NCM 118 RLE Finals PDF

NCM 118 RLE NURSING CARE OF CLIENTS WITH LIFE THREATENING CONDITIONS, ACUTELY ILL/MULTI-ORGAN PROBLEMS, HIGH ACUITY AND EMERGENCY SITUATIONS (ACUTE & CHRONIC) RLE MODULE 5F: FIRST AID, BANDAGING, SPLINTING, EMERGENCY RESCUE AND TRANSFER, BASIC LIFE SUPPORT...

NCM 118 RLE NURSING CARE OF CLIENTS WITH LIFE THREATENING CONDITIONS, ACUTELY ILL/MULTI-ORGAN PROBLEMS, HIGH ACUITY AND EMERGENCY SITUATIONS (ACUTE & CHRONIC) RLE MODULE 5F: FIRST AID, BANDAGING, SPLINTING, EMERGENCY RESCUE AND TRANSFER, BASIC LIFE SUPPORT (BLS) Group D-5: Climaco, Climar Jann Gornez, Nicole Andrea Hagensen, Ed Vincent Herbias, Anne Margareth Hermoso, Janna Matthea Ibanez, Cziane Jumawan, Crisha Reham Facilitator: Mr. Jeremy Brian M. Arendain, RN Date Submitted: September 21, 2024 1  TABLE OF CONTENTS CLO # DESCRIPTION PAGE CLO #1: Review on the concepts of first aid and Page 3 emergency nursing preferably in a hospital setting. CLO #2: Discuss the Basic Life Support concepts. Page 7 CLO #3: Elaborate on the different aspects of Page 19 bandaging and splinting. CLO #4: State the steps in arm and leg splinting. Page 30 CLO #5: Explain the factors to consider in Page 33 performing emergency drags and carries. CLO #6: Identify the materials and equipment used Page 39 in emergency rescue, transfer and ambulation. CLO #7: Demonstrate beginning skills in Page 47 performing CPR and defibrillation. 2 CLO #1: Review on the concepts of first aid and emergency nursing preferably in a hospital setting. (Gornez, Nicole Andrea B.) First Aid In a hospital setting, first aid refers to the initial, immediate care provided to individuals suffering from sudden illness or injury. The primary aim is to prevent the condition from worsening, alleviate pain, and, when possible, stabilize the individual until professional medical treatment is available. First aid can include actions like CPR, treating burns, or addressing cuts and fractures. The overarching goals are often summarized as the "Three Ps": Preserve life, Prevent further injury, and Promote recovery. (World Health Organization) Emergency Nursing Emergency nursing involves the specialized care of patients in urgent situations, often within the Emergency Department (ED). Emergency nurses must rapidly assess and prioritize patient care based on the severity of illness or injury. Their responsibilities range from triage, resuscitation, and stabilization to the management of life-threatening conditions. Emergency nurses work in a fast-paced, unpredictable environment, requiring them to make quick decisions, coordinate with healthcare teams, and provide patient education. (World Health Organization) Both first aid and emergency nursing are integral to the immediate management of acute medical conditions, focusing on rapid, effective interventions that can significantly impact patient outcomes. Concepts of first aid and Emergency Nursing: In a hospital setting, first aid and emergency nursing play a vital role in the continuum of care. The environment is more structured, with access to advanced medical resources, but the underlying principles remain focused on providing immediate, life-saving care. Key Principles: a) Key Principles of First Aid Immediate Response - In a hospital, first aid often involves a rapid response to incidents such as falls, cardiac arrest, or other emergencies that occur within the facility. This includes applying CPR, stopping bleeding, or stabilizing fractures until the patient can be fully assessed. 3  Use of Hospital Resources - Unlike in community settings, first aid in a hospital leverages available medical resources, such as defibrillators, oxygen supplies, and emergency medications. The first aid provided can be more comprehensive and integrated with ongoing care. Coordination with Medical Teams - Hospital-based first aid involves immediate communication with emergency teams, ensuring that patients are swiftly transferred to the emergency department or other appropriate areas for further treatment. Preserve Life - The primary aim of first aid is to save lives by providing immediate care to prevent the condition from worsening. Prevent Deterioration - First aiders must act to prevent the patient’s condition from worsening, which includes managing bleeding, preventing shock, and stabilizing fractures. Promote Recovery - First aid should also focus on promoting recovery by providing appropriate care, which could include wound cleaning and dressing or providing reassurance to the patient. Protect the Unconscious - Ensuring the airway is clear and the patient is in a safe position (e.g., recovery position) is vital. Provide Comfort and Reassurance - Psychological support is also an essential part of first aid, helping to calm the patient and reduce anxiety. b) Key Principles of Emergency Nursing Advanced Triage and Prioritization - Emergency nurses in a hospital must prioritize patients based on severity using established triage systems like the Emergency Severity Index (ESI). This is crucial for managing multiple patients simultaneously and ensuring that the most critical receive care first. Rapid Assessment and Intervention - Emergency nurses must be skilled in conducting rapid assessments and initiating appropriate interventions, often within minutes of a patient’s arrival. Team Coordination and Communication - Emergency nurses often work alongside physicians, surgeons, respiratory therapists, and other specialists to provide comprehensive care. Effective communication and collaboration are essential for optimal patient outcomes. Continuous Monitoring and Assessment - In a hospital emergency department, nurses must continuously monitor patients, reassess their condition, and adjust care plans as needed. This includes managing vital signs, administering medications, and preparing patients for procedures. 4  Patient Advocacy - Emergency nurses often serve as advocates for patients, ensuring that their needs are met quickly and effectively, and that they are treated with dignity and respect. Adaptability and Crisis Management - Emergency nurses must be adaptable, as they often work in fast-paced and unpredictable environments that require quick thinking and crisis management. Aims/Goals of First Aid & Emergency Nursing Aims/Goals of First Aid Aims/Goals of Emergency Nursing To Preserve Life To Provide Immediate and The foremost goal of first aid is to Effective Care save lives by providing Emergency nursing aims to immediate care to those in need. deliver rapid and effective care to stabilize patients, manage pain, and address life-threatening conditions. To Prevent Further Harm To Improve Patient Outcomes This involves not only preventing By ensuring that patients receive the patient’s condition from prompt and appropriate care, worsening but also ensuring that emergency nursing aims to the environment is safe and that improve overall patient the patient does not suffer outcomes, reduce morbidity, and additional injuries. minimize long-term effects. To Promote Recovery To Ensure Patient Safety First aid aims to stabilize the Emergency nursing involves patient’s condition and facilitate creating a safe environment for recovery until more advanced patients, ensuring they receive care can be provided. the correct treatments, and preventing medical errors. To Facilitate Continuity of Care Emergency nurses aim to provide seamless care, ensuring that patients are appropriately transferred to the next stage of care, whether that be inpatient care, surgery, or discharge with follow-up instructions. 5  Steps of First Aid in hospital setting Source: National Institute for Health and Care Excellence (NICE) 1) Initial Assessment Primary Survey - Perform a rapid assessment using the ABCDE approach: ➔ Airway: Ensure the airway is clear. Check for obstructions. ➔ Breathing: Assess if the patient is breathing adequately. Look, listen, and feel for breathing. ➔ Circulation: Check for a pulse and signs of circulation. Look for signs of bleeding. ➔ Disability: Assess neurological status. Check responsiveness and pupil reaction. ➔ Exposure: Examine the patient for other injuries or conditions. Keep them covered to maintain body temperature. 2) Immediate Care ➔ Airway Management: If the airway is compromised, assist in providing advanced airway devices like endotracheal tubes. Administer supplemental oxygen if needed. ➔ Breathing Support: Provide mechanical ventilation or oxygen therapy if the patient has difficulty breathing. ➔ Circulatory Support: Administer intravenous fluids, medications, or blood products as needed. Use defibrillation or cardioversion for cardiac arrhythmias. ➔ Wound Care: Clean and dress wounds. Assist in providing surgical interventions if required for severe injuries. 