Healthcare Provider Considerations:
Healthcare Providers when performing CPR should consider the following considerations:
Use of BVM or Bag Value Mask: A bag valve mask is a device that is commonly used in healthcare settings to deliver rescue breathing to person who is not breathing or is breathing ineffectively. A BVM delivers positive pressure ventilation and forces the volume of the air in the device into the victims lung. The device may be used with or without oxygen. If used with oxygen, high flow oxygen (greater than 10 liters per minute) should be used. Room air contains approximately 21% oxygen with high flow oxygen attached to a BVM approximately 90% oxygen is delivered with each breath.
The mask supplied with a BVM is similar to that used in a pocket mask. With one hand use the thumb and index finger to grasp the mask. Place the thumb over the raised portion of the mask. This visually looks like the letter C. Standing at the victims head, place the pointed end over the bridge of the victims nose. Place the remaining three fingers on the victims chin. This visually looks like an E. This technique is called the EC clamp technique and is the preferred method of using a BVM.
With the second hand attach the bag portion of the device to mask and squeeze slowly touching finger to finger to deliver the majority of the volume of air within the bag device. Upon delivering a breath and seeing the chest rise, slowly release the bag allowing it to refill while holding the mask firmly on the victims face. Deliver additional breaths as indicated. Do not hyperventilate or forcefully squeeze the bag.
BVM’s come in Adult, Pediatric, and Neonate sizes – You should use the most appropriate sized mask/device dependant on patient size.
Checking for a Pulse: Healthcare Providers should check for a pulse if they feel comfortable before performing chest compressions on a victim in cardiac arrest.
For Adults and Children, a pulse should be assessed in the carotid artery for 5 to 10 seconds. The carotid artery is assessed due to it being central and likely to be palpable if a pulses exists. During cardiac compromise the body shunts circulation to the heart, lungs, and brain as they are most important for survival of life. Therefore it is possible a carotid pulse may be present while a peripheral pulse such as the radial may not. In an infant, a brachial pulse should be assessed as it will be larger and easier to evaluate.
Ratio of Compressions for Infants and Children: Healthcare Providers should recognize that children likely are hypoxic and are in need of oxygen during CPR. Therefore, in a healthcare setting with two or more rescuers present, compressions should performed at the ratio of 15 compressions to 2 breaths instead of the traditional 30:2. By using 15:2, the victim receives breaths twice as frequent, increasing the overall oxygenation of the patient. This method is used when multiple rescuers are present to help reduce fatigue. If alone, use 30:2 until additional rescuers arrive.
Compressions for Infants with two or more rescuers: Healthcare providers providing CPR to an infant in a healthcare setting may use an alternative technique to the standard two finger compression method.
The alternative method is called the two thumbs encircling technique and allows for more effective compressions when working with another rescuer. The compressing rescuer encircles the infants body with both hands as in going to pick up the child. The rescuer compresses the chest while on a hard firm surface with both thumbs. The second rescuer delivers breaths every 15 compressions. The compressing rescuer never removes the hands from the victims body while breaths are being delivered to allow for immediate resumption.
Advanced Airway: When an advanced airway such as an ET or Combitube is placed CPR changes slightly. Compressions are performed at the rate of 100 compressions per minute without interruption and breathing is performed every 6 seconds (10 times per minute) continually. Compressions and breaths are performed simultaneously once an advanced airway is in place.