...issues in cardiopulmonary resuscitation (CPR) Mark Hilberman, Jean Kutner, Debra Parsons, and Donald J Murphy The Carbondale Clinic, Carbondale, Colorado, University of Colorado Health Sciences Center, St Joseph's Hospital, and the Colorado Collective for Medical Decisions, Denver, Colorado, USA Abstract Outcomes from cardiopulmonary resuscitation (CPR) remain distressingly poor. Overuse of CPR is attributable to unrealistic expectations, unintended consequences of existing policies and failure to honour patient refusal of CPR. We analyzed the CPR outcomes literature using the bioethical principles of beneficence, non-maleficence, autonomy and justice and developed a proposalfor selective use of CPR. Beneficence supports use of CPR when most effective. Non-maleficence argues against performing CPR when the outcomes are harmful or usage inappropriate. Additionally, policies which usurp good clinical judgment and moral responsibility, thereby contributing to inappropriate CPR usage, should be considered maleficent. Autonomy restricts CPR use when refused but cannot create a right to CPR. J7ustice requires that we define which medical interventions contribute sufficiently to health and happiness that they should be made universally available. This ordering is necessary whether one believes in the utilitarian standard or wishes medical care to be universally available on fairness grounds. Low-yield CPR fails justice criteria. Cardiopulmonary resuscitation...
Words: 1339 - Pages: 6
...In Pre-Hospital Cardiac Arrest Patients, How Does Hands-Only CPR Compared To Standard CPR, Affect Neurological Outcomes? Abstract Summary Out-of-hospital cardiac arrest is the leading cause of death in the U.S. Increasing bystander-initiated CPR through “hands-only” CPR and EMS dispatcher instructed “hands-only” CPR improves survival rates. Methods CINAHL, PubMed, and OvidMD were searched for the following key terms or combination thereof: “hands-only”; “compression-only”; chest compression-only”; “bystander”; “CPR”; “dispatcher”; and “neurological affect”. We initially restricted our search to peer-reviewed studies published in English between January 2004 and June 2014, but agreed by consensus to use a 2000 study located during a manual search of included study references. Results We identified nine Level II, III, and IV studies comparing “hands-only” CPR and “standard” CPR, published between 2000 and 2013, and occurring in the countries of Japan, London, Sweden and the U.S. All but one of the study results recommend that “hands-only” CPR is at least equal or superior to “standard” CPR. Conclusions Guidelines should be established to teach bystander “hands-only” CPR nationwide, to increase public awareness of the effectiveness of “hands-only” CPR and start to teach out-of-hospital “hands-only” CPR. Introduction Sudden cardiac arrest is the leading cause of death in the United States (Neumar, Barnhart, Berg, Chan, Geocadin, Luepker,… Nichol, 2011). According...
Words: 5900 - Pages: 24
...CARDIOPULMONARY RESUSCITATION (CPR) TRAINING: HANDS-ONLY * Set Induction * Introduction to what Hands-Only CPR is. * “Who can tell me what CPR stands for?” What are the benefits to knowing CPR?” Can CPR be performed on babies too? * Cardiopulmonary resuscitation- emergency procedure for reviewing heart and lung functions, involving special physical techniques and often the use of electrical and mechanical equipment. Abbreviation: CPR * The benefits in knowing how to perform CPR are high; it is Tyour knowledge isn’t %100 complete. It’s always best to try rather than doing nothing, that could be someone’s life. * Yes CPR can be done to a child or infant. The procedure is essentially the same as that for an adult. * Tell: What we will be learning today. * What to check for before beginning. * “ARE YOU OKAY?” * How to use your surroundings as help. * How to perform chest compressions on adults and children. * Link here: hands-only cpr red cross * Show * Demonstrate in complete steps for the class what the skill looks like in action. * Share with the class again, yet this time slow, and speaking out loud for the class to hear you. * Invite * Break the class into groups so they can practice * Have a leader in each group go first, while their team mates correct and encourage them in what they might be doing right or what might need Improvement. * Have each person take turns until everyone has performed...
Words: 352 - Pages: 2
...University of Phoenix Material Health Care Museum This paper is a Health Care Hall of Fame Museum proposal, it’s composed of five exhibits Marine Hospital Service, Polio Vaccination, Cardio Pulmonary Resuscitation (CPR), Emergency Medical Services (EMS), and Electric Health Records (EHR). This part of the exhibit will cover the history, and how did it affect our current health care system. The second part talks about how does everything ties together. Part 1: Health Care Hall of Fame Museum Proposal |Development |Description |Analysis (How does the development affect the current U.S. health care system?) | |1. Marine Hospital |The "Decades Of Healthcare Service" (). In 1798, President John Adams signed into |The relevance of the Marine Hospital service is by the government recognized that | |Service |law the Act for the Relief of Sick and Disabled Seamen. Creating the Marine Hospital|the servicemen needed federal regulated healthcare. This service was centered to | | |Service. This plan marked the nation’s first pre-paid health insurance plan and was |providing medical care to our servicemen, it evolve to a big organization known as| | |the birth of the modern American medical system. During that time, twenty cents was |the Public Health Service. According to "U.s Department Of Health And Human ...