3) Monitoring and Stabilization ➔ Continuous Monitoring: Use monitoring equipment to track vital signs such as heart rate, blood pressure, oxygen saturation, and respiratory rate. ➔ Stabilization: Provide appropriate medications and interventions to stabilize the patient’s condition. This may include pain management, anticoagulants, or antibiotics. 4) Documentation/Record Keeping - Document all interventions, observations, and patient responses accurately and comprehensively in the medical record. 5) Communication and Handoff - When transferring the patient to another team or unit, provide a detailed handoff report including the patient’s condition, treatment received, and any ongoing concerns. 6) Follow-Up Care - Continuously reassess the patient’s condition and response to treatment. Adjust the care plan as necessary based on clinical status and ongoing evaluation. 6 CLO #2: Discuss the Basic Life Support concepts. (Ed Vincent Hagensen) Basic Life Support According to the American Heart Association, it refers to the level of medical care used to assist individuals experiencing life-threatening conditions such as cardiac arrest, respiratory failure, or choking. BLS focuses on maintaining airway patency, supporting breathing, and ensuring circulation through techniques like cardiopulmonary resuscitation (CPR), chest compressions, and defibrillation without using advanced medical equipment. Recent CPR guidelines (American Heart Association 2020) ○ Laypersons are encouraged to initiate CPR for suspected cardiac arrest, as the risk of harm is low if the patient is not in arrest. ○ For non-shockable rhythms, administering epinephrine as soon as feasible is recommended. ○ The use of audiovisual feedback devices during CPR is suggested for optimizing real-time performance. ○ Monitoring physiological parameters (e.g., arterial blood pressure or ETCO2) can help optimize CPR quality when feasible. ○ The effectiveness of double sequential defibrillation for refractory shockable rhythms is still uncertain. ○ Providers should prioritize establishing IV access for drug administration during cardiac arrest. ○ Survivors of cardiac arrest should undergo comprehensive rehabilitation assessment and treatment for physical, neurologic, cardiopulmonary, or cognitive impairments before hospital discharge. A. Pediatric CPR Guidelines Infants Chest Compressions: Depth: About 1.5 inches (4 cm) or one-third the depth of the chest. Use two fingers (index and middle) just below the nipple line for a single rescuer, or the thumbs-encircling technique if two rescuers are available. Rate: 100-120 compressions per minute. 7 Rescue Breaths: Same 30:2 compression-to-breath ratio for a single rescuer. For two rescuers: 15 compressions to 2 breaths. Cover both the infant’s nose and mouth with your mouth to provide breaths. Procedure: Assess the infant by tapping the soles of the feet or gently patting. If unresponsive and not breathing, begin CPR. Compressions should be performed with two fingers (single rescuer) or two thumbs (two rescuers) on the breastbone. Avoid excessive ventilation—each breath should be gentle and only enough to make the chest rise. Children Chest Compressions: Depth: About 2 inches (5 cm), ensuring it’s about one-third the depth of the chest. Rate: 100-120 compressions per minute. One-handed or two-handed compressions, depending on the size of the child. Rescue Breaths: Same ratio: 30 compressions to 2 breaths for a single rescuer. If two rescuers are available: 15 compressions to 2 breaths. Each breath should be just enough to make the chest rise, but not too forceful. Procedure: Verify responsiveness by tapping or shouting. If unresponsive and not breathing, begin CPR. Use the heel of one hand (or both if necessary) for chest compressions. 8  If an AED is available, use pediatric pads; if they aren’t available, use adult pads ensuring they don’t overlap. Special Note for Children: If the collapse is unwitnessed, perform 2 minutes of CPR before calling for help (or getting an AED), as children are more likely to suffer from respiratory arrest rather than sudden cardiac arrest. 9 Pediatric Basic Life Support Algorithm 10 B. Adult CPR Guidelines Adults Chest Compressions: Depth: At least 2 inches (5 cm). Rate: 100-120 compressions per minute. Allow full chest recoil between compressions to allow the heart to refill with blood. Rescue Breaths: Ratio: 30 chest compressions followed by 2 rescue breaths. Each breath should last about 1 second, causing visible chest rise. Minimize interruptions in chest compressions, aiming for less than 10 seconds. Procedure: Ensure the scene is safe. Check for responsiveness and breathing (look for normal breathing, not just gasping). Call for help and get an automated external defibrillator (AED) if available. Begin compressions at the center of the chest, using the heel of one hand on top of the other. Continue with 30 compressions and 2 breaths until an AED is available or emergency personnel arrive. KEY STEPS for CPR: 1. Check Scene Safety 2. Check for Responsiveness 3. Call for Help 4. Open the Airway 5. Check for Breathing 6. Start Chest Compressions 7. Give Rescue Breaths 8. Check for breathing again, if there is no breathing continue CPR. If there is breathing, position the patient in a recovery position. 11 Adult Basic Life Support 12  Pediatric and adult chain of survival Chain of Survival - The “Chain of Survival” refers to the chain of events that must occur in rapid succession to maximize the chances of survival from sudden cardiac arrest (SCA). The metaphor is a simple way to educate the public about its vital role in helping SCA victims. It suggests that each link is critical and interdependent, and the Chain of Survival is only as strong as its weakest link. Bystanders can help save lives by addressing the first four links in the Chain of Survival. Pediatric Chain of Survival In-Hospital Cardiac Arrest (IHCA) and Out-of-hospital cardiac arrest (OHCA) IHCA 1. Early Recognition and Prevention: a. Be aware of conditions that may lead to cardiac arrest (e.g., congenital heart defects) and recognize early warning signs. 2. Activation of Emergency Response: a. Activate emergency response while ensuring that someone else begins CPR. 3. High-Quality CPR: a. Use two fingers for infants or one/two hands for older children, ensuring compressions are effective and at a rate of 100-120 per minute. 13  4. Advanced Resuscitation: a. Emergency responders provide similar interventions, using appropriate equipment (e.g., pediatric pads for defibrillation). 5. Post-Cardiac Arrest Care: a. Emphasize neurological care, hemodynamic stability, and family support. 6. Recovery: a. Provide ongoing support for development and emotional well-being, considering family dynamics. OHCA 1. Prevent Cardiac Arrest a. Prevention of injuries that can cause cardiac arrest b. Preventing injuries can help save more lives c. Unintentional injuries is the number one killer of children 2. Early Cardiopulmonary resuscitation (CPR) a. The sooner that high-quality CPR is started, the better chances of surviving 3. Prompt access to the emergency response system a. Calling emergency services as soon as possible so that the child can have emergency care quickly improves outcome 4. Rapid pediatric advanced life support (PALS) a. To provide urgent treatment to cardiac emergencies. 5. Integrated post-cardiac arrest care a. To restore quality of life. Adult Chain of Survival In-Hospital Cardiac Arrest (IHCA) and Out-of-hospital cardiac arrest (OHCA) 14 IHCA 1. Early Recognition and Prevention: a. Identify risk factors (e.g., heart disease, lifestyle) and signs of cardiac arrest quickly. 2. Activation of Emergency Response: a. Call emergency services immediately upon suspecting cardiac arrest. 3. High-Quality CPR: a. Begin chest compressions immediately at a rate of 100-120 compressions per minute, with a depth of 2-2.4 inches. 4. Advanced Resuscitation: a. Emergency responders provide advanced interventions, including medications and defibrillation. 5. Post-Cardiac Arrest Care: a. Focus on stabilizing the patient, monitoring vital signs, and addressing potential complications. 6. Recovery: a. Support rehabilitation efforts, addressing both physical and psychological recovery. OHCA 1. Recognition and activation of the emergency response system a. It is the first link of survival in which a heart attack victim should be offered immediate help to prevent cardiac arrest by calling emergency services. 2. Immediate high-quality CPR 15  a. In case the person is not breathing and there is no pulse, start performing CPR since this increases the odds of the person surviving a heart attack. 