NURSING AT McLEAN
CODE? CALL FOR CAB (Compressions, Airway, Breathing)
by Paula Bolton, RN/NP
When faced with an unresponsive patient, staying calm and remembering the basics are important. Instead of calling a cab to get away from the situation, use the CAB (chest compressions, airway, breathing) acronym to help remind you of the sequence to follow in resuscitation.
It has become increasingly evident that in health care settings, high-quality CPR is crucial to resuscitation. Even advanced cardiac life support measures take a back seat to adequate chest compressions, ventilations, and defibrillation. Advanced airway management, IV therapy, and medications used during a code have not been shown to improve outcomes much over good basic CPR and early defibrillation.
After many years of promoting the ABCs (Airway, Breathing, Circulation/Chest Compressions), the American Heart Association (AHA) is re-educating the general public and health care professionals. Their new 2010 recommendations change the sequence of resuscitation to reduce the time it takes for chest compressions to begin. It has been documented that the highest survival rates in cardiac arrest victims occur when the arrest is witnessed and early chest compressions and defibrillation, followed by airway and breathing techniques are initiated.
Studies done in community settings have revealed that bystander CPR is often delayed, perhaps due to difficulty opening the airway and delivering rescue breaths, especially if no protective resuscitation device is available on the scene. Starting with chest compressions, which are easily taught and easily administered, may empower lay people to provide this part of CPR. Chest compressions will help circulate the blood throughout the body and may improve the success of defibrillation.
According to the American Heart Association’s 2010 Guidelines, Basic Life Support (BLS) is “the foundation for saving lives following cardiac arrest.” The steps of BLS are: 1) Recognize the event – an unresponsive person with no breathing or abnormal breathing (i.e. only gasps or grunts); 2) Activate the emergency response system – calling 2222 here at McLean or 911 in the community; 3) Begin chest compressions, followed by airway and breathing at a ratio of 30 chest compressions to every two breaths; and 4) Get ready to defibrillate with an AED.
Recognizing sudden cardiac arrest early is very important to minimize delays in resuscitation. Victims of cardiac arrest may have different presentations. Some slump over and stop breathing completely, some appear to be having a seizure, and some present with gasping respirations. It is important to establish that the person is indeed unresponsive by calling and shaking him or her, getting assistance, and beginning chest compressions immediately after unresponsiveness is established. Interruptions in chest compressions should be kept to a minimum. So, while one person does chest compressions, another delivers ventilations, another calls the 2222 emergency line, while yet another person turns on the AED and gets it ready.
The role of the first responder – an MHS, CRC or RN on the unit – is of utmost importance in saving lives. So become familiar with the new recommendations. Forget the taxi and call C-A-B.