Words: 2232 - Pages: 9
...terms CPR: Cardiopulmonary Resuscitation. DNACPR: Do Not Attempt Cardiopulmonary Resuscitation. NMC: Nursing & Midwifery Council. GMC: General Medical Council. BMA: British Medical Association. GP: General Practitioner Introduction The Aim of this module is to encourage me to enhance my personal and professional skills, to increase the efficacy of patient care and interaction. Also to make me more aware of the legal, professional and ethical implications of practice. The module allowed me to further develop my knowledge of these topics: Ethics & Accountability, Legal Aspects of Practice, finally Accountability & Professional Practice. I was then asked to submit an essay of 4500 words based on the following: “Critically analyse an aspect of care from your practice setting that encompasses the ethical, professional & legal role of the nurse. Issues of accountability should be incorporated into this essay”. Aspect of care The aspect of care I have chosen to include in my essay is the “Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)” Adult Policy 2010 (please see Appendix 1). I decided to choose this topic as there was a situation on my ward recently where a patient discovered a DNACPR form in the front of her nursing notes. The patient was very upset as she was not aware of this decision. She was an elderly lady with end stage Chronic Obstructive Pulmonary Disease. It came to light that the consultant had decided that CPR would...
Words: 5245 - Pages: 21
...Needs The purpose of my training session was to give delegates a guidance of the skills and knowledge to understand Cardiopulmonary resuscitation (CPR) should it ever be required in an emergency situation. I felt that the simple knowledge of basic CPR is important for all to know for personal reasons. Training needs are identified in numerous ways. It maybe that an employee would be required to do a full first aid at work course within their working environment under Health & Safety legislation or just the companies preference to increase their provision. It maybe required under their occupation e.g. working with children that they are required to hold this qualification. The individual may simply have the desire or feel they lack the knowledge and skills should they ever be required. An individual may simply by deemed the best person to have first aid qualification because the come in to contact with many members of the public. As such one never knows when an emergency situation could arise and there might only you in the vicinity. Training Objectives My main aim for my course was to make this a realistic fun and interactive course but not to forget the seriousness of how important it is for everyone to know basic Cardiopulmonary Resuscitation. By making the course fun and interactive I hoped this would make everyone be able to remember the training in an achievable way...
Words: 794 - Pages: 4
...Original article | Published 3 February 2011, doi:10.4414/smw.2011.13157 Cite this as: Swiss Med Wkly. 2011;141:w13157 Do not attempt resuscitation: the importance of consensual decisions A qualitative study Lorenz Imhofa, Romy Mahrer-Imhofa, Christine Janischb, Annemarie Kesselringc, Regula Zuercher Zenklusend a b c d Zurich University of Applied Sciences ZHAW, Institute of Nursing, Winterthur, Switzerland Department of Education, Training and Professional Development, Stadtspital Waid Zurich, Switzerland Institute of Nursing Science, University of Basel, Switzerland Department of Medicine, Pourtalès Hospital, Neuchâtel, Switzerland Correspondence: Lorenz Imhof PhD RN Zurich University of Applied Sciences Institute of Nursing School of Health Professions Technikumstr. 71 CH-8401 Winterthur Switzerland lorenz.imhof@zhaw.ch pivotal. Therefore, leadership by experienced senior physicians and nurses is needed and great efforts should be made with regard to multidisciplinary education. Key words: decision-making; multidisciplinary collaboration; end-of-life issue; resuscitation orders Introduction Since the 1980s, “do-not-attempt-resuscitation (DNAR)” orders have become common in medical practice. DNAR orders are given for 50–60% of patients who die a non-sudden death, with wide variations among countries. DNAR orders apply to only 19% of hospitalised patients in Italy, but to as many as 83% in Sweden and 86% in Switzerland [1, 2]. The frequency of DNAR decisions in...
