I recently went on vacation & was on an airplane. A person on the plane had a seizure & then went into full arrest. There was another RN on the plane with me. We are both ER nurses & ALCS certified. We used a BVM & an AED. We started an IV and gave epi. All supplies were from the plane. My license is in California. We Diverted to Nevada.
Looking back I wonder if I was covered under the good Samaritans law or did I practice outside my state & scope of practice. Technically, although we left California we landed in Nevada so I wasn't in my state. Also, there was no doctor on the flight who gave the epi order.
not necessarily. They may not have a palpable pulse and depending on where you check for a pulse but could still be perfusing.
I would certainly hope that no one would give Epi to a patient in rapid a-fib or SVT because these patients will have a pulse!!!! That would be a seriously bone-head move.
The patient can have an issue without a palpable pulse due to decreased cardiac output from a decrease in stroke volume. Cardioversion would indicated not epinephrine.
As already stated, these patients (afib rvr and svt) would have a pulse. Assess the PATIENT. If you have no apical, carotid or femoral pulses, they need epi.
So are you thinking I can give any medication to any patient anywhere as long as it is prescribed to the patient?
Huh?
I'm sure there are exceptional circumstances, and nobody said anything about giving any medication to any patient anywhere, but within a narrow scope such as assisting a debilitated person to take their own prescribed medication in a situation where in your professional judgement it was both safe and important for them to do so... of course you could. And should! If a little old lady at the grocery store collapsed with chest pain and asked you to help her get one of her prescribed PRN SL nitro under her tongue, would you not do it because it didn't say "to be administered by HHER, RN" on the bottle? What if someone started having an anaphylactic reaction and managed to squeak out that they had an epi pen in their bag before they started to lose their airway, would you withhold that care because it was prescribed to *them*, and tough cookies if they can't self-administer what with all the swelling and dying?
You're held to a higher standard of judgement because of your training and experience, so don't do something you know to be negligent, but for heavens' sake, don't let your training and experience *stop* you from rendering needed aid.
If the AED is one of those used in BLS, that looks like a Fisher Price toy, it will detect a shockable rhythm in a person in cardiac arrest. It does not detect or deliver synch cardioversion.
I want to correct what I wrote yesterday. I would not give an antiarrythmic (lido) without having the ability to see the rhythm. I would definitely give the pressor (epi) as per ACLS.
If the person had severe symptomatic bradycardia with hypotension I would give the Atropine 0.5mg IV in that kit.
The patient can have an issue without a palpable pulse due to decreased cardiac output from a decrease in stroke volume. Cardioversion would indicated not epinephrine.
Unless you're watching Grey's Anatomy, cardioverting asystole won't do a damn thing. And going back to your original point that an AED doesn't tell you what rhythm, just that it's shockable, no one is giving epi if the AED says its delivering a shock. That will occur in VT/VF and may be pulseless. SVT and afib RVR will have a pulse, at the very least apical. Symptomatic bradycardia will also have a pulse, albeit potentially thready. That's why you check more than one place for a pulse. No pulse anywhere, you get the AED on, but you better have someone drawing up the epi, too, if you have the extra hands available to you.
TREAT THE PERSON, NOT THE MACHINES.
I have to ask - are you a nurse, and do you have ACLS certification?
You are not going to perform a head-to-toe assessment because even a physician doesn't perform a head to toe assessment if someone is in full cardiac arrest.
You are not going to be charting on the plane at all. You are going to stay with that passenger.
You give report to the medics when they arrive at the airport and ask them if you need to write anything down...many times it's not needed, they do it for you.
Wow do you carry ACLS flow sheets with you? I am ACLS certified, but haven't used it enough to memorize it, nor would I really want most people working from memory. When I work a code the MD is there by the time we've gotten the crash cart and the patient on the board. I guess we're lucky.
To be fair to rnmaybe, SVTs (which include RVR A-fib) can actually be pulseless and it's not totally unheard of. A pulse refers to a detectable variation in arterial flow, which makes it a term that is variable based on the sensitivity of how your measuring it, where you're measuring it etc. For the purposes of BLS/ACLS we're talking about a palpable carotid pulse, since the lack of one confirms that someone's unconscious state is due to lack of perfusion to the brain which then justifies resuscitation. Whether you can see some slight variability from 0 on an art line which technically is a type of pulse, it's still "pulseless" in the context of ACLS. I've had patients who have both runs of a reentry SVT and VT who have more pulsatility by art line in VT than in SVT.
No one said anything about cardioverting asystole (which is impossible) except yourself. You can't treat a patient properly without the proper tools and cardiac monitor is one of those tools. Please enlighten us on how you palpate your apical pulses?
Unless you're watching Grey's Anatomy, cardioverting asystole won't do a damn thing. And going back to your original point that an AED doesn't tell you what rhythm, just that it's shockable, no one is giving epi if the AED says its delivering a shock. That will occur in VT/VF and may be pulseless. SVT and afib RVR will have a pulse, at the very least apical. Symptomatic bradycardia will also have a pulse, albeit potentially thready. That's why you check more than one place for a pulse. No pulse anywhere, you get the AED on, but you better have someone drawing up the epi, too, if you have the extra hands available to you.
TREAT THE PERSON, NOT THE MACHINES.
I have to ask - are you a nurse, and do you have ACLS certification?
rnmaybe
40 Posts
not necessarily. They may not have a palpable pulse and depending on where you check for a pulse but could still be perfusing.