Special Considerations
The following conditions may or
may not require changes in standard CPR procedures; however,
each condition requires some special consideration.
Condition Changes or Special Considerations
Pregnancy Assess scene/patient: A=Airway
(no change) B=Breathing (no change). C=Compression (no change).
Chest compressions may not be effective
when a woman who is 6 months pregnant or more is lying flat
on her back. This is because the baby puts pressure on the
major vein that returns blood to the heart. If possible, prop
up the patient slightly on her left side using a rolled blanket
(or similar) when performing chest compressions. This will
reduce this pressure and provides the most blood flow to mother
and baby. Perform chest compressions higher on the breast
bone, slightly above the center. D=Defibrillation (no change)
Hypothermia Assess Scene/patient (change). Get inside or out
of wind. Prevent additional heat loss by removing wet clothes
and insulating the patient from further exposure. If the body
is frozen solid, the nose and mouth are blocked with ice and
chest compression is impossible. Do not start CPR. A=Airway(no
change) B=Breathing (no change) C=Circulation (no change)
D=Defibrillation (change) If the patient does not respond
to 1 shock, focus on continuing CPR and re warming patient
to a range of 30 degrees C.-32 degrees C. ( 86-89.6 F) before
repeating the defibrillation attempt.
Submersion/Near drowning Assess scene/patient
(change). Caution Scene may be unsafe (waves, currents, cold
water, bad weather). Proper training in the use of personal
lifesaving equipment, such as torpedo buoys and personal flotation
devices, is critical for safe rescue. If available, get the
patient into a boat or other vessel. If no boat is available,
get the patient to shore.
Condition Changes or special considerations
Submersion/ Start BLS/CPR when indicated,
as
Near-drowning soon as it is safe to do so. A=Airway
Cont. (no change). B=Breathing (no change). Expect vomiting.
When it occurs, turn patient’s mouth to side and remove
with a gloved finger sweep or cloth. If head, neck or back
injury is suspected, us the HAINES method or roll the patient
like a log. Minimize movement. Avoid twisting the head, neck,
or back. Do not attempt to drain water from the lungs using
abdominal thrusts or the Heimlich maneuver. It is unnecessary
and potentially dangerous. C=Circulation. (no change). D=
Defibrillation (change). Move patient out of freestanding
water and dry their chest before attaching AED.
Electric Shock Assess scene/patient (change). Consider any
fallen or broken wire extremely dangerous. Do not tough (or
allow your clothing to touch) a wire, patient or vehilcle
that is possibly energized. Do not approach within eight feet
of it. Notify the local utility and have trained personnel
sent to the scene. Metal or cable guard-rails, steel wire
fences and telephone lines may be energized by a fallen wire
and may carry the current a mile or more from the point of
contact. Never attempt to handle wires yourself unless you
are properly trained and equipped. Start BLS/CPR if indicated,
as soon as it is safe to do so. A=Airway (no change) B=Breathing
(no change). C=Circulation (no change). D. Defibrillation
(no change).
Lightning Strike Assess scene/patient
(change). When multiple patients are struck by lightning at
the same time, give highest priority to those without signs
of life (reverse triage). Start BLS/CPR if indicated, as soon
as it is safe to do so. Because many patients are young, they
have a good chance for survival if immediate CPR is given.
Remove smoldering clothing, shoes and belt to prevent burns.
A=Airway (no change) B=Breathing (no change). C=Circulation
(no change). D. Defibrillation (no change).
Cardiac Arrest and Assess scene/patient
(no change)
Injury A=Airway (change). Clear mouth of blood, vomit and
other secretions.
B=Breathing (no change). C=Circulation (no change).
D. Defibrillation (no change).
Family Presence Studies show that family
members want to be present during a resuscitation attempt.
Doing so may help them adjust to the death of their loved
one and ease their own grieving. Other studies show that healthcare
providers often disapprove of this practice, fearing psychological
trauma to family members, legal concerns, and a fear of distracting
the resuscitation team. Despite this, there is evidence that
when family is present there are fewer legal actions, and
less second-guessing about provider competence. There apparently
is no evidence that family presence Is harmful. Consequently,
family presence during resuscitation is a reasonably and potentially
desirable option for families. An experienced healthcare provider,
first responder or other professional rescuer should be assigned
to the family to answer questions, explain procedures and
offer comfort. Bother the providers and family should have
a connection to professional counseling resources for continued
care if necessary (clergy, crisis workers, social workers).
|
