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So now let's talk about the team approach as it relates to CPR for a moment. Now in this case, there are three main takeaways that I would like you to get from this. And that is that it's important to have an established team leader when you have a team approach to any type of life support. That team leader is set up as a director of sorts; and they help orchestrate a very fluid and organized manner of rescue skills and attempts. Number two, that we use great communication skills, which include something called 'closed-loop communication.' Now an example of closed-loop communication would be that the team leader gives a directive to another rescue team member. That rescue team member repeats back that command that they heard and it's established that they understand it and that they're going to execute it. Thirdly, ideally taking notes and logging when we're beginning skills, when we're doing them, and that we understand them correctly. The team leader will also be watching for variations or for quality assurance. Which means if the team leader sees that CPR is not being done correctly, rescue breaths are not being done correctly, or any facet of the rescue at all, that team leader should then encourage through positive notions that the person needs to either increase something or decrease something and help them get back on track. Now lastly, you might notice we're in the back of an ambulance. This ambulance is an advanced cardiac life support ambulance. And we've used a few props to help you have more of a realism to this scenario. But don't be confused by that and we really don't even mean for you to be maybe distracted by it so much. This is about basic life support. So we want you to stay focused on that. With the inclusion of the automated external defibrillator. You may also and lastly notice that we're using a real human patient and therefore full CPR compressions will not be done for obvious reasons. I'm going to go ahead and grab a blood pressure here, sir. So you're going to feel a squeeze on your arm. Speaker 2: Cindy, make sure you're writing down the times and everything please with the vitals and everything. Speaker 3: Writing down the times. Speaker 1: How long have you been feeling this chest pain? Did it just come on this morning? Or what? Can you tell me? I mean has it been happening for a while? Sir? Can you hear me? Speaker 2: Just a minute here, let me check. Sir, sir? Are you okay? You alright? I'm not getting a response. He's not breathing. Speaker 1: No, I didn't get a blood pressure either and I don't have a radio pulse. Speaker 2: Eyes look clouded. Would you go ahead and bare his chest and start CPR, please? Cindy, could you go ahead and write the time down on CPR? Speaker 3: Write the time down. Speaker 1: CPR beginning at 12:51. Speaker 2: Okay. Cindy would you also go ahead and get the AED prepared and ready to use? Speaker 3: I'll get the AED ready. Speaker 2: The action ready to go. Speaker 1: fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty-one, twenty- two, twenty-three, twenty-four, twenty-five, twenty-six, twenty-seven, twenty-eight, twenty- nine, thirty. Speaker 2: Breaths. Breathe. Speaker 1: Good breath in. Chest rise. Speaker 2: Continue. Speaker 1: One, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty- one, twenty-two, twenty-three, twenty-four, twenty-five, twenty-six, twenty-seven, twenty- eight, twenty-nine, thirty. Speaker 2: Breaths go in. breaths rise. Kay, clear. Speaker 3: Clear. Speaker 1: Clear. Speaker 3: Everyone clear. Speaker 1: Clear. Speaker 2: Back to it please. Speaker 1: Okay. First shock delivered at 12:52. Speaker 2: Okay, Cindy, you got that? Speaker 3: I got that. 12:52. Speaker 1: Six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty-one, twenty- two, twenty-three, twenty-four, twenty-five, twenty-six, twenty-seven, twenty-eight, twenty- nine, thirty. Speaker 2: Breaths going in. Speaker 1: Good chest rise and fall. Speaker 2: Second breath. Speaker 1: Good chest rise and fall. Speaker 2: Continue. Speaker 1: Three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty-one, twenty-two, twenty-three, twenty- four, twenty-five, twenty-six, twenty-seven, twenty-eight, twenty-nine, thirty. Speaker 2: Okay. Breaths going in. Speaker 1: Good chest rise and fall. Good chest rise and fall. Speaker 2: Continue. Speaker 1: Four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty-one, twenty- two, twenty-three, twenty-four, twenty-five, twenty-six, twenty-seven, twenty-eight, twenty- nine, thirty. Speaker 2: Okay. Breath in. Speaker 1: One breath in. Good chest rise and fall. Speaker 2: We got about another minute right here. After the two minute mark, I'd like to go ahead and call for a switch so Cindy can take over please. Speaker 1: Switch after