facial trauma due to the risk of displacement. Interrupt suctioning and administer oxygen if any deterioration in clinical picture is observed during suctioning. STEP 2: Select an airway device that is the correct size for the person.
Choose the device that extends from the corner of the mouth to the earlobe. STEP 4: Insert the device into the mouth so the point is toward the roof of the mouth or parallel to the teeth. STEP 5: Once the device is almost fully inserted, turn it until the tongue is cupped by the interior curve of the device. Choose the device that extends from the tip of the nose to the earlobe. Use the largest diameter device that will fit. STEP 3: Lubricate the airway with a water-soluble lubricant or anesthetic jelly.
STEP 4: Insert the device slowly, moving straight into the face not toward the brain. STEP 5: It should feel snug; do not force the device into the nostril. If it feels stuck, remove it and try the other nostril. Extend the catheter to the maximum safe depth and suction as you withdraw. Therefore, sterile technique should be used. Remember the person will not get oxygen during suctioning. It is a specific type of tracheal tube that is inserted through the mouth or nose.
It is the most technically difficult airway to place; however, it is the most secure airway available. Only experienced providers should perform ET intubation. This technique requires the use of a laryngoscope. Fiber optic portable laryngoscopes have a video screen, improve success, and are gaining popularity for field use.
It is acceptable to use the LMA as an alternative to an esophageal-tracheal tube for airway management in cardiac arrest. This tube has only one larger balloon to inflate and can be inserted blindly. This device provides adequate ventilation comparable to an ET tube. The combitube has two separate balloons that must be inflated and two separate ports. The provider must correctly determine which port to ventilate through to provide adequate oxygenation.
Give one breath every 6 to 8 seconds. ET absorption of drugs is poor, and optimal drug dosing is unknown. Therefore, the intraosseous IO route is now preferred when IV access is not available. Below are the priorities for vascular access.
Central line access is not necessary during most resuscitation attempts, as it may cause interruptions in CPR and complications during insertion. Placing a peripheral line does not require CPR interruption.
If a drug is given via peripheral route of administration, do the following: 1. Intravenously push bolus injection unless otherwise indicated.
Flush with 20 mL of fluid or saline. Raise extremity for 10 to 20 seconds to enhance delivery of drug to circulation. IO access can be used for all age groups, can be placed in less than one minute, and has more predictable absorption than the ET route.
The effect of medications given may not be seen until even longer. High-quality CPR helps circulate these drugs and is an important part of resuscitation. This table only provides a brief reminder for those who are already knowledgeable in the use of these medications. Moreover, Table 1 contains only adult doses, indication, and routes of administration for the most common ACLS drugs. An individual presents with symptomatic bradycardia. Her heart rate is Which of the following are acceptable therapeutic options?
Atropine b. Epinephrine c. Dopamine d. All of the above 2. A known alcoholic collapses and is found to be in torsades de pointes. What intervention is most likely to correct the underlying problem? Rewarm the individual to correct hypothermia. Administer glucose to correct hypoglycemia. Administer naloxone to correct narcotic overdose. You have just administered a drug for an individual in supraventricular tachycardia SVT. She complains of flushing and chest heaviness.
Which drug is the most likely cause? Aspirin b. Adenosine c. Amiodarone d. D Atropine is the initial treatment for symptomatic bradycardia. If unresponsive, IV dopamine or epinephrine is the next step. Pacing may be effective if other measures fail to improve the rate.
Administration of IV magnesium may prevent or terminate torsades de pointes. B Adenosine is the correct choice for SVT treatment and commonly results in reactions such as flushing, dyspnea, chest pressure, and lightheadedness.
When a fatal arrhythmia is present, CPR can provide a small amount of blood flow to the heart and the brain, but it cannot directly restore an organized rhythm. The likelihood of restoring a perfusing rhythm is optimized with immediate CPR and defibrillation.
The appropriate energy dose is determined by the design of the defibrillator—monophasic or biphasic. If you are using a monophasic defibrillator, give a single J shock. Use the same energy dose on subsequent shocks. Biphasic defibrillators use a variety of waveforms and have been shown to be more effective for terminating a fatal arrhythmia. Many biphasic defibrillator manufacturers display the effective energy dose range on the face of the device.