3. Rapid Defibrillation a. This will deliver an electric shock to the heart to help restore normal heart rhythm. 4. Basic and advanced emergency medical services a. Receiving assistance by trained medical personnel helps in stabilizing the patient through administration of oxygen, medication and other advanced protocols. 5. Advanced life support and post arrest care a. To optimize cardiopulmonary function and vital organ perfusion b. To assist survivors with rehabilitation services when required c. To transport patient to an appropriate hospital with a comprehensive post-cardiac arrest treatment system of care Manual Defibrillation Require more experience and training to handle them effectively. Therefore, they are only common in hospitals and in some ambulances where personnel are trained to use them. In this type of manual external defibrillator, the user (health care provider) must know how to interpret the different heart rhythms, recognize the shockable rhythms and then manually determine the voltage (joules) to be administered, through external paddles or adhesive electrodes, on the chest of the patient. Indications Contraindications Pulseless ventricular tachycardia Conscious patient○ If the patient (VT) is conscious and breathing ○ Pulseless VT is a medical normally, they do not require emergency that requires manual defibrillation. immediate ○ If you perform defibrillation defibrillation.Delaying on someone who doesn't manual defibrillation in have ventricular pulseless VT dramatically tachycardia (with no 16  decreases the survival pulse) or ventricular rate. fibrillation, you may cause ventricular fibrillation and Ventricular fibrillation (VF) cardiac arrest. ○ Manual Defibrillation is highly effective in Presence of pulse terminating VF when ○ Manual defibrillation can performed as close to the only be used on someone onset of VF as with a rapid heart rate to possible.When create a pulse. It works by defibrillation is shocking the heart back delayed,effectiveness is into action. reduced by almost 10% per minute. Pulseless electrical activity (PEA) ○ Pulseless electrical Cardiac arrest due to or resulting activity(PEA) is a condition inVF where your heart stops because the electrical Sudden cardiac arrest in infants. activity in your heart is too ○ Manual defibrillators are weak to make your heart also the most appropriate beat. When your heart medicaldevices to use on stops,you go into cardiac babies under one year old arrest, and you don't have who are suffering from a pulse. PEA is a “non sudden cardiac arrest. shockable” heart rhythm, meaning a defibrillator won't correct. 17 CLO #3: Elaborate on the different aspects of bandaging and splinting. (Herbias, Anne Margareth & Hermoso, Janna Matthea) Bandaging (Herbias) Bandaging refers to the application of a strip or roll of cloth or other material that may be wound around a part of the body in a variety of ways to secure a dressing, maintain pressure over a compress, or immobilize a limb or other part of the body. I. Guidelines 1. Before applying bandages or binders, inspect and palpate for adequacy of circulation (skin temperature, color, and sensation). 2. Whenever possible, bandage the part in its normal position, with the joint slightly flexed. 3. Pad between skin surfaces and over bony prominences. 4. Always bandage body parts by working from the distal to the proximal end. 5. Bandage with even pressure. 6. Whenever possible, leave the end of the body part (e.g., the toe) exposed. 7. Cover dressings with bandages at least 5 cm (2 in.) beyond the edges of the dressing. II. Parts of a triangular bandage 18  Triangular bandages are used to hold dressings in position,control bleeding by direct pressure when used as a broad or narrow folded bandage, support and immobilise injured limbs, joints, and sprains. a. A triangular bandage has 3 parts: the base, the point, and the ends. i. Base – this is the longest part of the triangular bandage ii. Point – this is the corner that is directly opposite to the middle of the base iii. Ends – the remaining two corners III. Phases of triangular bandage a. This is from the open phase to the cravat phase. b. A triangular bandage may be used open or folded. When folded, it is known as a cravat. It is prepared as follows: i. A broad cravat (two folds) is made by folding lengthwise along a line midway between the base and the new top of the bandage, in effect, folding the wide cravat bandage in half lengthwise. ii. A narrow cravat (three folds) is made by repeating the folding. This method has the advantage that all bandages can be folded to a uniform width, or the width may be varied to suit the purpose for which it is to be used. To complete a dressing, the ends of the bandage are tied securely. 19 IV. Types 1. Circular bandaging This technique involves wrapping the bandage in a circular manner around a limb or body part. It's often used to secure gauze dressings or coverings on wounds. Steps: 1. a turn is made around the part and anchored. 2. Similar succeeding turns are made, overlying each other completely. 3. The bandage is then terminated and secured. Video: https://www.youtube.com/watch?v=3 v9rCwpNumA 2. Spiral bandaging This technique is usually used for cylindrical parts of the body. Similar to circular bandaging, the spiral technique involves wrapping the bandage in a diagonal or spiral pattern around a limb. This provides a more even distribution of pressure and is commonly used for sprains and strains. Steps: 1. Anchor at wrist. 2. Apply succeeding spiral turns up the forearm, with each turn overlapping one-third of preceding turn. 3. Terminate and secure just below elbow. Video: https://www.youtube.com/watch?v=v PqsdolPxx0 3. Figure-of-eight bandaging This involves two turns, with the strips of bandage crossing each 20  other at the side where the joint flexes or extends. It is usually used to bind a flexing joint or body part below and above the joint. Steps: 1. Anchor bandage on hand with cireular turns near ends of fingers. Carry obliquely across back of hand to thumb. Bring under thumb and across palm to back of hand. 2. Carry obliquely across back of hand to bottom of primary turn and across palm. 3. Follow with several similar turns, each one overlying about two-thirds of preceding turn on back of hand. After sufficient turns, terminate with circular turns around wrist and secure. Video: https://www.youtube.com/watch?v=b -dJ40PVHZk 4. Reverse spiral bandage This involves spiral bandaging where the bandage is folded back on itself by 180° after each turn. Steps: 1. Anchor at wrist with primary turns in usual way, bring bandage obliquely up forearm to just below elbow, and make a circular turn. 2. Bring obliquely downward to wrist, and circle wrist. (These turns hold the dressing while the spiral reverse is being applied.) 3. Then start the bandage 21  obliquely upward again. 4. Instead of continuing upward as in a figure-of-eight, fold bandage back and hold told with thumb. 5. Continue around arm and repeat procedure until arm is covered. Each turn must overlie about two-thirds of preceding turn and reverses must be in a straight line. 6. Terminate with circular turns below elbow and secure. Video: https://www.youtube.com/shorts/Ykl- Yr27SZo 5. Sling Bandaging This technique is used to immobilize the arm and shoulder by wrapping the bandage around the torso and supporting the arm at a 90-degree angle. Steps: 1. Bend arm at elbow so that little finger is about a hand-breadth above level of elbow. 2. Place one end of triangle over shoulder on injured side and let bandage hang down over chest with base toward hand and apex toward elbow. 3. Slip bandage between body and arm. 4. Carry lower end up over shoulder on uninjured side. 5. Tie the two ends, by square knot, at the neck. Knot should be on either side of neck, not in the middle where it could cause discomfort when patient is lying on back. 6. Draw alax of bandage toward elbow until snug, bring it 22  around to front, and fasten with safety pin or adhesive tape. Video: https://www.youtube.com/watch?v=C 63rt-fleGY 6. Scalp Bandaging This technique can be useful for injuries to the forehead or scalp, providing some compression, protection, and immobilization for the injured area Steps: 1. Place middle of base of triangle so that edge is just above the eyebrows and bring apex backward, allowing it to drop over back of head (occiput). Bring ends of triangle backward above ears. 2. Cross ends over apes at occiput, carry ends around forehead. and tie them in a square knot. 3. Turn up apex of bandage toward top of head. Pin with safety pin or tuck in behind crossed part of bandage. Video: https://www.youtube.com/watch?v=F BO0sxzhqQQ 7. Chest Bandaging This bandage is used to hold dressings on burns or wounds of chest or back. Steps: 1. Drop apex of triangle over shoulder on injured side. Bring bandage down over chest (or back) to cover dressing, so that middle of 23  base of bandage is directly below injury. Turn up a cuff at base. 2. Carry ends around and tie in a square knot, leaving one end longer than the other. 