two minutes. Seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty-one, twenty-two, twenty-three, twenty four, twenty-five, twenty-six, twenty-seven, twenty-eight, twenty-nine, thirty. Speaker 2: Breaths go in. Speaker 1: Good chest rise and fall. Good chest rise and fall. Seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty-one, twenty-two, twenty-three, twenty-four, twenty-five, twenty- six, twenty-seven, twenty-eight, twenty-nine, thirty. Speaker 2: Breaths going in. Speaker 1: Good chest rise and fall. Good chest rise and fall. Four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty-one, twenty-two, twenty-three, twenty- four, twenty-five, twenty-six, twenty-seven, twenty-eight, twenty-nine, thirty. Speaker 2: Let's all stand clear. Speaker 3: Clear. Speaker 1: Clear. Speaker 3: Everyone clear. Speaker 1: Clear. Speaker 2: Cindy go ahead and take over compressions. Would you go and get the I.V. established? Speaker 1: Yep. Speaker 3: One, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty-one, twenty-two, twenty-three, twenty-four, twenty-five, twenty- six, twenty-seven, twenty-eight, twenty-nine, thirty. Speaker 2: And the breaths. Speaker 3: Good chest rise and fall. Good chest rise and fall. Speaker 2: Continue. Speaker 3: One, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty-one, twenty-two, twenty-three, twenty-four, twenty-five, twenty-six, twenty- seven, twenty-eight, twenty-nine, thirty. Speaker 2: Breaths. Speaker 1: I.V. is established and patent. Speaker 3: Good chest rise. Good chest rise and fall. Speaker 2: Continue please. Speaker 3: One, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty-one, twenty-two, twenty-three, twenty-four, twenty-five, twenty six, twenty-seven, twenty-eight, twenty-nine, thirty. Speaker 2: Just going to start our first dose of epi please. Speaker 1: First dose of epi. What dosage? Speaker 2: Go ahead and do one milligram I.V. push. Speaker 1: One milligram. I.V. push. Speaker 1: We hope that this scenario helps. And we know that understanding a good team approach to CPR encourages great practices which leads to more lives saved.
This lesson focuses on the team approach to CPR when three or more responders or healthcare professionals are involved.
There are three main takeaways from this section:
The team leader is orchestrating the actions of the other team members – who is doing what and when – but also monitoring the others for quality assurance. If the team leader sees that something is being done incorrectly or could be improved upon, it's his or her job to point out the intended improvement or change in rescue care and encourage that team member through positive reinforcement.
Begins performing the correct number of chest compressions based on the size of the patient and counting out loud.
Takes a position at the victim's head and readies the bag valve mask for use, performing two rescue breaths after a round of compressions have been completed and making sure that the chest rises and falls each time.
Takes notes of responder one and two's actions and times of each action. Responder three will also assist in some other aspect of care, if needed, including getting the AED ready. Responder three is also ready to jump in elsewhere when the switch occurs – when the compressor's two minutes are up and responder one switches places with responder two or three.
All three responders are communicating all vital information to the rest of the team while they work. The team leader will indicate when a switch is about to occur, who is taking over for whom, if an IV should be established, what drugs will go into the IV, as well as dosages, and other important information and directives.
A good team approach is vital in a rescue situation. It ensures that everyone is doing his or her job to the highest standards of care. In short, good practices and habits in a team approach leads to more saved lives.
If a patient has an advanced airway such as a supraglottic airway device or an endotracheal tube, CPR will be performed a little differently.
A supraglottic airway device, which allows for improved ventilation, is an advanced airway that does not enter and directly protect the trachea like an endotracheal tube. When using a supraglottic airway device, like a laryngeal mask airway, a minimum of two responders must be present.
Responder one provides one ventilation every six seconds, which is about 10 ventilations per minute. At the same time, responder two is performing compressions at the normal rate of between 100 and 120 compressions per minute. It's important to note that there is no pause between compressions or ventilations, and responders do not use the standard 30:2 compressions to ventilations ratio.
Advanced airway devices provide a continuous delivery of compressions and ventilations without any interruptions.