If the first shock does not terminate the arrhythmia, it may be reasonable to escalate the energy delivered if the defibrillator allows it. Be sure to clear the individual by ensuring that oxygen is removed and no one is touching the individual prior to delivering the shock. Immediately after the shock, resume CPR, beginning with chest compressions.
Give CPR for two minutes approximately five cycles. A cycle consists of 30 compressions followed by two breaths for an individual without an advanced airway. Those individuals with an advanced airway device in place can be ventilated at a rate of one breath every 5 to 6 seconds or 10 to12 breaths per minute.
An AED is both sophisticated and easy to use, providing life-saving power in a user-friendly device which makes it useful for people who have never operated one and for anyone in stressful scenarios. However, proper use of an AED is very important. Once the pads are attached correctly, the device will read the heart FPO rhythm. If the pads are not attached appropriately, the device will indicate so with prompts. Once the rhythm is analyzed, the device will direct you to shock the individual if a shock is indicated.
A shock depolarizes all heart muscle cells at once, attempting to organize its electrical activity. Power on the AED. Choose adult or pediatric pads. Attach the pads to bare chest not over medication patches and make sure cables are connected. Dry the chest if necessary.
Place one pad on upper right side and the other on the chest a few inches below the left arm. Clear the area to allow AED to read rhythm, which may take up to 15 seconds. If there is no rhythm in 15 seconds, restart CPR.
If the AED indicates a shock is needed, clear the individual, making sure no one is touching them and that the oxygen has been removed. Immediately resume CPR starting with chest compressions. Continue to follow the AED prompts. Do not waste excessive time troubleshooting the AED. They include an overview of the ways life-saving interventions should be organized Rapid to ensure they are delivered efficiently and Response effectively.
As with any chain, it is only as strong as its weakest link. Clear the mouth or blood or secretions with suction, if possible. Insert the device so that the point is toward the roof of the mouth or parallel to the teeth Do not press the tongue back into the throat. Once the device is almost fully inserted, turn it so that the tongue is cupped by the interior curve of the device. Select an airway that is the correct size for the patient. Lubricate the airway with a water-soluble lubricant.
Insert the device slowly, straight into the face not toward the brain! Adequate suctioning usually requires negative pressures of — 80 to mmHg. Rapid heart rate, narrow QRS complex,. Fluid resuscitation. Decreased heart rate. Airway management, oxygen. Hydrogen Ion Acidosis. Fingerstick glucose testing.
IV Dextrose. Flat T waves, pathological U wave. IV Magnesium. Peaked T waves, wide QRS complex. History of cold exposure. Tension Pneumothorax. Slow heart rate, narrow QRS complex, acute dyspnea, history of chest trauma. Thoracotomy, needle decompression. Tamponade Cardiac. Rapid heart rate and narrow QRS complex.
Variable, prolonged QT interval, neuro deficits. Thrombosis pulmonary. Rapid heart rate, narrow QRS complex. Fibrinolytics, embolectomy. Thrombosis coronary. Fibrinolytics, Percutaneous intervention. Second or third degree heart block; tachycardia due to poisoning. Pulseless ventricular tachycardia Ventricular fibrillation. First dose: mg bolus Second dose: mg Max: 2. Second or third degree heart block; hypotension may result with rapid infusion or multiple doses.
Symptomatic bradycardia No longer recommended for PEA or asystole. Cardiac arrest Anaphylaxis Symptomatic bradycardia instead of dopamine. Cocaine-induced ventricular tachycardia May increase oxygen demand. Symptomatic bradycardia if atropine fails Pressor for hypotension. Wide complex bradycardia Should not be used in cases of acute myocardial infarction Observe for signs of toxicity.
Wide complex tachycardia with pulse: 0. Rapid bolus may cause hypotension and bradycardia; Can also be used to reverse digitalis poisoning. Deliver through central line Peripheral IV administration can cause tissue necrosis. Inclusion Criteria. Exclusion Criteria. Ischemic stroke with neurological deficit. Onset of symptoms 3 hours. History of brain. Age 18 years old. Brain tumor, arteriovenous malformation, or aneurysm. Brain or spine surgery in last. Arterial line or blood draw in last week.
Possible subarachnoid hemorrhage. Serum glucose. Currently bleeding internally or bleeding diathesis. Elevated aPTT if known. Currently taking anticoagulants. Hemorrhage on CT. Relative Exclusion Criteria. Minor neurologic deficits.
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