Resuscitation Error

The patient is a 72-year-old female who arrived to the emergency department in cardiac arrest. Emergency medical services reports the patient was last seen eating breakfast at her nursing home and was found an hour later face down and unresponsive. After it was determined the patient was in asystole, an intravenous catheter was started and two rounds of Epinephrine was administered. Upon arrival to the emergency department the patient had pulseless electrical activity with sinus tachycardia on the monitor. Airway management was in process with a bag valve mask on 100% oxygen and chest compressions in progress. After intubation and stabilization the

Therefore, the prudent approach for the anesthetist would be to plan for a rapid sequence induction, using a short-acting muscle relaxant such as succinylcholine. The patient’s clinical picture indicates that there is still some occult bleeding and she remains hypotensive despite resuscitation. Therefore, versed, propofol, and large amounts of inhalational agent should be avoided. Small doses of versed can worsen hypotension. Inhalational agent such as Desflurane or Sevoflurane should be kept to less than 1 MAC. Opioids, ketamine and etomidate in decreased doses are better choices when attempting to optimize intubating conditions. According to Barash (2013), metabolic disturbances in the acute trauma patient cannot reliably prevent recall. However, scopolamine, (0.6 mg), and midazolam, if the patient can tolerate it, given before airway management may decrease the likelihood of this complication. Intraoperative use of the bispectral index (BIS) monitor and, whenever possible, titrating anesthetics to bispectral bispectral index levels < 60 may prevent recall in trauma

The case study I choose is Scenario No. 2: DNR. DNR stands for Do Not Resuscitate. A DNR is a legal document in which health care teams will follow once you are faced with serious health problems or when you are at the end of life. This document lets you choose if you would like CPR or electric shock if your heart stops. Also, this document lets you decline any support if your heart stop or it will let you decide different medical measures that you would like. This document is very important to be looked over carefully by the patient as this piece of paper will try to save

| Lesson Outline: Allocated teacher-NExplaining legal requirements : Duty of care: A duty of care is implied when the person who is requiring your assistance is in your workplace. E.g. patient, co-worker or visitor. Consent of an unresponsive patient is assumed in an emergency situation. (Crouchman, 2009; Milne &amp; Mellman-Jones, 2010).Cultural awareness/sensitivity: We need to mindful of varying cultures when assisting patients, as different cultures prefer to be unexposed which is necessary when defibrillation is required. Eg, Muslims (Hattersley &amp; Keogh, 2009). Confidentiality: Following an emergency situation it is vital to refrain from speaking to others outside the workplace about the patient to ensure the patient’s privacy and dignity. Think about how you would feel if you where in the patient’s situation. (Maeder, Martin-Sanchez, Croll, &amp; Ambrosoli, 2012)?Limitations: Remember that once you start you can’t stop until you’re physically unable to or help arrivesDebriefing: Participating in the debriefing process is vital due to the enormity of the situation, enabling the nurse to express

Methods to identify appropriate treatments for the various stages of ventricular fibrillation (VF) involve differentiating groups of subjects who will respond to defibrillation with return of spontaneous circulation (ROSC) and those who require other therapies (e.g., CPR, drugs) prior to defibrillation. The use of quantitative waveform measures (QWM) which measure the frequency and fractal dimension of the VF electrocardiogram have shown success in predicting response to defibrillatory shock in animal models. Patients in cardiac arrest are often taking medications affecting adrenergic activity such as the beta blocker metoprolol and the combined alpha and beta blocker, labetalol. How this exposure might alter the QWM and ROSC

should be initiated as soon as possible after resuscitation, but even when delayed for a few

Research has also shown that patients who receive early CPR are five time more likely to survive than patients who do not receive early CPR4. Studies have shown that early delivery of defibrillation is very import in survival and with each minute that a shock is delayed the success rate for patient declines by 10% which supports the idea that time is critical for patient who are experience cardiac arrest4. These things are necessarily to reduce the effects of PCAS. The main causes of cardiac arrest are related to cardiovascular disease however, there are also other causes of cardiac arrest such as choking, drowning, having an obstructed airway and drug abuse7.

