Handling Cardiac Shock Emergencies in the Sterile Processing Department: A Practical Guide for SPD Educators

 

 

Martin Li, M.A., CRCST, CER, CIS, CHL

Why I Write This Article?

This article is inspired by a traumatic incident I witnessed in the workplace, where a staff member experienced cardiac shock and collapsed. The event profoundly impacted me, highlighting the critical importance of effective leadership and preparedness in healthcare settings. Through this article, I aim to advocate for leadership styles that foster a supportive and empowered work environment, ultimately ensuring the safety and well-being of all staff members.

Introduction: BLS, CPR, and AED 

Cardiac emergencies can occur unexpectedly in any healthcare setting, including the Sterile Processing Department (SPD). As SPD educators, it is imperative to equip staff with the knowledge and skills necessary to respond effectively to such emergencies. This article focuses on the basic knowledge and essential practices of Basic Life Support (BLS), Cardiopulmonary Resuscitation (CPR), and Automated External Defibrillator (AED) usage in handling cardiac shock scenarios in the SPD, for general educational purposes.

Understanding Cardiac Shock

Cardiac shock, also known as cardiogenic shock, occurs when the heart suddenly can't pump enough blood to meet the body's needs. Symptoms of cardiogenic shock include:

·         Rapid breathing.

·         Extreme shortness of breath.

·         Sudden, rapid heartbeat known as tachycardia.

·         Losing consciousness.

·         Weak pulse.

·         Low blood pressure or hypotension.

·         Sweating.

·         Pale skin.

It is a life-threatening condition that requires immediate intervention. In an SPD, where the focus is often on maintaining sterile environments and processing medical instruments, the sudden onset of cardiac shock can be overwhelming.

Basic Life Support (BLS)

BLS is a critical component of the emergency response to cardiac shock. It involves recognizing the emergency, activating the emergency response system, and performing CPR until advanced care arrives. SPD staff should be trained to:

1. Recognize Cardiac Emergencies: Early recognition of symptoms such as chest pain, shortness of breath, and loss of consciousness is crucial.
2. Activate Emergency Response: Immediately call for help and ensure that emergency medical services (EMS) are on their way.
3. Perform High-Quality CPR: Begin chest compressions at a rate of 100-120 compressions per minute, ensuring full chest recoil after each compression.

Cardiopulmonary Resuscitation (CPR)

CPR is a lifesaving technique that is essential in the event of cardiac shock. High-quality CPR maintains circulation and oxygenation until advanced care can take over. The key components of effective CPR include:

1. Chest Compressions: Push hard and fast in the center of the chest, allowing for complete chest recoil between compressions.
2. Rescue Breaths: Provide rescue breaths after every 30 compressions, ensuring the airway is open and breaths make the chest rise .
3. Minimize Interruptions: Avoid unnecessary interruptions in chest compressions to maximize perfusion to the heart and brain.

Five Key tips

Source: 5 Key Tips for Performing CPR on Adults Effectively (mycprcertificationonline.com)

 

Automated External Defibrillator (AED)

The use of an AED can significantly increase the chances of survival during a cardiac emergency. AEDs are designed to be user-friendly and provide step-by-step instructions. Key steps include:

1. Turn on the AED: Follow the device's audio and visual prompts.
2. Apply the Pads: Place the pads on the patient's bare chest as shown in the diagrams on the AED.
3. Analyze the Heart Rhythm: Ensure no one is touching the patient while the AED analyzes the heart rhythm.
4. Deliver a Shock if Advised: If a shock is advised, ensure everyone is clear of the patient and press the shock button.

Following is AED Protocal Chart, Source: https://www.azdhs.gov/

 

Following is Pad placement for defibrillation

Source: Cheskes S, Verbeek PR, Drennan IR, et al. Defibrillation strategies for refractory ventricular fibrillation. N Engl J Med 2022; 387:1947. Copyright © 2022 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society. Graphic 103268 Version 3.0 © 2024 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Note: Vector change defibrillation consists of altering the direction of the vector. In clinical practice, this typically means moving the electrode pads from their standard position to an anterior-posterior position, as shown above. Double sequential external defibrillation (DSED) consists of rapid sequential shocks from 2 defibrillators. DSED: double sequential external defibrillation; VC: vector change.

SPD educators should ensure that all staff are familiar with the location and operation of AEDs within their department.

Training and Drills

Regular training and emergency drills are vital in preparing SPD staff for cardiac emergencies. These drills should simulate real-life scenarios to build confidence and competence in handling such situations. Training should include:

1. Hands-On Practice: Regular hands-on practice sessions for CPR and AED usage.
2. Scenario-Based Drills: Simulations that mimic potential cardiac emergencies within the SPD.
3. Review and Feedback: Post-drill reviews to identify strengths and areas for improvement.

Following is the comprehensive Guide chart by American Heart Association CPR & First Aid

 

 

Following is a simplified chart from Source https://www.uptodate.com/ 

Source: Advanced cardiac life support (ACLS) in adults - UpToDate https://www.uptodate.com/ 

 

Conclusion

In conclusion, handling cardiac shock emergencies in the SPD requires a well-prepared and trained team. As SPD educators, it is our responsibility to ensure that staff are equipped with the skills and knowledge to perform BLS, use AEDs effectively, and administer high-quality CPR. By fostering a culture of preparedness and continuous learning, we can improve the chances of survival for patients experiencing cardiac emergencies.

References:

1. American Heart Association. (2023). "Cardiogenic Shock." Retrieved from https://www.heart.org/
2. Jacob C Jentzer 1, David A Baran 2 “The changing face of cardiogenic shock: definitions, epidemiology, and severity assessment.” Retrieved from https://pubmed.ncbi.nlm.nih.gov/

3. National Institute of Health. (2022). "Basic Life Support (BLS)." Retrieved from https://www.ncbi.nlm.nih.gov/
4. WebMD. (2023). "Signs and Symptoms of Cardiac Shock." Retrieved from https://www.webmd.com/  
5. Red Cross. (2023). "Activating Emergency Response Systems." Retrieved from https://cpr.heart.org/
6. American Heart Association. (2022). "CPR Guidelines." Retrieved from https://cpr.heart.org/
7. Healthline. (2023). "How AEDs Save Lives." Retrieved from https://www.healthline.com/health/
8. British Heart Foundation. (2023). "Using an AED." Retrieved from https://www.resus.org.uk/
9. Cleveland Clinic. (2023). "CPR Techniques." Retrieved from https://health.clevelandclinic.org/
10. Johns Hopkins Medicine. (2023). "Rescue Breaths in CPR." Retrieved from https://johnshopkinshealthcare.staywellsolutionsonline.com/Conditions/Heart/1,4542
11. Journal of Emergency Nursing. (2023). "The Importance of Emergency Drills." Retrieved from https://www.researchgate.net/
12. Mayo Clinic. (2023) “When do you need AED?” retrieved from https://www.mayoclinic.org/
13. Uptodate (2023) “Advanced cardiac life support (ACLS) in adults” retrieved from https://www.uptodate.com/