Clinical Cases in Paramedicine. Группа авторов

      1 Given the chain of survival, high‐quality compressions are urgently required for this patient. What is your next move? Consider what you have just walked through.Moving the patient to the spacious lounge room you have just walked through is ideal. This will provide a better working area and ensure that good‐quality uninterrupted compressions can be achieved.

      2 You have moved the patient out to the lounge room to a large area. Your partner is a qualified advanced care paramedic. What are the first steps you are going to take with this patient?If there are no signs of life, e.g. no pulse, or no normal breathing, chest compressions need to be started and continued while the patient’s chest is exposed by removing his pyjama top (cutting it off). The defibrillation pads can then be attached to the patient.

      1 The person performing chest compressions asks you where their hands should be positioned on the patient’s chest and how to best perform compressions. What would you say?Kneel down to the side of the patient. Place the heel of your hand in the centre of the patient’s chest this should be on the lower half of the sternum, roughly between the nipples (ANZCOR, 2016). Ensure that it is not placed over ribs or the upper abdomen. Their other hand is then placed on top of this hand and the fingers may be interlocked. Keep your arms straight and position yourself vertically above the patient’s chest and press down on the sternum at least one‐third the depth of the chest (5–6 cm). Ensure that pressure is released after each compression and that you don't lean on the chest wall, allowing recoil.

      2 Your partner is continuing chest compressions and the neighbour will assist them. You are positioned at the head of the patient. What actions will you take next?By positioning yourself at the head of the patient you are in an ideal position to manage the airway. First check the airway for any obstructions, suction the saliva out of the patient’s mouth and check for any foreign bodies. Next an oropharyngeal (OP) tube needs to be correctly sized to the patient and inserted. The sizing is important, as inappropriate size will be ineffective and can be detrimental to the patient by not sitting in the correct position and causing trauma. Size the airway by measuring from the middle of the front teeth to the angle of the jaw.

      3 After an oropharyngeal (OP) tube has been inserted, what ratio of compressions to ventilations will be used?The ratio is 30 : 2. Perform 30 compressions to every 2 ventilations, with compressions at a rate of 100–120 per minute.

      4 How often should the person performing compressions change over?The person performing compressions should be changed every 2 minutes to prevent fatigue and ensure that good‐quality compressions are been delivered.

      1 You have completed 6 minutes of BLS and another crew arrive to assist. The patient is now is asystole and you are completing rhythm checks every 2 minutes. What other interventions could now be considered?An advanced airway can now be inserted: a supraglottic airway device (SAD) can be correctly sized and inserted to ensure effective ventilations. Once this is inserted and confirmed in position, compressions can become continuous and the patient can be ventilated at a rate of 6–10 bpm (approx. 1 every 6 seconds).An IV line can be inserted, or an intra‐osseous (IO) infusion if your skill set allows, with adrenaline administration commenced.