The population of world is growing each and every year. With more people the more food needs to be made and the greater the strain on healthcare and many other things. However, there is still much room to grow throughout the world. China is an nation with a very large population and has an extremely high birth rate, in fact it is over 17 million live births a year. However, with such a large number of births there is also the problem of of the infant death rate (Matandrea, 2009). The death rate is 29.2 per 1000 births (Matandrea, 2009). That is very high. Over twenty percent of deaths are caused by asphyxia, or lack of oxygen to the body. Through recent efforts, a company called the Freedom of Breath helped

People die everyday from drowning and heart attacks because people around them do not know how to respond. CPR should be initiated within the first three minutes of a cardiac arrest or drowning for CPR to be effective. If everyone knows what to do in an emergency no one would panic. Within the first few minutes of an arrest it is crucial to survival that you continue pumping blood and oxygen to the vital organs by using chest compressions. The American Heart Association states the new standards is ‘pump hard and pump fast’. You buy precious time before the paramedics arrive. After four minutes brain damage is probable and on an average it takes 8 minutes for an ambulance to arrive. When CPR is initiated it can double or even triple a person’s chance of

“Epinephrine has been used in advanced cardiac life support for cardiopulmonary resuscitation (CPR) since 1896” (ACLS Algorithms, 2016). “Indications for the use of this drug are cardiac arrest, symptomatic bradycardia, normovolemic hypotension, anaphylactic reactions, and severe

Project goal: Promotion of the cardiac chain of survival which includes early recognition and initiation of CPR and the delivery of an electrical shock to the heart within 3-5 minutes.

Shortly after the publication of these studies, the International Liaison Committee on Resuscitation, endorsed the use of therapeutic hypothermia stating that patients with a Glasgow coma scale of eight or less who regained spontaneous circulation after an out-of-hospital cardiac arrest and initially presented with ventricular fibrillation should be cooled to a core body temperature between 32 to 34 ºC and remain at that temperature for 12 to 24 hours (Nolan et al., 2003, p. 118-121). The American Heart Association soon followed suit and in 2010 proposed a nearly identical protocol, adding patients who first presented with ventricular tachycardia to the group of individuals who were eligible for this type of medical treatment (Peberdy et al., 2010, p.

Another assumption will be that the American society of anesthesiologists will have additional guidelines that we can combine to AAHAs guidelines to make this a safer experience. “These standards apply to all anesthesia care although, in emergency circumstances, appropriate life support measures take precedence” (http://www.asahq.org/quality-and-practice-management/standards-and-guidelines#). The assumption that these guidelines are reasonable and easy to follow in every case is one that will ensure a patient’s safety.

A Do not resuscitate (DNR) order is a legal document written by a licensed physician, which is developed in consultation with the patient, surrogate decision maker, and attending physician. This document indicates whether the patient will receive resuscitative care, cardiopulmonary resuscitation (CPR), or advanced medical directives, in the setting of cardiac and/or respiratory arrest. A DNR can also be referred as a no code when identifying a patient’s resuscitation status. If a patient has an existing DNR it allows the resuscitation team, taking care of the patient, to either withhold or stop any resuscitation measures, and therefore respect the patient’s wishes. Historically, DNR orders did not become active in the care of patients until 1974, when it was identified that patients who received CPR, and survived, had significant morbidities (Braddock & Derbenwick-Clark, 2014). Braddock and Derbenwick-Clark further noted, the American Heart Association (AHA) recommended that physicians, in consultation with the patient, family, and or surrogate, place on the patients chart when CPR was not indicated. This documentation is now what we refer to as the DNR order and has become the standard to allow autonomous respect for patients, and their families, to make informed medical decisions. Therefore, the purpose of this paper is to discuss the legal aspects, ethical issues, and the application surrounding the DNR order.

Acute unstable arrhythmias should be treated with external defibrillator according to ACLS algorithm and it has been suggested that biphasic waveform defibrillation is more effective than monophasic defibrillation[173]. Treating the patient’s arrhythmia in hospital is a secondary prevention but as the proportion of out of hospital death is more, there is a need to focus on primary prevention