3. Bring apex down and tie to long end of first knot. Video: https://www.youtube.com/watch?v=d Zm7zMCVzcY 8. Cravat for Eye The cravat bandage of the eye is used to hold a dressing over the eye. Two cravats are required. Steps: 1. Lay center of first cravat over top of head with the front end falling over uninjured eye. 2. Bring second cravat around head, over eyes, and over loose ends of first cravat. Tie in front. 3. Bring ends of first cravat back over top of head, tying there and pulling second eravat up and away from uninjured eye. Video: https://www.youtube.com/watch?v=h ctgpA04UpU https://www.youtube.com/watch?v=n XJP9dxuG64 9. Cravat for Cheek/Ears This is used to hold dressings on the chin, cheeks, ears and scalp and as a temporary support to immobilize a fractured or dislocated jaw. Steps: 1. Make a cravat or close bandage, place the center of the bandage (apex area) on 24  top of the injury either ear or cheek. 2. Bring the two points on the opposite side, making one point passing through the chin and the other point through top portion of the head and intersect them on the level of the forehead. 3. Cross the bandage on the level of the forehead. 4. Bring back the two points to the injured side, passing one point from the back portion of head and the other on forehead maintaining the level over the forehead so as not to cover the eye and make a square slightly above the ear. 5. Insert the excess (points) of the bandage for housekeeping purposes. Video: https://www.youtube.com/watch?v=T MzbmPPLBRY 10. Cravat for Knee The cravat of the knee is used to hold dressings around the knee. Steps: 1. Place center of cravat over kneecap and let ends hang down each side of knee. 2. Cross ends underneath and continue several overlapping descending turns down calf, and several overlapping ascending turns up thigh. 3. Bring ends together and tie under knee. Video: 25  https://www.youtube.com/watch?v=t- LmyTr0yp4 11. Cravat for armpit The shoulder-armpit cravat (bis-axillary) is used to hold dressings in the armpit (axilla) or on the shoulder. Steps: 1. Place cravat over dressing in armpit so the front end is longer than the back. Carry the ends upward. 2. Bring ends across each other over top of shoulder. 3. Cross ends over back and chest respectively to opposite armpit. Tie ends just in front of uninjured armpit. Video: https://www.youtube.com/watch?v=k 4IEel8nKPs Splinting (Hermoso) Splinting immobilizes the joint at a site distal and proximal to the fracture, relieves pain, restores or improves circulation, prevents further tissue injury, and prevents a closed fracture from becoming an open one. I. Guidelines 1. Cover open wounds with dry dressing before applying splint. 2. Splint only if it won't cause further pain. 3. Splint in position found. 4. Warn victim of pain. 5. Use splint that will extend beyond joints above and below injury. 6. Apply firmly, but do not affect circulation. 7. When possible, splint on both sides of injury. 8. Elevate extremity after splinting. 9. Apply ice pack. 26  10. If possible spine injury, the patient should not move. 11. Stabilize spine with rolled blankets on each side of the neck and torso 12. Seek medical care if the following appears: - swollen, hot, tender, or painful joint - deformity, tenderness, swelling over bone - snap, crackle, pop was heard - lack of rapid improvement II. Types 1. Rigid Splints - Made from wood, board, magazine, piece of plastic or other things that can be converted to support the fracture. - Inflexible device used to maintain stability - Must be long enough to be secured above and below fracture site 2. Soft Splints - Made from pillows, rolled blankets, towels, or other soft materials - Useful for lower leg and forearm 27 3. Anatomical Splints - Self-splint - Using a part of the body to support a fractured area - Bandaging an injured leg to the uninjured leg or fingers together 28 CLO #4: State the steps in arm and leg splinting. (Ibañez, Cziane) Steps on Splinting the ARM 1. Visually inspect the arm for obvious signs of injury such as swelling, deformity, bleeding, or bruising. Ask the patient about pain, numbness, or tingling in the arm. - Assessing the injury helps determine the severity and type of injury (fracture, dislocation, etc.). Identifying neurovascular compromise (e.g., loss of circulation or nerve damage) is crucial to prevent further complications. 2. Stabilize the arm in its current position without forcing it to move. If the arm is already in a slightly bent or straight position, keep it that way. - Moving the arm can cause additional damage to the bones, muscles, or nerves, especially in the case of fractures or dislocations. Keeping the arm in a position of comfort minimizes pain and trauma. 3. Check the pulse, capillary refill, and sensation in the injured arm before splinting. Ensure the patient can wiggle their fingers or feel light touch. - A baseline neurovascular assessment is crucial before immobilization. This ensures you can later detect if splinting affects circulation or nerve function. 4. Gather a rigid or semi-rigid splint (commercial or improvised), padding (e.g., gauze, cloth), bandages, and an arm sling. - The splint needs to be firm enough to prevent movement but padded to provide comfort and avoid pressure sores or further injury to soft tissues. 5. Gently wrap padding around the injured area, especially around bony prominences (e.g., wrist, elbow). - Padding prevents pressure points and reduces the risk of skin breakdown or discomfort under the splint. 6. Carefully place the splint on either side of the arm, ensuring it spans the joints above and below the injury site (e.g., from the hand to the elbow for a wrist fracture). - Immobilizing the joints above and below the fracture reduces movement at the injury site, preventing further injury and promoting proper alignment. 7. Use bandages or cloth to gently but firmly secure the splint. Start at the distal end (closest to the fingers) and work upward, ensuring even pressure without tightening too much. 29  - Securing the splint properly keeps the arm stable. Wrapping from distal to proximal helps reduce swelling and promotes circulation back to the heart. 8. After applying the splint, recheck pulse, sensation, and the ability to move the fingers. Look for signs of compromised circulation such as paleness, coldness, or numbness. - Ensuring the splint isn’t too tight or impeding circulation is critical for avoiding complications like compartment syndrome or nerve damage. 9. Place the injured arm in a sling or use a bandage to secure it across the chest, keeping the hand slightly elevated above heart level. - Elevating the arm helps reduce swelling, while the sling supports the weight of the arm and reduces strain on the injury site. 10. Continue to monitor the patient’s arm for signs of increased pain, numbness, or changes in circulation. - Ongoing assessment ensures that no complications arise from the splinting and that the injury is healing properly. 11. Once the arm is immobilized, transport the patient for further medical evaluation (X-rays, possible fracture reduction). - Splinting is a temporary measure to stabilize the injury; professional medical evaluation is needed to confirm the diagnosis and determine definitive treatment. Steps on Splinting the LEG 1. Visually inspect the leg for obvious signs of injury such as swelling, deformity, bleeding, or bruising. Ask the patient about pain, numbness, or tingling in the leg. - Identifying the nature of the injury helps determine whether the splint is needed for a fracture, sprain, or other injury. Noticing signs of neurovascular compromise is critical in preventing further complications. 2. Without moving the leg, keep it in the position found. Avoid manipulating or realigning the leg unless there is no pulse or other clear circulation problems. - Moving a fractured or injured leg could worsen the injury or damage nerves, blood vessels, or soft tissue. Stabilizing the leg as found reduces the risk of further trauma. 3. Before splinting, check for pulses (dorsalis pedis or posterior tibial), skin color, temperature, and the ability to wiggle toes. Ask the patient if they can feel you lightly touch their toes. - A baseline assessment of circulation and sensation ensures you can detect any changes after the splint is applied. It also helps you recognize early signs of compromised blood flow or nerve damage. 