ER SKILLS

Basic Life Support

1. CPR
2. Artificial Respiration
3. CPR with ETT or TT
4. Heimlich Maneuver (FBAO)
5. Abdominal Thrust (FBAO)
 Cricothyrodotomy
 Opening of the trachea
 Upper airway
obstruction
 Thyroid cartilage
landmark
 1st cricoid ring
landmark
 First aid measure
 Bring to the hospital
 Tracheostomy
 INTUBATION
 To maintain patent airway
 ETT endotracheal tube
 Tracheostomy tube
 Patient must be unconscious
before insertion
 Done only by trained and
skilled health workers
 NPO if possible (OR case)
 PREMEDS: Sedatives,
Lidocaine and Atropine
 Check for equal sounds after
it is inserted
 Attach to: ambu bag or mech
vent
 Endotracheal Tube
 Nurse’s Role: ASSIST only
 Maintain patent airway
 Check equal lung sound
before cuff inflation
 Reposition tube every 8 hours
or as ordered (2 Nurses)
 Maybe attached to mech vent
or O2 source
 Humidify air and prevent RTI
 Private Room
 TRACHEOSTOMY
 Surgical opening of the neck to the trachea
(between cricoid ring 2 and 3) through which
an indwelling catheter can be inserted
 if the procedure was done under emergency
the tracheostomy is closed after normal
respiration is restored
 if it is permanent such as with laryngectomy
the patient is taught selfcare
 TRACHEOSTOMY TUBE
 Surgical insertion of hollow tube of rubber, metal or plastic to
relieve from obstruction, to deliver oxygenation
 Attach to mechanical ventilation machine, to suction secretion etc.
 Auscultate after insertion to check if the tube is in the right place
 NURSING CARE:
 maintenance of patency
 adequate humidification
 wound care and sterile tracheal suctioning and cleaning of the
materials
 assess breath sounds every 2 hours to verify needs of suctioning
 provide oral suctioning adequately
 perform oral care ( tooth brush, swabs and antiseptic mouthwash
or hydrogen peroxide diluted with water)
 turn every 2 hours
 maintain semi-fowler’s or sitting position whenever possible
 Humidified air
 Gastric Lavage
 NGT insertion: NEX,
aspirate, xray
 Clean procedure
 Salem sump a multi
lumen tube
 Levin tube a single
lumen tube
 Purpose: aspirate
blood/air/poison/food,
diagnostic
 Peritoneal Lavage
 Nurse’s Role: ASSIST
only
 Paracentesis
procedures
 Site: hypogastric
 Void first to prevent
bladder trauma
 Purpose: dx for
internal injuries,
specimen collection
 Control of Bleeding
Stop the bleeding
 Elevate (optional)
 Pressure Application
1. Site

2. Proximal

3. Torniquet application (LAST RESORT)

 Note: assess the DISTAL part for 5 P’s

Paresthesia, Pain, Pulselessness,

Poikilothermia, Pallor
 Torniquet Application
 Assess
Venous bleeders
 Dark red
 Oozing
 Apply torniquet snugly

