ADVANCE CARDIAC

LIFE SUPPORT SYSTEM

 ADVANCE CARDIAC LIFE
SUPPORT SYSTEM
A. ENDOTRACHEAL INTUBATION –
GOLD standard in airway
management
B. ECG TRACING
C. DEFIBRILLATION
D. PULSE OXIMETER
E. Assisting in IVF therapy
 ENDOTRACHEAL
INTUBATION
1. EQUIPMENTS: LARYNGOSCOPE, ET Tube,
10 cc syringe
2. Prepare patient: HTLC maneuver
3. Gently press on the throat to push the vocal
cords into view (this is where the tube is
inserted)
4. Once the tube is properly inserted, the cuff
is inflated with air (to hold the tube in place)
5. While holding the tube, use a stethoscope to
listen for the lung sounds (to check if the
tube is properly inserted)
 ENDOTRACHEAL
INTUBATION
6. Tape the tube in place, the 22cm mark on the
tube should be at the level of the patient’s
teeth
7. Hold the tube with one hand while the other
hand is working on the bag
8. While ambubagging, report any changes in
resistance and in the patient’s mental status
9. In the absence of IV line, Epinephrine will be
injected to the ETT for faster absorption,
after administration, hyperventilate (give
ventilation at a faster rate than normal)
 ELECTROCARDIOGRAM
(ECG)
• Provides data on electrical activity of
the heart; records the heart
relaxation and contraction
• Recognizes life-threatening rhythm
disturbances
• 12-lead ECG: leads (electrodes) on all
4 extremities, right and left sternal
border, lateral to the sternal border,
midclavicular 5th ICS, anterior axillary
line, mid-axillary line
 DEFIBRILLATION
1. Prepare EQUIPMENTS:
DEFIBRILLATOR with the 2 paddles,
conducting gel or paste, airway tube,
cardiac board, resuscitator bag,
Emergency cart, O2 equipment
2. Verify ECG reading
3. Validate client unresponsiveness
4. Plug defibrillator and turn it ON, start
with 200 joules
5. Cardiac board under the torso
6. Dry the patient’s chest
 DEFIBRILLATION
7.Spread conducting paste to surfaces of the paddles,
one paddle on sternum below right clavicle, other
paddle on left anterior axillary line
8. Instruct people around to hands off from the patient
8. Apply paddles with firm pressure
9. Depress discharge buttons simultaneously to ensure
appropriate energy
10. Check the ECG monitor to determine the effects of
defibrillation
11. Reinstitute CPR and medications if fibrillation
persists while preparing for 2nd attempt at defibrillation
12. Increase the energy to 300 joules
13. Repeat the procedure of defibrillation
 PULSE OXIMETER
• photoelectric device that monitors the
amount of O2 circulating in the blood
• Clip onto the patient’s finger or earlobe
• Displays a % measurement of oxygen
saturatio (N=95% and above)
• For assessing the effectiveness of
artificial respiration , o2 therapy,
bronchodilator therapy and BVM
ventilation
 IV THERAPY
7. Hold fluid bag higher than the drip
chamber
8. Open the flow regulator and allow fluid
to flush all the air from the tubing
9. Turn off the flow
10. Make certain that the setup stays
clean until the needle is already inside
the patient’s vein
11. Splint the hand
 IV THERAPY
1. Gather EQUIPMENTS: IVF, venoset,
abbocath, alcohol swipes, micropore tape
2. Inspect the IVF bag. Remove wrapper
3. Select the proper venoset. Extension set if
needed
4. Make sure that the flow regulator is closed,
roll down the stopcock
5. Remove the protective covering of the spiked
end of the venoset
6. Insert the spiked end with a quick twist into
the fluid bag
 SWAN GANZ CATHETER
• CVP does not give information on the status of the left
ventricle and the pulmonary vascular pressure
• Has 4 or 5 tips: proximal lumen-for CVP, distal-
measures PAP, pulmonary artery wedge pressure, 3rd
lumen-connected to syringe for balloon inflation, 4th-
cardiac output
• Objective: indirectly assesses LVEDP
provide info regarding the fluid volume
measure cardiac output
assess the need for cardiac therapy
 CENTRAL VENOUS
CANTHETERIZATION
• OBJECTIVES:
1. TO MEASURE THE CVP
2. To have a venous access when no
peripheral veins are available
3. to administer vasoactive/inotropic
drugs which cannot be administered
peripherally
4. To administer hypertonic solutions
including TPNs
5. For hemodialysis/plasmapheresis
 CENTRAL VENOUS
PRESSURE
7. Once inserted, push the catheter slowly until the
tip of the catheter is just above the right atrium
8. Connect the primed IV tubing (with heparinized
solution) to catheter and allow to flow at a
minimum rate to keep vein open
9. The catheter should be sutured in place
10. Place a sterile occlusive dressing over site
11. Obtain a chest x-ray
CENTRAL VENOUS PRESSURE
To measure CVP
1. Place the patient in a position of comfort
2. Position the zero point of the manometer at the
level of right atrium ( at the manubrium)
3. Make certain that the client is relaxed at time
of measurement
4. Instruct client not to strain, cough or do any
other activity that increases the intrathoracic
pressure
5. Make your measurement
6. Record
 CENTRAL VENOUS
PRESSURE
1. Identify the patient
2. Gather equipments (CVP catheter, Heparin, IV
tubing, 12-16 gauge intracatheter, sterile gloves,
betadine, cotton balls, gauze)
3. Wash hands
4. Explain the procedure to the patient. Hook the
patient in ECG monitor
5. Lighting is adjusted to visualize the jugular vein
clearly (may use the subclavian vein)
6. Remove any of the client’s clothing that could
constrict the neck or upper chest
Clean the site of insertion ( the medial aspect of the
neck) then percutaneous insertion of the catheter is
performed
 INSULIN ADMINISTRATION
• FUNCTION OF INSULIN
1. FACILITATES THE CELL UPTAKE OF
GLUCOSE FROM THE CIRCULATION
2. PROMOTES FAT DEPOSITION
3. PROMOTES GLUCOSE STORAGE IN THE
LIVER IN THE FORM OF GLYCOGEN
• SITES OF ADMINISTRATION: ABDOMEN,
POSTERIOR ASPECT OF THE FOREARM,
SCAPULAR AREA, ANTERIOR ASPECT OF THE
LEGS, BUTTOCKS
• SUBCUTANEOUS : for all types of insulin
• INTRAVENOUS: only REGULAR (HUMULIN R)
insulin
 INSULIN ADMINISTRATION
1. Gather equipments and take the
medications to the patient’s room
2. Check the client’s identiband
3. Explain the procedure
4. Wash hands and don clean gloves
5. Select site for injection by identifying
anatomical landmarks. Alternate sites
each time, injection should be 1 inch
apart from previous injection
 INSULIN ADMINISTRATION
6. Clean area with alcohol in circular motion
7. Take off needle guard, remove bubbles
8. Grasp subcutaneous tissue between thumb
and forefinger on abdomen
9. Insert needle 45 or 90 degree angle
10. Release SQ tissue, inject slowly then
withdraw slowly to prevent insulin leakage
11. Return client to position of comfort
12. Discard needle, do not recap needle
13. Chart med and injection site