Here are five steps you must take now
Here are five steps you need to take immediately to implement the new guidelines for emergency cardiovascular care from the Dallas-based American Heart Association (AHA):
1. Read the guidelines.
Every ED nurse should obtain a copy of the guidelines immediately, stresses Mary Fran Hazinski, RN, MSN, FAAN, senior science editor for the AHA’s emergency cardiovascular care programs and clinical specialist in the division of trauma in the departments of surgery and pediatrics at Vanderbilt University Medical Center in Nashville, TN.
"Nurses should also subscribe to Currents in Emer-gency Cardiovascular Care newsletter to keep up to date on new science or revisions," she recommends. (See sources for ordering information.)
The AHA has a manual available for purchase titled the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. "It includes all changes, the science that precedes the change, and specifics related to each course, including basic, advanced, and pediatric advanced life support," says Darlene Bradley, RN, MSN, MAOM, CCRN, CEN, director of emergency/trauma services at UCI Medical Center at University of California-Irvine. The manual is particularly appropriate for ED nurses, who must be knowledgeable in each of those categories, she adds.
The 2000 Handbook of Emergency Cardiovascular Care is also available from the AHA, notes Hazinski. It contains all the new neonatal, advanced cardiovascular life support (ACLS), pediatric advanced life support (PALS), and basic life support (BLS) algorithms and drug dosages, she says.
2. Update colleagues.
Physicians, paramedics, and other nurses are dependent on the ED nurse to practice and communicate knowledgeably about the current guidelines and recommendations, Bradley stresses. "It is an opportune time for you to get educated and speak knowledgeably about these changes," she says.
Begin to incorporate skill changes in practice, including bag-valve mask ventilation, two-thumb compression technique for infants, and insertion of new airway devices such as the Combitube (Kenall/Sheridan Healthcare Products, Argyle, NY) or laryngeal mask airway, advises Bradley. "All of these skills reflect a greater understanding of the guideline changes."
When resuscitation occurs in your ED, begin to offer suggestions on medication or treatment based on current research, urges Bradley. "It’s an opportunity for everyone to learn and to acquire greater skill in their practice."
ECG is one key factor
3. Revise protocols to correspond to the new algorithms.
"In our current practice of triage, we already [evaluate] patients based on a primary and secondary assessment," Bradley reports. "The electrocardiogram is only one of the key factors we [evaluate] when searching for causes, continuing assessments, or planning and [evaluating] interventions."
4. Increase knowledge of airway management.
The guidelines address alternative airway devices including the Combitube, laryngeal mask airway, and the pharyngotracheal lumen airway, Bradley says. "Education and training regarding the tube’s placements must be provided and practiced," she says.
The use of capnography, or end-tidal CO2 devices can be used to help confirm placement, adds Bradley.
You’ll need to be familiar with these new devices for airway management, says Hazinski. "In some settings, nurses may now be placing these devices," she reports. "You need to know how to confirm proper placement. Some of these devices can be checked for placement using exhaled CO2, and some cannot."
The guidelines recommend education in alternative techniques, notes Rebecca L. Stark-Johnson, CRNA, APNP, anesthesia manager at Fort Atkinson (WI) Memorial Health Services and a regional faculty instructor for the AHA’s ACLS Program. However, tracheal intubation should be attempted only by providers experienced in this skill, she cautions.
Previously, airway management techniques were considered only within the realm of an advanced life support provider, but now they are included in training of basic life support providers, says Bradley. These providers must now become proficient in airway management and delivery of ventilation via these devices, she advises.
Advanced airway procedures such as endotracheal intubations still are recommended if the rescuer is skilled in performing the procedure, says Bradley. "They must learn to provide ventilation with barrier devices, as
well as ventilations by a bag-valve mask device. This is required for ventilation support for victims of all ages."
The tidal volume of the ventilations has been decreased to prevent complications such as gastric inflation, Bradley reports.
ACLS providers unable to obtain regular field experience with tracheal intubation (six to 12 times per year) should use alternative, noninvasive techniques, says Stark-Johnson. These include the Combitube, laryngeal mask airway, and the pharyngotracheal lumen airway, she says.
5. Sign up for a BLS, ACLS, or PALS course.
The new guidelines are being rolled out by the AHA, reports Bradley. "National faculty have been updated on the science and practice changes," she says. "Throughout the country, conferences are being organized to update regional faculty and instructors teaching these courses."
As of June 2001, all basic and advanced life support courses are required to use the new books and guidelines, but you should enroll in a course now to obtain the updates, urges Hazinski. Before the end of this year, courses will include the current guidelines and recommendations, she notes.
Sources
For more information on the guidelines, contact:
• Darlene Bradley, RN, MSN, MAOM, CCRN, CEN, UCI Medical Center, University of California-Irvine, 101 The City Drive, Route 128, Orange, CA 92868-3298. Telephone: (714) 456-5348. Fax: (714) 456-5390. E-mail: [email protected].
• John M. Field, MD, FACC, FACEP, Pennsylvania State University College of Medicine, Division of Cardiology, 500 University Drive, Hershey, PA 17033. Telephone: (717) 531-1790. Fax: (717) 531-1793. E-mail: [email protected].
• Mary Fran Hazinski, RN, MSN, FAAN, Vanderbilt University Medical Center, 243 Medical Center S., 2100 Pierce Ave., Nashville, TN 37212. Telephone: (615) 936-0194. Fax: (615) 936-0185. E-mail: [email protected].
• Rebecca L. Stark-Johnson, CRNA, APNP, Fort Atkinson Memorial Health Services, 611 Sherman Ave. E., Fort Atkinson, WI 53538. Telephone: (920) 568-5225. Fax: (920) 568-5365. E-mail: [email protected].
Resources
The Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care were published in the Aug. 22 issue of Circulation, the official journal of the American Heart Association (AHA). Reprints are available for $20 plus $7 shipping and handling. The 2000 Handbook of Emergency Cardiovascular Care is available for $10 plus $7 shipping and handling. To order, contact:
• Channing L. Bete, 200 State Road, South Deerfield, MA 01373-0200. Telephone: (800) 611-6083 or (413) 665 7611. Fax: (800) 499-6464 or (413) 665 2671. E-mail: [email protected]. Web site: www.channing-bete.com.
Key changes are outlined on the AHA Web site (www.cpr-ecc.americanheart.org). Click on "What’s New" and "Guidelines Released." The fall 2000 issue of Currents in Emergency Cardiovascular Care contains a 28-page summary of the new guidelines. Individual copies are available for $5, including shipping and handling. To order a copy, contact:
• CurrentsOnLine.com, 27500 Interstate 45 N., Suite 124, Spring, TX 77386-1357. Telephone: (888) 999-4210 or (281) 419-1992. Fax: (281) 419-8238. E-mail: [email protected].
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