Arterial bleeders
 Bright red
 Spurting
 Apply torniquet tightly and
release every 15 min
 Place a mark on the
forehead indicating the
presence of TORNIQUET
 Esophageal bleeders
 SENGSTAKEN BLAKEMORE TUBE
 UGIB
 Iced saline gavage and lavage
 Epistaxis
 Pinch and bow, nasal pack, cautery
 Eyes – suspect CSF leak
 Ears – suspect CSF leak
 Blood Transfusion
 Check serial number, ABO, Rh,
Blood Typing
 2 Nurses for validation
 4 hours to deliver BT starting
from BLOOD bank to the last
drop of BT
 Warm the BT first (wrap with
towel)
 Prepare: Drip chamber with
filter (one use only), BT set,
plaster, torniquet, blood unit,
PNSS 500 ml, IV set with G 18
needle , premeds (antihistamine)
 Blood Transfusion
 Slow drip for first 15 minutes and observe for
untoward effects (dyspnea, back pain, chills)
 If there will be sign of BT reaction, stop the BT, run
the PNSS, notify the MD, bring BT products to the
LAB
 If 5 units or more BT was given, administer Calcium
Gluconate (citrate-dextrose
( or citrate-phosphate
destroys Calcium)
 Agitate the BT bag frequently
 After BT watchout for delayed reactions
 Document
 Logrolling
 3-4 Nurses (unconscious)
 2-3 Nurses (client
cooperates)
 Indication: spinal cord
injury, spinal surgery,
fracture of the spine
 3 nurses positioning:
 In between arms of the
nurses (knees, hip joint
and shoulder of the client)
Note: 1 nurse must maintain client’s
head and neck alignment
 Lower the bed (waist level) and side rails
 Client’s arms across the chest
 Nurse’s arms under the client (knee, hip, shoulder)
 Client’s weight centered between arms of the nurse
 Pull the client to the side (1 nurse: count 1..2..3)
 Elevate side rails
 Move to the other side of the bed
 Place 1-2 pillows between client’s legs
 Roll the client (1 nurse: count 1..2..3)
 Support client’s head, back, upper and lower extremities
with pillows
 Raise the side rails
END
 Basic Life Support
1. CPR
2. Artificial Respiration
3. CPR with ETT or TT
4. Heimlich Maneuver (FBAO)
5. Abdominal Thrust (FBAO)
 Survey
 Check responsiveness
 Call for HELP
 Open airway
 Assess…give 2 blows (AB)
 Check carotid
 Start compression
 Reassess after 5 cycles
JAW THRUST
 Always start with compression (RESUME)
 Adult: 30:2 (1&2 RESCUERS)
 Child and infant: 30:2 (1 RESCUER)
 Child and infant: 15:2 (2 RESCUERS)
 Adult: 2 hands, 1 ½ - 2 inches (CALL, 2min CPR)
 Child: 1 hand, 1 - 1½ inches (2min CPR, CALL)
 Infant: 1-2 fingers, ¾-1 inch (2min CPR, CALL)
 Counting (Adult)
30:2
 1,2,3,4,5,6…27,28,29,1….. AR (2 full blows)
 1,2,3,4,5,6…27,28,29,2….. AR (2 full blows)
 1,2,3,4,5,6…27,28,29,3….. AR (2 full blows)
 1,2,3,4,5,6…27,28,29,5…AR (2 full blows)
 REASSESS
 Counting (Child)
30:2
 1,2,3,4,5,6…27,28,29,1….. AR (2 half blows)
 1,2,3,4,5,6…27,28,29,2….. AR (2 half blows)
 1,2,3,4,5,6…27,28,29,3….. AR (2 half blows)
 1,2,3,4,5,6…27,28,29,5…AR (2 half blows)
 REASSESS
 Counting (Infant)
30:2
 1,2,3,4,5,6…27,28,29,1….. AR (2 puffs)
 1,2,3,4,5,6…27,28,29,2….. AR (2 puffs)
 1,2,3,4,5,6…27,28,29,3….. AR (2 puffs)
 1,2,3,4,5,6…27,28,29,5…AR (2 puffs)
 REASSESS
 When to stop CPR
 B breathing is spontaneous
 E exhausted
 T trained personnels arrived
 U unsafe to do so
 P physician arrived
 Basic Life Support
1. CPR
2. Artificial Respiration
3. CPR with ETT or TT
4. Heimlich Maneuver (FBAO)
5. Abdominal Thrust (FBAO)
 Adult
 1,2,3,1…full blow (1)
 1,2,3,2…full blow (1)
 1,2,3,3…full blow (1)
 1,2,3,4…full blow (1)
 1,2,3,5…full blow (1)
 REASSESS
 CHILD: counting same to adult: half blow (1)
 INFANT: counting same to adult: puff (1)
 Basic Life Support
1. CPR
2. Artificial Respiration
3. CPR with ETT or TT
4. Heimlich Maneuver (FBAO)
5. Abdominal Thrust (FBAO)
 2 Rescuers
 100 chest compressions/min
 Press ambu bag every 6-8 seconds
 Basic Life Support
1. CPR
2. Artificial Respiration
3. CPR with ETT or TT
4. Heimlich Maneuver (FBAO)
5. Abdominal Thrust (FBAO)
 Universal Distress
 Ask victim: Are you
choking? Do u need help?
 Perform Heimlich Maneuver
 Position closed fist between
xiphoid and umbilicus
 Deliver the thrust….
 Unconscious: Abdominal
Thrusts 5-6x
END