Emergen. Bls&Shock

8/14/2019 Emergen. Bls&Shock

http://slidepdf.com/reader/full/emergen-blsshock 1/73

Emergency Nursing: BLS

Prepared by:

Ms. Cherry Ann G. Garcia, RN



Basic life support (BLS)

• A means of providing oxygen to

the brain, heart and other organs

until help arrives

• Also known as

CARDIOPULMONARY

RESUSCITATION




• An adult is a person above age 8

• A child is any person age 1 to 8 years old

•An infant is anyone under 1 year




• The BLS follows the A-B-C principle

– A= airway

– B= breathing

– C= circulation




• Causes of cardiac arrest

– Respiratory arrest

– Direct injury – Drug overdose

– Cardiac arrhythmias




ADULT

• STEPS in CPR: First STEP

– ASSESSMENT: determine Unresponsiveness

– Assess for 5-10 seconds – Shake the victim’s shoulder and ask: “are you

okay”




ADULT

• STEPS in CPR: Second Step

– Survey the area




ADULT

• STEPS in CPR: Third Step

– Call for HELP

– Activate emergency medical system

– Note: for child and infant this is done LAST




ADULT

• STEPS in CPR: Fourth step

– Place Victim in Supine position on a flat firm

surface

– Log roll the patient when moving




ADULT

• STEPS in CPR: Fifth step

– OPEN the airway

– Head tilt-Chin Lift method

– Jaw thrust maneuver if neck injury is suspected




ADULT

• STEPS in CPR: Sixth step

– Assess BREATHING

• Place ear over the nose and mouth• Look for chest movement

• Perform for 3-5 SECONDS




ADULT

• STEPS in CPR: Sixth step

– Assess BREATHING

• If breathing: place on side if no neck injury; DONOT move if with neck injury

• If NOT BREATHING: deliver INITIALLY 2 rescuebreath via mouth to mouth

• Then deliver 10-12 breaths/minute




ADULT

• STEPS in CPR: Seventh step

– Assess CIRCULATION

• Check for the carotid pulse on the side close toyou for 5-10 SECONDS

• If with (+) pulse ; continue giving 10-12

breaths/minute




ADULT



• If withOUT pulse: START Chest Compression

• Correct hand placement: LOWER HALF of sternum

one hand over the other with fingers interlacing

• Depress: 1 ½ to 2 INCHES

80-100 compressions/min




ADULT



• If withOUT pulse: START Chest Compression

• ONE-rescuer: 15 chest: 2 breaths

• TWO-rescuer: 5 chest: 1 breath

• DO FOUR cycles and re-assess for pulse




CHILD

1-8 years old

• AIRWAY: assess unresponsivenessand keep airway patent by HTCL or JT

• BREATHING: assess for airflow andchest movement

• If breathing: maintain patentairway

• If NOT breathing : deliver 2rescue breaths by mouth tomouth

• DELIVER 20 breaths/minute




CHILD

1-8 years old

• CIRCULATION: assess the carotid pulse

• If with pulse: continue to deliver 15- 20 breaths/minute

• If WITHOUT pulse: start chestcompression

• Correct hand placement: lower half of sternum using heel of ONE HAND

• DELIVER: 1 to 1 ½ inches 80- 100 chest

compressions/min

5:1 (do 20 cycles EMS)




INFANT

Less than 1

• Determine unresponsiveness

• AIRWAY: Place head of infant in NEUTRAL

position• BREATHING: assess for rise-fall of chest

and airflow

– If breathing: maintain patent airway

– If NOT breathing: initiate 2 rescuebreathing via mouth to mouth and nose

– DELIVER 20 breaths/min SLOWLY




INFANT

Less than 1

• CIRCULATION: assess for pulse: TheBRACHIAL pulse is utilized!!

– If with pulse: continue to deliver 20breaths/min

– If WITHOUT pulse, start chest compression

– Correct hand placement: just below thenipple line in the sternum using 2-3 fingers

of one hand!! – DELIVER: ½ to 1 inch depth

100 chest com/min

5:1 ratio (do 20 cycles EMS)



AIRWAY Obstruction

• Incomplete

– Crowing sound is heard

encourage to cough

• Complete

– Clutching of the neck

– Ask: “Are you choking?”

– Perform Heimlich’s



AIRWAY Obstruction

• Complete

– If patient becomes unconscious:

• Place supine on flat surface

• Perform tongue-jaw lift maneuver

• FINGERSWEEP to remove object

• Open airway and attempt ventilation

• Perform Heimlich while supine

• Reattempt ventilation

• SEQUENCE: TJL finger-sweep

rescue breaths Heimlich’s TJL



AIRWAY Obstruction

Pediatric consideration

CHILD: NEVER DO Blind Finger

sweep



AIRWAY Obstruction

Obstetric considerations:

Hand is placed over the middle part

of sternum: backward chestthrust

If unconscious: place pillow below

the RIGHT abdomen to displace

uterus



Shock

• An abnormal physiologic state

where an imbalance exists

between the amount of circulating

blood volume and the size of thevascular bed .



