What is the teaching on cardiac resuscitation in a care setting

[anamazingfind]

My brother has recently started work in a care home. Not nursing, but supporting mentally vulnerable adults in a residential setting. Not medically trained and the clients are not medically vulnerable. One of the clients has a cardiac history and he is concerned about if he collapses and has a cardiac arrest. He will ask his supervisor what to do but he's asked me as I am a nurse. I said it's a different situation from hospitals, and I think you do not do any kind of mouth to mouth any more unless you have ambu bags and airways and so on. I'm not sure though as it's community and quite different.

Anyone have any community training or similar residential home care training?

Hi I work in a nursing home and due to covid restrictions we are not doing mouth to mouth resuscitation as it’s AGP. We do have ambu bag but can only use if wearing FFP3 and have been fit tested. More important to try and get effective chest compressions.

Mouth-to-mouth has been unfashionable in adult resus for some time (paed resus is slightly different) but is still taught as, in the out of hospital BLS scenario, a lay person is most likely to be resuscitating a loved one and may be more prepared to do it (it’s generally gross though and probably doesn’t often help). In an ambulatory adult with cardiac disease (or even without) the likely cause of cardiac arrest is going to be a heart problem rather than an oxygenation problem and for that reason emphasis seems to be slowly shifting towards prioritising chest compressions above ventilation at least in the first few minutes.

In ‘normal times’ chest compression only CPR with the airway held patent is what’s mainly taught for BLS (and is what I’d do and I suspect actually provides a better combination of gas exchange and cardiac resus), with the addition of an ambubag/OPA of available, however currently there is obvious concern re the possibility of aerosol generation.

In-hospital guidance is that currently we shouldn’t start cpr at all without level 2 protection and shouldn’t do AGPs (including BMV) unless fully donned, but in reality I don’t think I know anyone who’d feel comfortable delaying the onset of resus to get properly donned. Out-of-hospital I believe the resus council advice is to start chest compressions and put a cloth over the customers mouth & nose (!) until better protection arrives.

For your brother, the care home will (/should!) have very well defined resus protocols and he should follow those should the scenario arise (knowing that whatever he does, the outcome from cardiac arrest is still generally poor and doing anything is better than doing nothing because your so worried about doing the wrong thing). Hope that helps.

Get him to download the iresus app and take a look at the Adult BLS and Adult choking. The flow charts are excellent.

Thank you so much everyone! He did BLS pre covid and they had a plastic thing over the mouth, but I told him not to do this. Just check and clear the airway and get a colleague to hold the airway open at the chin, and just do chest compressions until an ambulance arrives. I'll go over it again with him, but was really unsure of myself as I know this changes all the time, and its treated as a community arrest, not the same as hospitals and nursing homes, especially with Covid.

I'll get him to get the Iresus app too xx

I will also get on his back to get his Covid jab and stop fannying around!

I'm a nurse in a care home and it's compressions only. Usually it's the nurse who starts it and an experienced carer will take turns with me, while someone else calls 999.

I don't work in a care home but am first aid trained for work. We're taught chest compressions only.

Thank you xxx