Immediate Life Support (ILS)- Healthcare

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Course Content

Post CPR

Video 60 of 95
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Let us have a look at what happens after we perform CPR and use the AED. If the AED comes up and says that "No shock advised", we then check for a pulse. We can check a carotid pulse because the carotid pulse will be the first one to come back. Remember, the radial pulse is the last one to come back. So we go for a carotid pulse. And also remember the normal heart rate should be around 60-80 beats a minute. Experience tells us that when a heartbeat comes back, it is normally very vigorous and very strong. You can quite often see rather than feel it, but we need to actually find it. So we have got a carotid heartbeat, so we, now we have got a... The heart is now pumping again.

We now want to check the breathing; 12 to 20 breaths a minute is roughly an average breathing rate. So we want to look at the rise and fall of the chest. Once we are happy that the radial pulse and the carotid pulses are there and we have got breathing coming back in again, we can also put a pulse oximeter onto the finger to see what the oxygen saturations are. And they should start to climb because the patient is now breathing. We will raise the stretcher slightly just to help a little bit of postural draining. So anything that has been regurgitated back into the oesophagus and trachea whilst we have been working drains back into the stomach.

We change the bag and mask because we are not having to breathe for the patient anymore, so we change the bag and mask by taking the pipe off, replacing the pipe onto a mask or a non-rebreather mask and the non-rebreather mask now goes over the patient's face like so. The reason we change it to a non-rebreather is because now the patient is able to breathe on their own, on their own free will. We are not having to force oxygen in anymore, however, if they're not breathing well enough, we can stay with the bag and mask and keep oxygenated and positive pressure ventilation to keep pushing their oxygen saturation up. But if they are back breathing to a normal rate, the colour is coming back and the heart rate is decent, we can convert to a non-rebreather mask.

However, we always leave the defib pads in place and we leave the defib running. The defib will still analyse every two minutes. When it analyses, it should always say, "No shock advised". We should always check for a carotid pulse. The pulse is there, I can see the breathing and the defib is analysing and telling me that there is no shock advised. However, if the heart goes back into a shockable rhythm, the defib will analyse, tell me to perform a shock. If that is the case, the heart has gone into a non-beating rhythm, VF or VT or asystole. We need to then commence CPR and rounds of defibrillation again. So we will go back from the non-rebreather to the bag and mask, and we will start to shock the patient again to try and return the heart back to normal sinus rhythm.