Words: 6472 - Pages: 26
...is 5 minutes, 3 cm, 2 ml 3. What you write is always past tense it's over and everything could be completely different by the time someone reads it. You conducted a microsystems assessment and the findings were. When you include an article the author reported, the study demonstrated, 4. Check your outlines you always need a running head, title page with the name of the paper, course name and number, your name, school name, instructor's name, date, headings and reference page is always by itself 5. Read your paper like you are not familiar with the topic (helps to get non-nurse folks to read) all those abbreviations we use like IV, CPR always have to be written out the first time then and only if you plan to use it again make the abbreviation cardiopulmonary resuscitation (CPR) , never begin a sentence with an abbreviation so if I've use CPR a dozen times already but I...
Words: 659 - Pages: 3
...Maternal Resuscitation Aim To understand and be able to practive resiscitation of the mother and promote the positive outcomes. Resuscitation of the Mother The approach to apparently lifeless patient is the cardiopulmonary resiscitation (ABCD) drill: Rapid assessment of the Airway, Breathing, and remedy of the problems with these as they are found (search for and correct reversible causes), moving through to remedy of the absence of Circulation. 1. Ensure a safe environment for patient and rescuer. 2. Shake and Shout, if no response, call for help and return to patient. 3. Turn patient on to her back and place wedge under right side of abdomen to relieve aortocaval compression. 4. Open the Airway: Remove any obvious obstruction from mouth. Perform chin lift by placing two fingers under the point of the patient’s chin and lifting the chin forward. Jaw thrust, performed by placing fingers behind patient’s jaw and lifting jaw forward. 5. Assess Breathing for 10 seconds: Look for chest movements. Listen for breath sounds. Feel for movement of air. If the person is breathing, turn her in to the recovery position. If there is absence of breathing in the presence of an open airway, take this as an absence of circulation. Give 30 chest compressions followed by two breaths. Breaths are delivered by taking a full breath and placing your lips around the mouth and blowing steadily into the mouth. If possible, a facemask and ...
Words: 589 - Pages: 3
...Care Ethics & Medical Law Instructor: Eugene Elliott March 4, 2014 Do Not Resuscitate (DNR) orders are medical directives to withhold efforts to revive a patient who has a cardiac or respiratory arrest (Lee, M. B., M.D. 2012). DNR laws started in the late 70s because of the extensive practice of cardiopulmonary resuscitation (CPR). An unending discussion about DNR has involved the level to which patients or their surrogate have to make the decision to agree to such orders. Throughout the late 70’s and early 80s, a lot hospitals normally made DNR orders that did not including an discussion with the patient or the patient's family. Also, a lot hospitals did not clearly document the DNR order in the patient's chart. This practices were forsaken as the bioethics drive and the courts stressed the right of patients or their surrogate decision makers to decline medical treatment. This also including life insufficient treatment for example CPR. Most of health care providers, health professional groups and indorsing bodies started to support DNR policies. The DNR policies require that the patient be informed of the risks and benefits of CPR and to give consent that CPR not be used. (Lee, M. B., M.D. 2012) DNR is reflect one of the ethical dilemma in current society that came from medical development, ethical dilemmas arise in the area of health care when health care providers is in a position to choose between two or more harmful option, and a lot of time the physician...
Words: 1720 - Pages: 7
...clear that the word “family” draws upon much more than just blood relatives. In the health care setting a family can be viewed as the people who come together to support a patient during a health crisis. That support may be seen directly at the bedside, through conversations via phone, or helping to assist in the discharge process. As a nursing workforce it is our responsibility to understand how the roles of a family affect our individual patients, and work to incorporated those roles into their therapeutic environment. An issue in today’s emergency departments that continues to draw attention from aspects of the medical profession is the use of family presence during cardiopulmonary resuscitation. “While it appears that the evidence clearly indicates positive outcomes from family witnessed resuscitation (FWR), a majority of emergency departments fail to implement or even institute policies “(MacLean, et al 2003) . Lack of education, leadership support and patient understanding are just a few factors contributing to hospitals not participating in this patient centered approach. “Families seldom ask if they can be present unless they have been...
Words: 1157 - Pages: 5
...CARDIOPULMONARY RESUSCITATION * Collapses * Becomes unresponsive 1. Check Responsiveness * Tap the person's shoulder and shout, "Are you OK?" * Look for normal breathing. Call 911 if there is no response. * Start Hands-Only CPR. * Hands-Only CPR should not be used for adults whose cardiac arrest is due to drug overdose, near-drowning, or an unwitnessed cardiac arrest. In these cases, do a conventional CPR combination of chest compressions and rescue breathing. 2. Do Chest Compressions * Place the heel of your hand on the center of the person's chest. * Place the heel of your other hand on top of your first hand, lacing fingers together. * Keep arms straight and your shoulders directly over your hands. * Push hard and fast, compressing chest at least 2 inches. * Let chest rise completely before pushing down again. * Compress at least 100 times per minute. 3. Stop Only if: * The person starts breathing normally * A trained responder or emergency help takes over * You are too exhausted to continue * There is an automated external defibrillator (AED) to use 4. Use an AED as Soon as One Is Available * Turn on the AED. It will give you step-by-step instructions. * Wipe chest dry. * Attach the pads. * Plug in connector, if needed. * Make sure no one is touching the person. Say "Clear" so that people know to stay back and not touch the person. * Push the "Analyze" button if necessary. * If...