30 4. Gather a rigid or semi-rigid splint (commercial or improvised), padding (e.g., blankets, towels), bandages, and additional support (e.g., cravats, belts). - The materials need to immobilize the leg firmly but also ensure comfort and protection of soft tissue. Padding is important to prevent discomfort and pressure injuries. 5. Place padding around the leg, particularly over bony areas like the ankle, knee, and shin. Ensure padding covers the area where the splint will be applied. - Padding helps protect the skin from direct contact with the splint, preventing pressure sores and providing additional comfort for the patient. 6. Place the splint on either side of the leg (or underneath and on one side), ensuring that it extends from the foot to above the knee or the hip, depending on where the injury is located. - Immobilizing the joints above and below the injury site reduces movement at the fracture or injury site, helping prevent further damage and ensuring proper alignment. 7. Use bandages, cravats, or strips of cloth to secure the splint, starting at the ankle and working upward toward the thigh. Wrap firmly but not too tightly. - Securing the splint prevents movement of the leg and ensures the splint remains in place. Wrapping too tightly could impair circulation, so checking tightness is essential. 8. After securing the splint, reassess circulation by checking pulses, skin color, warmth, and sensation. Confirm the patient can still wiggle their toes. - Reassessing CSM ensures that the splint hasn’t been applied too tightly or in a way that compromises circulation or nerve function. This prevents complications such as compartment syndrome. 9. If it doesn’t cause discomfort, elevate the leg slightly using additional padding or a rolled-up blanket. If available, place the leg on a stretcher or board for transport. - Elevating the leg helps reduce swelling and encourages circulation back to the heart, reducing the risk of edema. Immobilizing the entire leg during transport minimizes further injury. 10. Continue to monitor the patient for any signs of worsening pain, swelling, numbness, or discoloration in the leg. - Continuous monitoring ensures that no complications arise after splinting, such as decreased blood flow or worsening injury. 11. Arrange for transport to a medical facility. Keep the patient calm and minimize movement of the injured leg during transport. 31  - Splinting is a temporary measure. Definitive care, including diagnostic imaging (e.g., X-rays) and possible realignment or surgical intervention, is necessary to ensure proper healing of the injury. CLO #5: Explain the factors to consider in performing emergency drags and carries. (Jumawan, Crisha Reham) Factors to consider in performing emergency drags and carries Principles: 1. Anatomy and Physiology - Nurses must be aware of how joints, muscles, and bones work together to prevent injury to both themselves and the patient. This knowledge helps in positioning the patient properly to maintain airway, breathing, and circulation, and to avoid worsening any injuries. 2. Body Mechanics - Proper body mechanics involve using the body efficiently and safely to minimize strain. This includes techniques like lifting with the legs rather than the back, maintaining a neutral spine, and positioning yourself close to the patient to reduce the risk of injury. Effective body mechanics help prevent musculoskeletal injuries in nurses and ensure safe patient handling. 3. Physics - Understanding the basic principles of physics, such as leverage, force, and center of gravity, can aid in performing drags and carries more efficiently. For example, using a sheet to drag a patient allows you to distribute the weight more evenly and reduce the force needed to move them, making the task easier and safer. 4. Safety and Security - Safety involves protecting both the patient and the healthcare provider during the process. This includes ensuring the patient is securely held to avoid dropping them and using equipment or assistance when needed. Security refers to keeping the patient stable and preventing further injury, especially if they have spinal injuries or other critical conditions. 32  5. Psychology - In emergencies, patients may be in shock, anxious, or in pain. Providing reassurance and emotional support during the drag or carry can help calm the patient, making the process smoother and reducing the overall stress of the situation. 6. Time and Energy - In emergency situations, time and energy are critical factors. Techniques must be quick and efficient to ensure the patient is moved out of harm’s way swiftly. At the same time, conserving energy is important to sustain the ability to continue providing care, especially in prolonged situations or when multiple patients need assistance. Considerations: 1. Check the patient’s responsiveness (whether they are conscious or not), as the method of moving them will depend on this. 2. Be cautious of any neck or spinal injuries that could be aggravated by lifting the patient. 3. Move the patient in an orderly, planned, and unhurried manner. 4. Use firm footing and proper body mechanics when lifting to ensure a stable stance and use of correct lifting techniques. 5. Judge your own capacity before lifting the patient. Do not attempt to move or lift someone if you are unsure of your physical ability to handle the weight. A loss of balance could lead to further injury to both you and the patient. 6. Be mindful of your breathing. Avoid holding your breath while lifting or carrying the patient to maintain your strength and reduce fatigue. 7. Use available resources and equipment such as backboards, stretchers, or blankets to assist in moving the patient. These resources can make the process safer and more efficient, especially for heavier patients or those with severe injuries. 8. Consider the environment for potential hazards, such as uneven ground, stairs, or debris, which could complicate the move. Clear the area if possible, and choose the safest route to avoid additional injury. 33  Proper handling and positioning One Rescuer Ankle Pull The fastest method for moving a victim a short distance over a smooth surface. This is not a preferred method of patient movement. 1. Grasp the victim by both ankles or pant cuffs. 2. Pull with your legs, not your back. 3. Keep your back as straight as possible. 4. Try to keep the pull as straight and in-line as possible. 5. Keep aware that the head is unsupported and may bounce over bumps and surface imperfections. Shoulder Pull Preferred to the ankle pull. It supports the head of the victim. The negative is that it requires the rescuer to bend over at the waist while pulling. 1. Grasp the victim by the clothing under the shoulders. 2. Keep your arms on both sides of the head. 3. Support the head. 4. Try to keep the pull as straight and in-line as possible. Blanket Pull The preferred method for dragging a victim. 1. Place the victim on the blanket by using the "logroll" or the three-person lift. 2. The victim is placed with the head approx. 2 ft. from one corner of the blanket. 3. Wrap the blanket corners around the victim. 4. Keep your back as straight as possible. 5. Use your legs, not your back. 6. Try to keep the pull as straight and in-line as possible. One-Person Lift This only works with a child or a very light person. 34  1. Place your arms under the victim's knees and around their back. Firefighter Carry This technique is for carrying a victim longer distances. It is very difficult to get the person up to this position from the ground. Getting the victim into position requires a very strong rescuer or an assistant. 1. The victim is carried over one shoulder. 2. The rescuer's arm, on the side that the victim is being carried, is wrapped across the victim's legs and grasps the victim's opposite arm. Pack-Strap Carry When injuries make the firefighter carry unsafe, this method is better for longer distances than the one-person lift. 1. Place both the victim's arms over your shoulders. 2. Cross the victim's arms, grasping the victim's opposite wrist. 3. Pull the arms close to your chest. 4. Squat slightly and drive your hips into the victim while bending slightly at the waist. 5. Balance the load on your hips and support the victim with your legs. Two Rescuers Human For the conscious victim, this carry allows the victim to Crutch/Two-Person swing their leg using the rescuers as a pair of Drag crutches. For the unconscious victim, it is a quick and easy way to move a victim out of immediate danger. 