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.
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.
Most unit nurses are going to have ACLS algorithms memorized. I don't understand the point of being ACLS certified if you don't have it memorized. Isn't the certification so you can take action during an emergency of a provider isn't
And if the patient is in rapid a-fib or SVT and you give epinephrine you have just killed the patient. The monitor is a tool to guide your assessment.
These are both rhythms with pulses- the OP states the patient was in a cardiac arrest, which I take to mean pulseless. Those rhythms are VT, VF, asystole, and PEA. Epi is indicated for all of those rhythms.
Also, I wonder what kind of documentation is required? It just wouldn't feel right not to chart a head to toe assessment and then fill out 3 or 4 different forms that all say the same thing. And who I gave report to once the airplane landed.
I'm more than confident that the airplane would have paperwork for you to fill out and that both the ambulance crew and hospital ED team would be interested in hearing some form of report.
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.
Epi q3-5 minutes. Remember high quality CPR- rate at least 100, sufficient chest compression, full recoil, switching compressors, interrupting compressions for less than 10 seconds. IV access. IO if that fails.
Adenosine 6mg then 12mg for SVT after failed valsava maneuvers. Synchronized cardioversion for unstable tachyarrythmias.
Atropine for bradycardia. Pacing for unstable bradycardia.
Bolus the patient, start an antiarrythmic drip, and cool them when you get them back.
I am an RRT, RN, and Flight Attendant. Many registered nurses are going into the flight attendant field since safety has superceeded the "waitress" reputation. Flight Attendant training is extremely intense in the areas of first aid and treating traumatic injuries as Boy Scouts would treat an emergency injury.
As far as the medical kit, the Pilot In Command calls all the shots as to who can use it. It's designed for practitioners, but if a flight attendant is also a nurse who is current on ACLS, well there is standing protocol. I worked as a flight RRT for years and we had standing orders and protocol to follow.
Flight Attendants are allowed to administer O2 via nasal cannula and NRB masks when someone is having chest pain, breathing trouble other than hyperventilation or panic, and O2 is also a physician's order. Keep in mind that no one has ever died on an airplane. Why? Because a doctor must be present to pronounce, therefore, the passenger isn't dead until you find one. So I would think it would be more risk of you start CPR then decide to stop CPR. As a flight attendant we are trained to not stop administering CPR until paramedics reach the plane once we have landed. If you stop, then you have determined the patient has died and that might be out of the scope, not sure. I have administered Epi as an RRT in an emergency, but I've also administered as a mother of a child with wasp allergies. RRTs typically do not administer meds during a code, but they may is ACLS.....only the meds in the crash box. Please keep us posted on any info you find out, so that all of us practice and protect our RN licenses!
My biggest concern was at the beginning of the thread. If you do not know the difference between 1:10,000 and 1:1000 epi by quickly looking at it... and know that they are 1 MG just 1 to 10000 is diluted in 10cc ns . I would rather you just do cpr. You should just do cpr/aed. If you pushed 1 to 1000 iv and my family member died...
Specializes in Complex pedi to LTC/SA & now a manager.
I am an RRT, RN, and Flight Attendant. Many registered nurses are going into the flight attendant field since safety has superceeded the "waitress" reputation. Flight Attendant training is extremely intense in the areas of first aid and treating traumatic injuries as Boy Scouts would treat an emergency injury.
As far as the medical kit, the Pilot In Command calls all the shots as to who can use it. It's designed for practitioners, but if a flight attendant is also a nurse who is current on ACLS, well there is standing protocol. I worked as a flight RRT for years and we had standing orders and protocol to follow.
Flight Attendants are allowed to administer O2 via nasal cannula and NRB masks when someone is having chest pain, breathing trouble other than hyperventilation or panic, and O2 is also a physician's order. Keep in mind that no one has ever died on an airplane. Why? Because a doctor must be present to pronounce, therefore, the passenger isn't dead until you find one. So I would think it would be more risk of you start CPR then decide to stop CPR. As a flight attendant we are trained to not stop administering CPR until paramedics reach the plane once we have landed. If you stop, then you have determined the patient has died and that might be out of the scope, not sure. I have administered Epi as an RRT in an emergency, but I've also administered as a mother of a child with wasp allergies. RRTs typically do not administer meds during a code, but they may is ACLS.....only the meds in the crash box. Please keep us posted on any info you find out, so that all of us practice and protect our RN licenses!
One universal reason to stop CPR, and not only to declare death, is if the rescuer(s) fatigued and can no longer effectively perform chest compressions with the caveat no other able bodied (and willing) person is able to take over. Fatiguing yourself to the point of injury is a greater risk than stopping CPR on a pulseless apneic human. Usually there is more than one CPR crew member and perhaps passengers willing to continue compressions until the plane lands and EMS takes over.
Unfortunately until the organizations that make these educational programs like TNCC, ACLS, PALS, ATLS & BTLS do not authorize under the license of a doctor to perform the procedures trained during the certification. Example of a tension Pneumo treatment of needle decompression emergently. IV/IO and O2 are simple procedures that are not outside the scope but require an order or protocol even though we do them regularly. What was done was probably appropriate and even if it wasn't 100% correct - you can't kill a dead person. How bout these organizations that provide certificates back them with protocols for procedures to be added to any medical certified profesional willing to perform from protocols emergently. How many medics coming back from service are better than doctors at placing central lines, IO or intubating. Let's use our resources and let the boards of states do something more than just look at professionals with drug issues. Let them decide what is right and wrong as outcomes are changed because medical professionals are getting involved with seriously basic first aid equipment. How many Astmatics or allergic reaction outcomes could be changed because a nurse or EMT gave Epi or albuterol? Awesome job!!!
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Most unit nurses are going to have ACLS algorithms memorized. I don't understand the point of being ACLS certified if you don't have it memorized. Isn't the certification so you can take action during an emergency of a provider isn't
present?