‘Your patient is in cardiac arrest: Step 1, leave the room’ – Nursing Times

Nursing in the Covid-19 pandemic: notes by a trauma nurse at a London Level 1 Trauma Centre (blog first published on 29 March 2020)

Covid19 Nursing

This week the medical and nursing staff on my unit had a joint training session run by an ICU registrar on what to do if your Covid-19 patient has a cardiac arrest.

Step 1, leave the room.

Confused? So were we. The problem is that CPR is considered an aerosolising procedure, as discussed in aprevious post. Aerosolising procedures require different PPE to regular patient contact.

This means that when a Covid-19 patients heart has stopped, whoever has witnessed this must immediately leave the room, shout for help,doff the PPEthey have on, wash their hands and then don PPE appropriate for CPR.

What should you do if your Covid-19 patient has ST-elevation on their ECG and you think theyre having an MI? You LEAVE THE ROOM because if theyre about to arrest you will potentially need to perform CPR.

Aerosolising procedures require different PPE to regular patient contact

We were taught a phrase in nursing school, time is myocardium. The longer you take to treat someone having a heart attack, the more heart muscle dies. Delays in CPR are even worse.

Medical literature shows us that if CPR is delayed by more than six minutes that person will have irreversible hypoxia.

Nurses with lots more experience say in reality its four minutes, whereas one neurology registrar once said to me unless you see me arrest and theres a crash trolley next to me, dont bother.

The registrar running this session has our own health and safety in mind. We were told that under no circumstances were we to perform chest compressions until we have PPE that would conform to aerosolising procedures. This goes against everything we have previously been taught.

When a member of staff asked the inevitable question: Why not just make everyone wear the more effective PPE at all times, so that we can immediately start CPR?.

We were told there wasnt enough to go around. Its very likely that delays like this will cost patients their lives.

Porters and domestic staff who are essential to the running of a hospital, but are obviously at far less risk than clinical staff, are routinely wearing more effective PPE than us.

We dont know how this is possible, but its happening. It may be that because they work for a private company they have access to different supply chains, or it may be that because they have access to many different areas of the hospital they are able to pinch PPE for themselves.

Clinical staff who have close patient contact are the ones that need to be scared

Its irritating, but if the latter is to be the case, I cant say that I blame them. Theyre scared.

But they dont need to be, clinical staff who have close patient contact are the ones that need to be scared.

On one of my shifts this week, a woman who was admitted with fractured ribs after falling down her stairs went into respiratory failure and we thought she was nearing arespiratory arrest.

We got her breathing properly again, but not before inserting multiple cannulas, giving nebulisers, inserting anasopharyngeal airwayand performing suctioning.

All without any PPE. When I came into work two days later I was told she was Covid-19 positive and had been moved to another ward.

None of the staff involved in the respiratory arrest call were informed of our potential exposure and none of us will be tested. The only reason I know is because I asked a colleague how the patient was doing.

The PPE guidance from the NHS is unclear and the guidance from my hospital is unclear. When we turn on the news, we see staff in other countries in full PPE at all times, regardless of the patients status.

I see more effective masks when I walk past nail salons. We are wearing aprons that look like theyre designed for dinner ladies. And eye protection? Whats that?

Nursing Timesis publishing blogs written byCovid19 Nursing,a trauma nurse at a London Level 1 Trauma Centre. Find out more at theirblog siteand follow them on Twitter@Covid19Nursing

Originally posted here:
'Your patient is in cardiac arrest: Step 1, leave the room' - Nursing Times