1. Start with the victim on the ground. 2. Both rescuers stand on either side of the victim's chest. 3. The rescuer's hand nearest the feet grabs the 35  victim's wrist on their side of the victim. 4. The rescuer's other hand grasps the clothing of the shoulder nearest them. 5. Pulling and lifting the victim's arms, the rescuers bring the victim into a sitting position. 6. The conscious victim will then stand with rescuer assistance. 7. The rescuers place their hands around the victim's waist. 8. For the unconscious victim, the rescuers will grasp the belt or waistband of the victim's clothing. 9. The rescuers will then squat down. 10. Place the victim's arms over their shoulders so that they end up facing the same direction as the victim. 11. Then, using their legs, they stand with the victim. 12. The rescuers then move out, dragging the victim's legs behind. Four-Handed Seat This technique is for carrying conscious and alert victims at moderate distances. The victim must be able to stand unsupported and hold themselves upright during transport. 1. Position the hands as indicated in the graphic. 2. Lower the seat and allow the victim to sit. 3. Lower the seat using your legs, not your back. 4. When the victim is in place, stand using your legs, keeping your back straight. Two-Handed Seat This technique is for carrying a victim longer distances. This technique can support an unconscious victim. 1. Pick up the victim by having both rescuers squat down on either side of the victim. 2. Reach under the victim's shoulders and under their knees. 3. Grasp the other rescuer's wrists. 4. From the squat, with good lifting technique, 36  stand. 5. Walk in the direction that the victim is facing. Three or More Rescuers Hammock Carry Three or more rescuers get on both sides of the victim. The strongest member is on the side with the fewest rescuers. 1. Reach under the victim and grasp one wrist on the opposite rescuer. 2. The rescuers on the ends will only be able to grasp one wrist on the opposite rescuer. 3. The rescuers with only one wrist grasped will use their free hands to support the victim's head and feet/legs. 4. The rescuers will then squat and lift the victim on the command of the person nearest the head, remembering to use proper lifting techniques. Three-Person Carry or Three or more rescuers get on both sides of the Stretcher Lift victim. The strongest member is on the side with the fewest rescuers. 1. Each person kneels on the knee nearest the victim's feet. 2. On the command of the person at the head, the rescuers lift the victim up and rest the victim on their knees. 3. On the command of the person at the head, all the rescuers will stand. 4. To walk, all rescuers will start out on the same foot, walking in a line abreast. 37 CLO #6: Identify the materials and equipment used in emergency rescue, transfer and ambulation. (Climaco, Climar Jann) Elastic Bandage A stretchable bandage used to support and compress injured areas, reduce swelling, and provide stability. Gait Belt A safety device worn around a patient's waist to assist with transferring and ambulating, offering caregivers better control and support. 38 Breathing Barriers Devices such as masks or shields that protect both the rescuer and the patient during emergency resuscitation, preventing direct contact and potential disease transmission. CPR Masks: These are plastic masks that cover the patient's mouth and nose, typically featuring a one-way valve to prevent exhaled air from reaching the rescuer. They are commonly used in CPR. Pocket Masks: Smaller, portable versions of CPR masks designed for ease of carrying and quick access in emergencies. They also have a one-way valve for safety. 39 Face Shields: Clear plastic barriers that provide a protective layer during mouth-to-mouth resuscitation, minimizing direct contact while allowing for ventilation. Bag-Valve Masks (BVM): These are more complex devices used in advanced airway management, consisting of a self-expanding bag, a unidirectional valve, and a mask. They are used to provide positive pressure ventilation. Ventilation Masks: Similar to CPR masks, but designed specifically for providing breaths to patients who are not breathing adequately. 40 Triangular Bandage A triangular bandage can be used to form a sling (a type of splint that holds an injured arm against the chest) as well as ties to keep other types of splints in place. Improvised splints 41  Branches, boards, cushioned pack straps, and rolled-up newspapers or magazines can all be used to make improvised splints. Slings can also be constructed from unused clothing. In these circumstances, there is no need to include additional items. Manual Defibrillator A manual defibrillator is a device that delivers an electric shock to the heart in order to try to restore normal cardiac rhythm. It is similar to an automatic external defibrillator (AED). 42 Stretchers Stretchers are pieces of medical equipment used to carry patients or injured individuals to another area for medical treatment. Stretchers can be used to convey people to an ambulance and then into a hospital or medical facility. Transfer stretcher It is outfitted with medical supplies and equipment, making it appropriate for patients with critical or specialized medical requirements. This comprises individuals who are bedridden, have serious injuries, or require medical attention during transit. Foldable stretcher 43  Is a portable, lightweight stretcher intended for usage during emergencies in which no spinal damage is suspected. The design is simple and flat, with wheels mounted on short, foldable legs. Wheelchair A wheelchair is a mobile chair with wheels that can be operated manually or electronically. A wheelchair prescription may be beneficial for individuals with disabilities, whether temporary or permanent. Spine board 44  A spine board is a patient-handling device commonly used in pre-hospital trauma care. It is intended to give firm support during mobility in a person with suspected spinal or limb injuries. They are mostly utilized by ambulance crews, as well as lifeguards and ski patrollers. 45 CLO #7: Demonstrate beginning skills in performing CPR and defibrillation. ADULT CARDIOPULMONARY RESUSCITATION (CPR) (Adopted from: American Heart Association – 2020 Guidelines and American Red Cross) DEFINITION: Cardiopulmonary Resuscitation (CPR) - an emergency lifesaving procedure performed when the heart stops beating. It is a critical step in the Chain of Survival and an essential component of the Basic or Advanced Cardiovascular Life Support. PURPOSES: - Keeps the blood flow active – even partially – extends the opportunity for a successful resuscitation once trained medical staff arrive on site. - Immediate CPR can double or triple chances of survival after cardiac arrest. EQUIPMENT/ MATERIALS: - CPR dummy/ mannequin - *Personal protective equipment (PPE) – as needed - Alcohol and wet wipes PROCEDURE RATIONALE 1. Verify or check for scene safety. Use *PPE Ensuring the safety of the rescuer and as needed. bystanders is critical before providing aid. Dangerous surroundings, such as traffic, fire, or hazardous materials, could harm the rescuer. Personal Protective Equipment (PPE) helps protect against infections or bodily fluids, ensuring the safety of both the rescuer and the victim. 2. Check for victim’s responsiveness by This step helps determine if the victim asking “Hey, hey! Are you okay?” 3 times is conscious or unconscious. Tapping while tapping the victim’s shoulder the shoulder and loudly calling ensures (shout-tap- shout). the rescuer gets a response if the person is just sleeping or dazed. If the person does not respond, this confirms the need for further action, like checking for breathing and pulse. 46  3. For the next 10 seconds, check for pulse Checking for breathing and pulse is and breathing. essential to determine if the victim is in cardiac arrest or has stopped breathing. Pulse check is done by palpating the The carotid artery is used because it’s carotid artery using the pointing and middle easy to palpate in emergencies. finger. Opening the airway with the head-tilt/chin-lift technique ensures the Breathing check is done by opening the airway is not blocked by the tongue or airway to a neutral position using the other obstructions. Looking, listening, head-tilt/chin-lift technique. Look, listen and and feeling for breathing helps verify feel for breathing. whether the victim’s lungs are functioning. Note: Also check for life-threatening bleeding or other life-threatening conditions. 