Pathophysiology of Shock

1. Cellular effects of shock• In the absence of oxygen, the cell will undergo

Anaerobic metabolism to produce energy sourceand with it comes numerous by-products like lactic

acid• The cell will swell due to the influx of Na and H20,

mitochondria will be damaged, lysosomal enzymeswill be liberated, and then cellular death ensues.



Pathophysiology of Shock

2. Organ System Responses

• When the patient encounters precipitating causes

of shock, the circulatory function diminishes

there is decreased cardiac output Hypotension

and decreased tissue perfusion will result



Shock Stages

3 STAGES:

• Compensatory stage• Progressive stage

• Irreversible stage



Shock Stages

THE COMPENSATORY STAGE OF SHOCK

• In this stage, the patient’s blood pressure is withinnormal limits.

• Patient’s blood is shunted from the kidney, skin and GITto the vital organs- brain, liver and muscles

• Manifestations of cold clammy skin, oliguria and hypoactive bowel sounds can be assessed.

• Medical management includes IVF and medication

• Nursing management includes monitoring of tissueperfusion & vital signs, reduction of anxiety,administering IVF/ordered medications and promotion of safety



THE PROGRESSIVE STAGE OF SHOCK

• In this stage, the mechanisms that regulate blood pressurecan no longer compensate and the mean arterial pressurefalls.

• The overworked heart becomes dysfunctional. Heart ratebecomes very rapid (as high as 150 bpm)

• Blood flow to the brain becomes impaired, the mentalstatus deteriorates due to decreased cerebral perfusionand hypoxia.

• Laboratory findings will reveal increased BUN andCreatinine. Urinary output decreases to below 30 mL/hour.



THE PROGRESSIVE STAGE OF SHOCK

• Decreased blood flow to the liver impairing

the hepatic functions. Toxic wastes are not

metabolized efficiently, resulting to

accumulation of ammonia, bilirubin and lactic

acids.

• The reduced blood flow to the GIT causes

stress ulcers and increased risk for GI

bleeding.

• Hypotension, sluggish blood flow, metabolicacidosis (due to accumulation of lactic acid),

and generalized hypoxemia can interfere

with normal blood function.



THE IRREVERSIBLE STAGE OF SHOCK

• This stage represents the end point where there issevere organ damage that patients do not respond anymore to treatment. Survival is almost impossible tomaintain.

• Despite treatment, the BP remains low, anaerobicmetabolisms continues and multiple organ failure results.

• Medical management is the use of life supporting drugslike epinephrine and investigational medications.



Assessment of Shock

Assessment Findings

Skin : Cool, pale, moist in hypovolemic and cardiogenic

shock

: Warm, dry, pink in septic and neurogenic shock

Pulse• Tachycardia, due to increased sympathetic stimulation

• Weak and thready

Blood pressure

• 1. Early stages: may be normal due to compensatory

mechanisms• 2. Later stages: systolic and diastolic blood pressure drops.



Assessment of ShockAssessment Findings

Respirations: rapid and shallow, due to tissue anoxia andexcessive amounts of CO (from metabolic Acidosis)

Level of consciousness: restlessness and apprehension,progressing to coma

Urinary output: decreases due to impaired renal perfusion

Temperature: decreases in severe shock (except septic shock).



Management of Shock

Nursing Interventions

• Management in all types and phases of shock

includes the following:

•

Basic life support • Fluid replacement

• Vasoactive medications

• Nutritional support



Management of ShockA. Maintain patent airway and adequate ventilation.

B. Promote restoration of blood volume; administer fluid andbloodreplacement as ordered

C. Administer drugs as ordered

D. Minimize factors contributing to shock.

E. Maintain continuous assessment of the client.

F. Provide psychological support: reassure client to relieveapprehension, and keep family advised

G. Provide Nutritional support



Hypovolemic Shock

This is the MOST common form of shock characterizedby a decreased intravascular volume

Risk factors: external Fluid Losses

• Trauma, Surgery, Vomiting, Diarrhea,Diuresis, DI

Risk factors: internal fluid shifts• Hemorrhage, Burns, Ascites,

Peritonitis, Dehydration



Hypovolemic Shock

• Decreased blood volume decreased venousreturn to the heart decreased stroke volume decreased cardiac output decreased tissueperfusion

• Assessment findings: cold clammy skin,tachycardia, mental status changes, tachypnea



Hypovolemic Shock

• MEDICAL MANAGEMENT: – The major medical goals are to

restore intravascular volume, toredistribute the fluid volume, and

to correct the underlying cause of fluid loss promptly



Hypovolemic Shock

• NURSNG MANAGEMENT:

– Primary prevention of shock is the most

important intervention of the nurse.

– General nursing measures include- safe

administration of the ordered fluids andmedications, documenting their

administration and effects. The nurse must

monitor the patient for signs of

complications and response to treatment.

Oxygen is administered to increase the

amount of O2 carried by the availablehemoglobin in the blood.