Words: 3116 - Pages: 13
...Swimming Survival Whenever learning swimming it is very important to not only get better in a fitness aspect and a way of staying healthy, but one of the most important things to learn about while swimming is swimming to survive. According to the U.S. Centers for Disease Control and Prevention, in 2004, there were 3,308 unintentional drowning’s in the United States, an average of nine people per day. Also according to the American Academy of Pediatrics it is estimated that for each drowning death, there are 1 to 4 nonfatal submersions serious enough to result in hospitalization. Children who still require cardiopulmonary resuscitation (CPR) at the time they arrive at the emergency department have a poor prognosis, with at least half of survivors suffering significant neurologic impairment. There are many different instances in which the ability to swim affectively can save yours or somebody else’s life in a certain situation. Some of these situations include flood, ocean, river or even your basic swimming pool can all produce its own level of hazards or obstacles that can potentially cause saver injury or death. One technique that will help in some of these situations according to essortment.com is back floating also known as "sculling," the back float is performed by lying flat on your back with your feet relaxed and slightly apart. Your arms are at your sides moving slowly side-to-side. If you feel yourself sinking, raise your chin putting your head further back in the...
Words: 285 - Pages: 2
...Advance Directives Advance directives are medical documents that are created by the patient that assist health care providers, and loved ones provide care and make decisions for the patient. Four types of advance directives exist including a Living Will, Durable Power of Attorney (DPOA), Uniform Anatomical Gift Act, and Do Not Resuscitate (DNR) orders (Fremgen, 2009). This paper will discuss one type of advance directives, the DNR order. The DNR order alerts medical professionals not to perform cardiopulmonary resuscitation (CPR), per the patient’s request. This means that health care professionals will not attempt emergency CPR if the patient’s breathing or heartbeat stops (Smith.). Advance directives and DNR orders are important to have drawn up by the patient because in the event they are unable to speak for themselves, an order is put in place stating their wishes. This helps in assisting family members and health care professionals in making decisions when the end of life is inevitable. Advantages and Disadvantages of a DNR Order When it comes to making this difficult decision, there are many advantages and disadvantages of a DNR order. The advantages as stated in the report called, “Recording “Do Not Resuscitate” and other Life-Sustaining Orders in the Out-of-Hospital Setting” are: * Available to all patients * No personal discomfort * Deals with a range of treatment * Easy to maintain * No loss of privacy (Pace, 2002). For example, when a person...
Words: 1232 - Pages: 5
...NURS1131: Complex Care Nursing – written assessment Part 1: Media Annotation tool Time sequence | code | comments | 0-30 seconds | BARCG – did not assess patient appropriatelyGuideline 4 AirwayGuideline 5 BreathingGuideline 8 Cardiopulmonary Resuscitation.PTS (18 sec)PNTS – comm (23 sec) | DRS ABC- did not assess for any danger, assessed for response however failed to assess airway, breathing and circulation and jumped straight to compressions.Poor assessment of response inappropriate pain stimuli response technique.No code blue called by the second responder. | 30 – 60 seconds | PTS (39 sec)BARCG- Guideline 11.2 Protocols for advanced Life support. (59 secs) | Defibrillator pad were not attached properly.Rhythm was not assessed after the shock. | 60 – 90seconds | PTS (64 sec)PTS (80 sec) | Guardel airway was inserted with nil airway assessment. Pillow was also not removed for enhancing airway.Nil jaw thrust for airway. | 90 – 120 seconds | PTS (119 sec)PNTS – DM (119 sec) | Hands were off the chest and not ready for compression during doctors assessment. Delay compression. | 120 – 150 seconds | PNTS- SA (135 sec)PNTS – TM (149 sec) | Nurse with her arm crossed not taking any initiative of taking any roles.Task evident, no one initiated the scribe role until the doctor appointed one. All incoming nurses showed no initiative in taking any roles. | 150 – 180 seconds | PTS (158 sec)PTS (176 sec) PNTS DM, Comm, TM | Poor documentation, no record of first, second shock...
Words: 2241 - Pages: 9