4. If there is no pulse and breathing, shout Immediate activation of emergency for nearby help or activate the services ensures that professional emergency response system. medical help is on its way while you start resuscitative efforts. Alerting others nearby can bring more assistance or someone who can take over or retrieve an AED. 5. Place the victim on their back on a firm, A firm, flat surface ensures that chest flat surface. compressions are effective during CPR. The body needs to be on a hard surface to allow adequate force to compress the heart and generate blood flow. 6. Begin CPR. Perform cycles of Starting CPR (Cardiopulmonary 30 compressions and 2 rescue breaths. Resuscitation) maintains circulation of oxygenated blood to the brain and vital In adult victims of cardiac arrest organs when the heart stops beating. Hand position: Two hands centered on the 30 compressions to 2 breaths is the chest Body position: Shoulders directly over recommended ratio for adults in cardiac hands; arrest, ensuring a balance between elbows locked providing oxygen and circulating bloo Depth: At least 2 inches (5 cm) Rate: 100 to 120 per minute Note: - Allow chest to return to normal position after each compression - Ensure each breath lasts about 1 second to make the chest rise; allow 47  air to exit before giving the next breath. - If the 1st breath does not cause the chest to rise, retilt the head and ensure a proper seal before giving the 2nd breath - If the 2nd breath does not make the chest rise, an object may be blocking the airway. 7. Continue giving sets of 30 compressions Continuing CPR maintains circulation and until more definitive treatment (e.g., 2 breaths. Use an automated defibrillation with an AED) can be external defibrillator (AED) when provided. The AED delivers an electric available. shock to the heart to restore a normal rhythm in certain types of cardiac arrest (ventricular fibrillation or pulseless ventricular tachycardia). 8. Stop performing CPR when you see an If the victim shows signs of life, such obvious sign of life such as breathing. as spontaneous breathing or movement, CPR should be stopped to avoid unnecessary chest compressions that could harm a now-functioning heart. 9. Place victim in a recovery position by The recovery position maintains an lifting the arm near you above the victim’s open airway and prevents choking by head and position the other arm across allowing fluids like saliva or vomit to the chest and against the cheek. Bend drain out of the mouth. This position is the victim’s leg at the knee and pull it stable and reduces the risk of airway toward you as you roll the victim onto his obstruction in unconscious victims who or her side. Position mouth to allow are breathing on their own. drainage. 48  CARDIAC DEFIBRILLATION (Adopted from: American Heart Association (AHA)- ACLS Cardiac Arrest *VTach and *VFib Algorithm) DEFINITION: Cardiac Defibrillation- a procedure of administering a transthoracic electrical current or shock to a person without response after initial cycles of CPR or to someone experiencing one of the two lethal ventricular dysrhythmias- ventricular fibrillation (VFib) or pulseless ventricular tachycardia (VTach). PURPOSES: - restores normal heartbeat during an emergency - prevents or treats arrhythmias - allows the heart's normal pacemakers to resume effective electrical activity EQUIPMENT/ MATERIALS: - AED or manual defibrillator - Clean gloves- worn in advanced; this may provide a - Conducting gel degree of protection from an accidental shock PROCEDURE RATIONALE 1. Perform initial assessment. Once cardiac The initial assessment confirms arrest is confirmed, alert the cardiac arrest whether the patient is in cardiac team and request for a defibrillator and arrest, characterized by no pulse or cardiac arrest trolley (hospital setting). breathing. Immediate activation of the cardiac arrest team and bringing the necessary equipment (defibrillator, cardiac arrest trolley) is crucial for timely, effective resuscitation efforts. 2. Begin CPR at 30 compressions to 2 Starting CPR immediately ensures ventilations. that oxygenated blood continues to flow to vital organs like the brain and heart while awaiting the defibrillator and advanced life support. The 30:2 ratio is optimal for providing oxygen and circulation in adults. 3. As soon as the defibrillator arrives, switch it Defibrillation is essential for treating ON and prepare the patient’s/ victim’s chest if shockable rhythms (VTach and VFib). necessary. Ensure CPR continues. Turning on the defibrillator as soon as it arrives allows for quick action, and 49  preparing the chest (e.g., removing hair, drying moisture) ensures proper electrode contact. CPR should continue to maintain blood flow until the defibrillator is ready for use, minimizing interruptions. 4. Apply defibrillator pads or paddles on the Proper placement of defibrillator pads patient’s/ victim’s bare chest following the is critical for effective shock delivery correct placement. Ensure CPR continues. to the heart. One pad is typically placed below the right collarbone, and the other on the left side of the chest. While the pads are applied, CPR should continue uninterrupted to maintain circulation. 5. Once the pads or paddles are in place and CPR is paused momentarily to allow connected to the defibrillator, ask the team to the defibrillator to assess the patient’s stop CPR and analyze the ECG tracing. heart rhythm. It is essential to determine whether the rhythm is shockable (such as VTach or VFib) or non-shockable, which guides the next steps in resuscitation. 6. If a shockable rhythm is identified (*VTach or If a shockable rhythm is detected, *VFib), restart chest compressions, select the compressions are immediately appropriate shock energy and charge up the restarted while the defibrillator is defibrillator. prepared. Monophasic defibrillators Monophasic defibrillators: 360 joules require 360 joules, while biphasic Biphasic defibrillators: 120- 200 joules defibrillators (which are more efficient) typically use 120-200 joules. Restarting CPR maintains blood circulation while the defibrillator charges. 7. Ask everyone except the person performing Ensuring that no one is in contact chest compressions to stand clear and, if with the patient or any conductive necessary, remove any oxygen delivery equipment (e.g., oxygen devices) device. during defibrillation prevents accidental electrocution of the rescuer and ensures the safety of the team. 8. Once the defibrillator is charged, ask the It is crucial to ensure that no one is person performing chest compressions to touching the patient during stand clear, and defibrillate the patient/ victim defibrillation. Delivering the shock is by pressing the shock button(s). intended to reset the heart's electrical activity, potentially restoring a normal rhythm. CPR should be paused only momentarily for the shock. 50 9. Immediately restart CPR at 30 compressions After defibrillation, restarting CPR to 2 ventilations for a further two minutes, immediately helps to re-establish during which time the cardiac arrest team blood flow to vital organs. It takes leader will prepare the team for the next time for the heart to recover even pause in CPR. after a successful shock, so compressions should continue to support circulation. The team leader prepares the next steps, ensuring smooth coordination for ongoing resuscitation efforts. The two-minute interval allows time for further assessment and preparation for the next rhythm analysis or intervention. 