Cardiogenic shock• Precipitating factors will cause decreased cardiac

contractility Decreased stroke volume and cardiac output leading to 3 things:

• Damming up of blood in the pulmonary vein willcause pulmonary congestion

• Decreased blood pressure will cause decreased

systemic perfusion• Decreased pressure causes decreasedperfusion of the coronary arteries leading toweaker contractility of the heart



Circulatory shock• This is also called distributive shock. It occurs when

the blood volume is abnormally displaced in thevasculature.

– Septic Shock

– Neurogenic Shock

– Anaphylactic Shock



Circulatory shock• Risk factors for Septic Shock

–Immunosuppression

–Extremes of age (<1 and >65)

–Malnourishment

–Chronic Illness

–Invasive procedures



Circulatory shock

• Risk factors for Neurogenic Shock

–Spinal cord injury

–Spinal anesthesia

–Depressant action of medications

–Glucose deficiency



Circulatory shock• Risk factors for Anaphylactic Shock

–Penicillin sensitivity

–Transfusion reaction

–Bee sting allergy

–Latex sensitivity



SEPTIC SHOCKThis is the most common type of circulatory shock and is caused

by widespread infection.The HYPERDYNAMIC PHASE

– High cardiac output with systemic vasodilatation. – The BP remains within normal limits. – Tachycardia

– Hyperthermic and febrile with warm, flushed skin andbounding pulses



SEPTIC SHOCK

The HYPODYNAMIC or irreversible phase – LOW cardiac output with VASOCONSTRICTION – The blood pressure drops, the skin is cool and pale, with

temperature below normal. – Heart rate and respiratory rate remain RAPID!

– The patient no longer produces urine.



SEPTIC SHOCK

• MEDICAL MANAGEMENT:

– Current treatment involves identifying and eliminating

the cause of infection. Fluid replacement must be

instituted to correct Hypovolemia, Intravenous

antibiotics are prescribed based on culture andsensitivity.



SEPTIC SHOCK

• NURSING MANAGEMENT:

– The nurse must adhere strictly to the principles of ASEPTIC

technique in her patient care.

– Specimen for culture and sensitivity is collected.Symptomatic measures are employed for fever,

inflammation and pain. IVF and medications are

administered as ordered.



Neurogenic ShockThis shock results from loss of sympathetic tone

resulting to widespread vasodilatation.

• The patient who suffers from neurogenic shock may

have warm, dry skin and BRADYCARDIA!



Neurogenic Shock

• MEDICAL MANAGEMENT:

– This involves restoring sympathetic tone, either through

the stabilization of a spinal cord injury or in anesthesia,

proper positioning.



Neurogenic Shock

• NURSING MANAGEMENT:

– The nurse elevates and maintains the head of the bed at

least 30 degrees to prevent neurogenic shock when the

patient is receiving spinal or epidural anesthesia.



Anaphylactic Shock• MEDICAL MANAGEMENT:

– Treatment of anaphylactic shock requires removing thecausative antigen, administering medications that restorevascular tone, and providing emergency support of basiclife functions.

– EPINEPHRINE is the drug of choice given to reverse thevasodilatation



Triage

• “trier”- to sort

• To sort patients in groups based on the

severity of their health problem and the

immediacy with which these problems

must be addressed



Triage in the E.R.

• Berner’s

1. Emergent

2. Urgent

3. Non-urgent



Triage in DISASTER!

• NATO

1. Immediate

2. Delayed

3. Minimal

4. Expectant



Triage1. Emergent

– Patients have the highest priority

– With life-threatening condition

2. Urgent – Patients with serious health problems

– Not life-threatening, MUST be seen in 1 hour 3. Non-urgent

– Episodic illness that can be addressed within 24 hours

Triage category

Priority Color Conditions



Triage in Disaster

g g y y

Immediate 1 RED Chest wounds, shock,open fractures, 2-3

burns

Delayed 2 YELLOW Stable abdominalwound, eye and CNSinjuries

Minimal 3 GREEN Minor burns, minor fractures, minor bleeding

Expectant 4 BLACK Unresponsive, highspinal cord injury



Preparing for terrorism

1. Recognition and Awareness

2. Use of personal protective equipments

3. Decontamination of contaminants



Biological Weapons

ANTHRAX

• Drug of choice is Ciprofloxacin or

Doxycycline

SMALLPOX

• Supportive



Chemical Weapons

Organophosphates – Supportive care

– Soap and water

– Atropine

– Pralidoxine

Cyanide

– Sodium nitrite, Amyl Nitrite, Methylene Blue

– Sodium thiosulfate

– Hydrocobalamin



CYANIDE POISONING



Radiation

Alpha Particles Cannot penetrate skin

Causes local damage

Beta Particles Moderately penetrate the skin

Can cause skin damage and internalinjury if prolonged

Gamma Particles Penetrate skinCan cause serious damage

X-ray is an example

Emergen. Bls&Shock

Documents

Transcript of Emergen. Bls&Shock