Louise Lipe Submitted 2015-12-20

Frozen. Blank. Irresponsible. Those are just a few of the feelings I had when I witness my first real-life BLS in action. Although I have participated in annual Basic Life Support (BLS) recertification, I never truly paid attention. If you are like me, BLS recertification was just one of those things I had to do for my job. It was cumbersome listening to the monotony of “Airway, Breathing, and Circulation.” How hard can it be to check for responsiveness, determine unresponsiveness, breath and push on the chest, right? Very hard! My first job was an ER technician at a busy, level I trauma center that serves a population of around 425, 363 residents. So, it is safe to say I have been witnessed almost every, kind of emergency out there. I remember the very first time I was part of the code team. So excited, and I was prepared for the 75 year old male found unresponsive with CPR in progress that the medics were bringing in. Or so I thought. First of all; it is imperative that healthcare providers know BLS inside and out because when it’s real, you need to be able to run on autopilot. Every second counts. I was mentally and physically so unprepared. I only lasted about 30 seconds worth of chest compressions before needing someone else to takeover. A person should be able to do one round of CPR, or 2 minutes. As I am getting ready to complete my senior practicum for nursing in the emergency department, I am doing things a little bit differently. When practicing BLS in simulation lab, I have found it helpful to pretend the patient is a family member or friend. Just the thought, triggers my adrenaline to kick in high gear and allows for me to work the scenario like it’s the real deal. It may seem obvious that communication is also a big deal; however, it is often the lack of communication that leads to poor outcomes. Practice saying out loud, “I do not feel a pulse,” I will start chest compressions,” or “I will grab the AED” will make it easier to do so in real life. Likewise it is important to be able to delegate. It may be that there is only 2 or 3 responders and someone needs to take charge by giving each person a job, otherwise precious seconds are lost. Be prepared to potentially have family or friends that may be present. Someone needs to tend to their needs as well, and even more importantly have trust and confidence that the BLS providers. Active CPR is not pretty. The downtime of the patient may be unknown, so blood may already be pooling, ribs get broken, and the patient’s skin on their chest may break open from the friction of compressions. Obviously this is not seen on a manikin, so thinking of the broader picture during practice and asking questions can help prepare for the havoc caused by CPR. Chest compression should not be interrupted to place the AED pads on the patient’s chest, and placement of the machine itself also is something to consider during simulation. If good communication is taking place, the pads can be place simultaneously and machine turned on ready to check patient’s rhythm as soon as possible. I am doing my senior practicum for nursing school in the emergency department in the Spring. I am preparing now by reviewing simple things, like the monitor (Life Pak). I want to know how to turn it on, know where the connection ports are, what they correspond with, and what each of the buttons do. Code carts are organized fairly similar nationally, so I have researched what is stored in each drawer. If you work in a hospital, one of the first things you should find out is, where is the code cart? I do not know about you, but the last thing I want to happen is for someone to direct me to get the code cart and have to run around in circles trying to track it down. Although we were briefly shown the algorithms for cardiac arrest, I have been reviewing the medications that are used, in what order, as well as interpreting cardiac rhythms on the monitor and recognizing the rhythms that require shocking and the rhythms that do not. I plan to take the ACLS course within the next month or two as well as keep informed of the latest evidence-based research that is published so that I can provide the safest, most up-to-date care to my patients. My goal is to eventually obtain my Master’s in nursing to that I can be part of a team that educates nurses, and implements evidenced-based, best practices.