51  REFERENCES American Nurses Association. (2023). Emergency Nursing: Scope and Standards of Practice. ANA Enterprise. Retrieved from https://www.nursingworld.org/ Boy Scouts of America. (1995). LIFTS AND CARRIES. CERT-LA. https://www.cert-la.com/downloads/liftcarry/Liftcarry.pdf Brookside Associates LLC. (2023, September 11). Lesson 6. Roller Bandages - fractures. Fractures - Fractures. https://brooksidepress.org/fractures/lessons/lesson-6-roller-bandages/ Chapter 35: Lifting and Moving Patients. (n.d.). SharpSchool. https://cdnsm5-ss10.sharpschool.com/UserFiles/Servers/Server_19985496/File/ Programs/Fire%20&%20Rescue%20Technology/Emergency%20Medical%20Te chnician%20Course/Chapter_35_Student_Notes.pdf DeMuro, J., & Scott, K. (2024, March 6). How to Splint a Fracture of the Lower Leg: 13 Steps. wikiHow. https://www.wikihow.com/Splint-a-Fracture-of-the-Lower-Leg Emergency Nurses Association. (2023). ENA Clinical Practice Guidelines. ENA Website. Retrieved from https://www.ena.org/ International Federation of Red Cross and Red Crescent Societies. (2016). First Aid Manual. IFRC. Retrieved from https://www.ifrc.org/ Stark, A. (2023, May 28). How to Splint a Humerus Fracture: 8 Steps (with Pictures). wikiHow. https://www.wikihow.com/Splint-a-Humerus-Fracture The triangular bandage. (n.d.). http://homepage.eircom.net/~mariobrazil/documents/Triangular.html World Health Organization. (2021). First Aid Guidelines. WHO. Retrieved from https://www.who.int 52  Cebu Doctors’ University College of Nursing Mandaue City, Cebu NCM 118 Care Of Clients With Communicable Diseases, Life-Threatening Conditions, Acutely Ill and Multi-Organ Problems, High Acuity and Emergency Situations (Acute And Chronic) RLE 6F: Mechanical Ventilation, Pace Making, and ECG Interpretation Section D Group 6 Abrea, John Vince Dahili, Kyle Kenjie Dela Rama, Wilchris Kenneth Dellera, Guen Christine Dinampo, Mary Antonette Enario, Penelope Lumasag, Filane Antonette Facilitator: Dr. Charles Andrew M. Gabriente, RN Date Submitted: October 18, 2024 Table of Contents 1 Course Learning Outcomes 2 CLO#1: define terms in the care of clients with a mechanical ventilator, pace 5 making and ECG interpretation CLO#2: identify the purposes, indications and contraindications of 13 mechanical ventilation, pace making and ECG analysis and interpretation CLO#3: discuss mechanical ventilation to enhance the care of clients in acute 15 and critical care settings CLO#4: elaborate on the care of clients with a pacemaker 27 CLO#5: review the basic concepts of electrocardiography 33 CLO#6: identify the different waves and complexes in relation of the cardiac 42 events CLO#7: examine the nursing responsibilities before, during, and after caring 43 for clients with mechanical ventilators, pacemakers and electrocardiography CLO#8: apply the beginning skills in ECG analysis, computation and 48 interpretation by computing for the atrial and ventricular rate using the triplicate and heart rhythm methods CLO#9: compute for the duration of P-R interval, QRS duration, Q- T interval, 52 S-T segment CLO#10: interpret the various heart rhythms 61 References 73 1 Course Learning Outcomes: CLO#1: define terms in the care of clients with a mechanical ventilator, pace making and ECG interpretation. Definition of Terms mechanical ventilation positive pressure negative pressure mandatory breath spontaneous breath pacemaker pacemaker lead capture pacing artifact milliampere sense sensitivity threshold electrocardiography electrocardiograph/ electrocardiogram electrophysiology electrodes lead automaticity excitability CLO#2: identify the purposes, indications and contraindications of mechanical ventilation, pace making and ECG analysis and interpretation. Purposes, indications and contraindications of: - mechanical ventilation - pace making - ECG analysis and interpretation 2 CLO#3: discuss mechanical ventilation to enhance the care of clients in acute and critical care settings Care of Clients for Mechanical Ventilation indication and criteria for use in clients criteria/ situation of discontinuing the use in clients weaning procedure types of ventilators various ventilation settings/ modes ventilator-related problems/ complications with corresponding nursing actions CLO#4: elaborate on the care of clients with a pacemaker Care of Clients with a Pacemaker types of pacemakers types of pacing sites of pacemaker insertion pacemaker failures and problems long-term management of individuals with pacemakers CLO#5: review the basic concepts of electrocardiography Electrocardiography membrane potential resting membrane potential action potential electrical conduction of the heart electrode placement precordial placement limb placement CLO#6: identify the different waves and complexes in relation of the cardiac events CLO#7: examine the nursing responsibilities before, during, and after caring for clients with mechanical ventilators, pacemakers and electrocardiography. CLO#8: apply the beginning skills in ECG analysis, computation and interpretation by computing for the atrial and ventricular rate using the triplicate and heart rhythm methods. 3 Drills/ Exercises on ECG interpretation CLO#9: compute for the duration of P-R interval, QRS duration, Q- T interval, S-T segment. CLO#10: interpret the various heart rhythms. Various heart rhythms normal heart rhythms common abnormal heart rhythms sinus bradycardia sinus tachycardia atrial bradycardia atrial tachycardia ventricular bradycardia ventricular tachycardia atrial flutter ventricular flutter atrial fibrillation ventricular fibrillation premature atrial contractions (PAC) premature ventricular contractions (PVC) Heart block Other complications: electrolyte imbalance,angina, myocardial infarction 4 CLO#1: Define terms in the care of clients with a mechanical ventilator, pace making and ECG interpretation. ABREA 1.1 Mechanical ventilation - It is a medical therapy that uses a ventilator machine to assist or replace spontaneous breathing when a patient is unable to breathe adequately on their own. - It involves applying positive pressure to move air into and out of the lungs, helping to deliver oxygen and remove carbon dioxide. 1.2 Positive pressure - It involves the use of a mask or, more frequently, a ventilator to deliver breaths and reduce the work of breathing in a critically ill patient. 1.3 Negative pressure - A mechanical ventilator that intermittently applies negative air pressure to the body to expand and contract the chest cavity, thereby stimulating the breathing of an ill individual. 5 1.4 Mandatory breath - An inhalation that is triggered and/or cycled by the machine. During a spontaneous breath, a mandatory breath may occur (e.g., High Frequency Jet Ventilation). By definition, a mandatory breath is assisted. 1.5 Spontaneous breath - Refers to a breath that is initiated and terminated by the patient's own respiratory effort, without being triggered or cycled by the ventilator. - It is a breath that is controlled by the patient's own neural respiratory drive. 6 1.6 Pacemaker - A pacemaker is a battery-operated, compact device that regulates the heart's rhythm. To obtain a pacemaker, surgery is required. The device is positioned under the skin in close proximity to the collarbone. 1.7 Pacemaker lead - The pulse generator and the heart are connected by wires known as the leads. These leads have the potential to provide a sudden surge of vitality. This surge of energy has the potential to either induce a faster heartbeat (as in the case of a pacemaker) or prevent hazardous, rapid cardiac rhythms. 7 1.8 Capture - The term "capture" refers to the efficient collection and confinement of airborne pollutants at their origin, preventing their dispersion into the surrounding environment. 1.9 Pacing artifact - Refers to electrical signals or disturbances that occur in the monitoring systems due to the operation of a pacing device, such as a cardiac pacemaker. These artifacts can interfere with the accurate interpretation of respiratory and cardiac signals. 8 1.10 Milliampere - Milliampere (mA) is a unit of electrical current that is often used to measure low levels of electrical signals in various medical devices, including those involved in respiratory monitoring and mechanical ventilation. 1.11 Sense - Refers to the ability of a ventilator or respiratory monitoring device to detect specific physiological signals from the patient, which are critical for triggering and regulating mechanical ventilation support. 1.12 Sensitivity - Refers to the threshold settings on a mechanical ventilator that determine how easily the device detects a patient's attempt to initiate a breath. - This sensitivity setting is crucial for ensuring that the ventilator responds appropriately to the patient's respiratory efforts. 1.13 Threshold - Threshold typically refers to the minimum electrical stimulus required to depolarize cardiac tissue and initiate a contraction, ensuring effective heart rhythm maintenance. 9 1.14 Electrocardiography - It is the process of producing an electrocardiogram (ECG or EKG), a graphical representation of the voltage versus time of the heart's electrical activity using electrodes placed on the skin. 1.15 Electrocardiograph or Electrocardiogram - An electrocardiogram (ECG) is a straightforward and non-invasive procedure that captures the electrical impulses generated by the heart. - An ECG is a diagnostic tool that can be used to identify specific cardiac disorders, such as irregular heart rhythms and coronary heart disease (heart attack and angina). 1.16 Electrophysiology - Electrophysiology is a diagnostic procedure used to evaluate the electrical activity of the heart and identify irregular heartbeats or arrhythmias. - The test is conducted by introducing catheters and wire electrodes, which gauge electrical activity, into the heart through blood arteries. 10 1.17 Electrodes - Electrodes are the key components in an electrocardiogram (