- This is based on actions IN a healthcare facility – as if you are the nurse and find an unconscious patient.
- In the community, the algorithm is slightly different, refer to the American Heart Association for details.
- Patient found unconscious:
- Always assess first
- Determine responsiveness (sternal pressure, yelling)
- Check for carotid pulse (MAX 10 seconds)
- Know/ask if a neck injury is suspected
- If no pulse
- Call for help (Code Button, yell, call light)
- Send someone for AED
- Begin chest compressions at a rate of 100-120 beats/min
- Do NOT delay chest compressions
- During chest compression, do not stop unless instructed
- Minimizing chest compression interruptions is ESSENTIAL
- Push hard and fast
- Must allow for recoil
- Help arrives
- Another health care provider will open airway
- Use BVM to administer breaths after 30 compressions
- 30 : 2 ratio until secured airway
- Other health care providers should be attaching the defibrillator pads, ensuring IV access
- Do not use the pediatric/child defibrillator pads on an adult
- 2-minute cycle finishes
- Check carotid pulse
- Analyze rhythm (AED mode if no ACLS providers present)
- If shock advised
- Resume compressions while defibrillator charges
- Clear patient to administer appropriate shock
- Immediately resume compressions
- If pulseless and no shock indicated, immediately resume CPR
- Begin ACLS algorithms when advanced practitioners available
- Clinical Judgment
In this lesson, we’re going to look at the overview of CPR.
Let’s talk CPR. It’s crazy, it’s fast, it’s confusing. Some people hate it, and some people love it. But you absolutely need to be prepped to jump in do what you can to save your patient. And that’s our goal here – to get you ready for when you need it, and we’ll do this by covering the basics.
When we look at CPR, we need to make sure that we identify the NEED first. What do I mean by “need”? Well, that patient actually NEEDS CPR. The first thing we want to do is make sure that our patient just isn’t in some deep sleep and is ACTUALLY unresponsive before we go pounding on their chest. If not, you can actually hurt your patient by doing unnecessary chest compressions, so I’m gonna talk you through some of this.
The first thing to do is assess the patient and make sure they won’t wake up. Do this by any means necessary. Sternal rub, inner arm pinching, yelling. Do what you can do wake them up.
If you get NO response, then check a pulse. I sometimes do this simultaneously. Check any pulse that you can. It was never abnormal to have me feeling in two different places (like the carotid with one hand and then the radial with the other).
Also, quickly check to see if the patient has any neck injuries. Sometimes they can have some sort of neck injury could permanently hurt them, so be sure to ask and never tilt the head back. By tilting the head back, you can cause permanent injury to the spinal cord. I once had a patient that went to the OR and they had to emergently intubate him and they tilted his head back. When they did, they ended up severing his spinal cord and he became a quadriplegic. So if you aren’t sure…use a jaw thrust instead.
If you can’t feel a pulse, and your patient won’t wake up, you’d better get someone else’s attention. Hit the code alarm, call light, kick chairs out of the room, start yelling…anything you can to get help. Also yell for someone to bring you an AED or the defibrillator.
Drop the head of the bed, and start compressions. Your compressions should be hard and fast, with at least 100 to 120 beats per minute. Quick way to remember the speed is “Staying Alive” by the Bee Gees. It’s such an annoying song, you won’t forget it.
Also, make sure that you DON’T DELAY compressions. Start them asap and keep going. Don’t stop compressions and make sure you allow full recoil of the chest. Only stop when a provider tells you too, and make sure everyone is on the same page. Helpful tip, when you switch people doing compressions, count down (or say “ready, set go”) that way you don’t have any delays in compressions.
When additional help arrives, there should be a provider that’s coming to place some sort of advanced airway. The ambu bag can only do so much, and there’s good likelihood the patient will need some help breathing, like with a vent. Sometimes they don’t but it’s not uncommon – just be prepared for it.
Continue compressions until they’re absolutely ready to place the tube. They get one shot to place it, and about 10 seconds. After that, tell them you’re going to continue compressions and restart. Any delay longer than 10 seconds means the patient’s not getting blood perfused because there aren’t any compressions going – so get back on it.
Whoever is using the ambu bag should give 2 breaths after every 30 compressions, and make sure they’re doing that until they can place the airway.
Use other nurses and healthcare providers to get new IVs, access lines, prep supplies and attach the AED or defibrillator. And also be sure to make sure that you don’t use the pediatric pads on an adult patient. It doesn’t deliver the appropriate shock.
Also, don’t stop compressions to let other people place the AED pads. Keep those compressions going!
Another thing we want to talk about are 2-minute cycles. Everything in CPR is on two minutes. So when you notice you have a code starting, make sure you look at the time. Everything is on two minutes.
Also, make sure that you’re checking the carotid pulse (or any pulse) at the end of each cycle. Don’t search for one longer than 10 seconds.
We commonly say check a rhythm, check a pulse. That means one nurse is analyzing the rhythm to see if the patient needs to be shocked and another provider is searching for a pulse. If there isn’t anyone who is ACLS certified, then use AED mode on the defibrillator, or use an AED.
When we talk about shocking a patient, do compressions until you’re ready to shock. The AED will analyze the rhythm and find out if a shock is needed. If it is, clear the patient. What we commonly say is “I’m clear, you’re clear, everybody clear!” and quickly look around to make sure no one is touching the patient. Be loud! You don’t want anyone else getting hurt by them hanging on to the patient and getting zapped by the defibrillator. Once that shock is delivered, then start with compressions again!
At the end of the cycle, be sure to start your cycle over. This will be your opportunity to also switch out providers so that if you’re exhausted from giving compressions.
So what do you do if a shock is NOT advised?
KEEP DOING COMPRESSIONS!!!
Continue with the 2 minute cycles of compressions and breaths and then trying to find a pulse. You’ll do this until other providers show up who are ACLS certified. Once that happens, they’ll take over with additional interventions.
Nursing concepts for this lessons are clinical judgment (because you’ve gotta know when to do CPR), then perfusion and oxygenation because your patient can’t do it without your help.
So, let’s recap:
First, identify that your patient needs CPR. Try to wake them up and check for a pulse.
If you don’t have a pulse, yell for help. Get someone’s attention, drop the head of the bed and start those compressions!
Do compressions first, hard and fast, and make sure you’re getting chest recoil.
Do 30 compressions and then 2 breaths; also watch for chest rise when you’re giving rescue breaths.
And finally, get your patient hooked up to the AED. Keep doing the compressions and let someone else place the pads. And make sure everyone’s clear!
That’s it for our lesson on CPR. Be sure to check with the American Heart Association and their most recent guidelines regarding CPR so you can stay up to date. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!