Visit to the E.R.: Nurse’s Reflection

A patient arrives in the ER. The patient has suffered major injuries after falling from the roof of his two-story home. The incident has left the patient unconscious fighting for his life. The patient appears to be a forty-something-year-old gentleman, about 245 pounds, and with no visible signs of any serious health conditions. He has been transported to the E.R. by his wife and children. He is in need of immediate cardiac pulmonary resuscitation (CPR). Family and everyone nearby are watching the next actions taken because these could be critical to saving this man’s life. It is also vital that the family remains calm and are confident in the medical staff helping their relative.

At this moment, remember all one’s training and education and remember that staying calm in this situation critically important. Consider whether the family should stay for the resuscitation. As Laskowski-Jones suggests ‘witnessing a futile resuscitation attempt can be psychologically damaging for relatives and may increase liability risks for caregivers’ (2007 p. 45). However, additional research shows that ‘after analysing surveys from people who witnessed CPR on a loved one, the conclusion was that what was previously thought to be an event too traumatic for family members to witness actually aided surviving family members in coping with grief’ (Sanford, Pugh, & Warren, 2002, p. 62). Therefore it is useful to go with instincts and prepare to give the patient CPR immediately.

The patient has apparently gone into cardiac arrest, which will require quick care and attentiveness. According to a published study, ‘in contrast to cardiac arrests, survival following primary RAs is significantly higher. Greater than 40% of respiratory arrest patients (i.e. requiring intubation but no need for chest compressions/defibrillation) survive to be discharged home. This compares with less than 15% discharged home following unwitnessed cardiac arrest’ (Brindley, 2010, p. 53). As the patient lies on the bed, the chest compressions need to be initiated, the heel of the hand is placed in the center of his chest. Press at least two inches deep, allowing the chest to recoil between each compression. After 30 compressions are administered, place the breathing apparatus into the patient’s mouth and began rescue breathing. After about 3 minutes of resuscitation, the patient regains consciousness and is breathing independently. The family is relieved. They are advised that everything is going to be fine and are apprised of the next course of action. He is then transported to a room for further observation and care.   

Although the patient is stable, quite a bit still needs to happen in order to make sure of a full recovery from the incident. According to the Emergency Medicine of Australasia (2011), ‘after the return of a spontaneous circulation (ROSC), resuscitation does not stop. It is essential to continue maintenance of airway breathing and circulation. ROSC is just the first step toward the goal of complete recovery from cardiac arrest. Interventions in the post-resuscitation period are likely to significantly influence the final outcome’ (2011, p. 292). Therefore, the patient is placed on oxygen to ensure that enough oxygen reaches the bloodstream, the blood glucose is continuously monitored and controlled, and the temperature is controlled, among other important tasks. Now the patient is completely stable and will be kept overnight for continual observation.    

References

Brindley, P. G. (2010). Cardiac and pulmonary resuscitation: Focusing on what matters. Canadian Journal of Respiratory Therapy, 46(1), 52-56

Laskowski-Jones, L. (2007). Should families be present during resuscitation? Nursing, 37(2), 44-47.

Emergency Medicine of Australasia. (2011). Post-resuscitation therapy in adult advanced life support. 23(3), 292-296. 

Sanford, M., Pugh, D., & Warren, N. A. (2002). Family presence during CPR: New decisions in the twenty-first century. Critical Care Nurse, 25(2), 61-66.