Adult CPR Team ApproachOn September 14, 2019 by Raul Dinwiddie
Now let’s cover basic life support for the adult in team approach. Team approach is best known when we’re talking about advanced cardiac life support with team leaders and running a mega code. In this case, we’re going to apply some of those same principles, but at a basic life support level. It works extremely well. This is a situation where you’re probably more in a clinical setting or with multiply trained rescuers. So, what’s neat about this is that you have the ability to step back as a team leader, and usually take a role of rescue breathing while you direct the other team members to do specific jobs. It’s efficient, it’s effective, and it’s a great way to provide this type of basic life support when you have extra help. So, we’re going to walk through these steps. The same thing is going to apply. The scene is safe, gloves are on, CPR shield is available. Ideally, you would bring in an AED, bag valve mask, crash cart immediately with you if you knew this was happening. But let’s just, for this scenario’s sake, say that someone made you aware, or a couple of people were in the hallway, that someone is not responsive. The first rescuer comes in and is going to actually do the same thing. Tap and shout, are you alright are you okay? Look to see if the patient is breathing normally, or not breathing, or in agonal respirations, which qualify as not breathing. If that’s the case, they’re going to call a code or activate the emergency medical response team. And then, they’re going to check for a pulse. No pulse found, patient non-responsive, no breathing, no moving, they’re going to go right into 2-person CPR if there’s two rescuers. If there’s only one rescuer, they’re going to call for help. The hallway is going to hear them, they’re going to come in and now they’re going to have at least a couple of rescuers. Now, keep in mind, the emergency medical response team has been activated. So, more help should be on the way. And, ideally, they’re going to be coming back with gear — AED, crash cart, bag valve mask. When we go through the practice session, we’re going to show what that looks like and how it works in a choreographed manner. While the person is doing CPR, if a person walks in with a bag valve mask, they can then come over and take team leadership and start the ventilations with the bag valve mask. The benefits of that is that with room air, you are giving the patient oxygen but no carbon dioxide. So, now, we’re not adding more carbon dioxide to the person’s bloodstream, causing that acidic problem that we were talking about before. This person can now be supportive role and exchange places with the initial compressor, which allows them to take a break and for us to consistently continue those deep, 2-inch plus compressions at least 100 times a minute in order to keep that circulation level up. Ideally, the AED is soon going to arrive, if it’s not already on scene. They’re going to go ahead and prepare the patient’s chest. Remember what we talked about with wiping off excess sweat. Making sure the scene is safe to be able to use the AED, meaning there’ s no combustibles, no liquids, no flammables. Then, they’re going to go ahead and apply the AED. Compressions will stop, respirations will stop, AED is in place. We let it do its thing. Ideally, then, if the crash cart is not already there, we have an additional runner who begins to come in. They’ll probably ask, “Is there anything I can do to help?” They could even be an administrative role. At this point, we say, “Yes, Janet. Could you please go and grab the advanced life support crash cart and return quickly?” They go ahead and do that, which is going to get us the medications, the intubation equipment, the suction equipment, everything else we need to turn this into a high-speed, life rescuing event, and it’s going to work really well if you practice this from a team approach. Scene is safe. Gloves, mask. Are you alright, are you okay? Rex, go activate the emergency response team and come right back. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23… Dan: I’m going to take over breaths now. Can you do compressions? Rex: Yes, I’m all ready. Roy: Hey guys, what’s going on? Dan: We’ve got a guy down. Roy: Ok, no pulse? Dan: No pulse Roy: Okay, I’m going to go ahead and take over rescue breathing. Jody just got here with the AED. Janet: Hey, is there anything I can do to help? Roy: Yeah, Janet, could you go ahead and go get the advanced life support crash cart? And then come back as quickly as possible, please. Janet: Yup, I’m on it. Roy: Thanks. AED: * Remove clothing from person’s chest * Roy: Looks like the scene is safe to use the AED. No combustibles, no standing liquids. AED: * Attach pads firmly to person’s chest as shown * Roy: Does anybody know how long this person was down? Dan: Just walked up to it and the person was unresponsive. AED: * Plug in connector * Roy: Did they have a no-code status or anything like that? Could you tell Janet to bring in the no-code status and paperwork? AED: * Shock advised… Charging. Everyone stand clear. * AED: * BEEP * Roy: Clear AED: * Everyone stand clear. Push the shock button. * Jody: Clear AED: * Shock delivered. Begin 5 cycles of CPR * Roy: Okay, at this point we’re going to continue 30 compressions to 2 rescue breaths, using the bag valve mask, if available. We’re going to continue this until the AED interrupts or until the full advanced life support crash cart gets here and we bring it to the next level.