COVID-19 outbreak has changed the norm in most aspects of human life. The coronavirus which started with just a few cases has now affected millions leaving over one million others dead. Researchers and health practitioners across the world have since the outbreak embarked on research on how to stop the spread of the virus.
Cases of the virus are still on the rise and anyone could be infected. Owing to the nature of their we work, healthcare workers are at a higher risk of infection. Statistics by the world health organization (WHO) show that about 12% of the total COVID-19 infections are healthcare workers. It becomes critical for these persons to take utmost precautions to avoid possible exposure to the virus. Relaxation of these measures could be a loss to the fight against the virus that has brought the world to a stand-still.
What You Need to Know About the Transmission of COVID-19?
COVID-19 virus results from SARS-CoV-2 virus and is easily transmitted among people in close contact through sneezing, coughing, talking, singing and breathing. The transmission is through aerosol, and respiratory droplet particles released from infected persons.
The virus entry points are mucosal cavities such as the mouth, nose and eyes. Infection is likely to occur when persons are in close contact of one meter. An infected person can infect as many people as they come into contact with, and these infections are also more likely to occur in crowded places where people spend a lot of time. Also important to note is that the virus has half-life of one hour during which it remains suspended in air with a likelihood of causing infection. Whenever an infected person coughs, they release the virus particles that remain suspended in air. These virus particles can land on surfaces and stay active for days. Anyone who touches infected surface can transfer the virus to their mouth, eyes and nose.
Infected persons can have symptoms, but in most cases those infected don’t show these symptoms. However, whether symptomatic or asymptomatic, they can infect others. The most common symptoms of COVID-19 patients include fever, feeling of tiredness and dry cough. Other less common symptoms include rash and discoloration of toes and fingers, loss of smell, headache, loss of appetite, conjunctivitis, diarrhea, sore throat and pains. Some patients who develop severe symptoms experience shortness of breath, difficult breathing, inability to talk or move and chest pain or chest pressure. From the time of infection, victims take between six and fourteen days to show symptoms.
Precautions When Giving CPR
CPR is a critical lifesaving procedure for cardiac arrest victims. It is, however, high aerosol generating and can put first aid responders and health workers at a high risk of infection. There are certain factors that place healthcare workers and rescuers at a high risk of infection:
- CPR involves teams working closely together
- The procedure is high aerosol generating
- Cardiac arrest exerts a lot of pressure on those involved and could lead to compromise to recommended standards
Covid-19 patients commonly develop cardiopulmonary arrest and cardiorespiratory problems. In these cases, the victim requires basic life support and advanced life support. The decision whether or not to provide CPR is dependent on certain factors which determine the chances of survival of the victim such as the age of the victim, and underlying illnesses and health conditions.
Guidelines for Performing CPR to COVID-19 Patients:
It is important to ensure the safety of the rescuer while providing utmost care to the victim. The American heart association alongside other bodies have provided a set of guidelines when performing CPR to Covid-19 victims:
- With the prevalence of COVID-19, health workers are reluctant to provide CPR to cardiac arrest victims. However, it is important to note that not every cardiac arrest victim is infected with Covid-19.
- For basic life support, prioritize hands only CPR – Hands only CPR is safer. However, health workers should wear full PPE (personal protective equipment).
- When performing CPR, first cover the victims mouth and nose with a piece of cloth or towel. In hospitalized care, Covid-19 patients who experience cardiac arrest should be resuscitated and defibrillated.
- Use the AED as soon as it is available to improve the outcome. Studies show that the AED doesn’t increase aerosol generation.
- Don’t leave anything at risk with the use of personal protective equipment. PPE is critical for health workers or rescuers taking care of COVID-19 patients. Before accessing the scene, all rescuers should wear the recommended PPE as per the institutional guidelines. These include: gowns, gloves, eye protection and respirators
- Mechanical CPR devices should be used in place of manual devices as this will reduce the number of professionals required on attending to a specific patient.
- The healthcare workers performing resuscitation procedures should be minimized as well as those entering isolation rooms. It helps in the reduction of the rate of exposure to the virus.
- The AHA recommends that doors remain closed during resuscitation to minimize the spread of the virus to the surrounding space.
- New healthcare workers arriving at the scene should be made aware of the Covid-19 status of the victim. The communication should be made to all health workers working in the facility. When calling for emergency response teams, the responder should also notify them if the patient has been found to have the infection.
- To reduce aerosolizing effects, intubated patients should remain in mechanical ventilators with high efficiency particulate air filter (HEPA). It helps reduce the effects of aerosolization and maintain a closed circuit.
- The ventilation should be adjusted to pressure control mode. The fraction of inspired oxygen (FiO2) should also be adjusted to 0.1. The pressure should also be adjusted to allow for the necessary chest rise, adults to 6Ml/kg and 4-6Ml/kg for neonatal.
- Intubation procedures are highly aerosol generating. It is therefore recommended that the health care provider uses a cuffed endotracheal tube connected to a ventilator with a HEPA filter in the exhaled gas path and inline suction catheter. The resulting circuit is safer and less likely to generate aerosol.
To achieve this you need to:
- Ensure to the HEPA filter is secured to the ventilation see device before the administration of breaths.
- After the assessment of rhythm and defibrillation, the patient should be immediately intubated with a cuffed tube and the endotracheal tube attached to a ventilator with a HEPA filter.
- Video laryngoscopy reduces the exposure of aerolized particles to the incubator.
- Before intubation, consider a T piece in neonates or a bag mask device with a tight seal and HEPA filter. For adults use passive oxygenation and non breathing mask protected by a surgical mask.
- In case of delayed intubation, use manual ventilation with a bag mask and HEPA filter or a supraglottic airway.
- Minimize disconnections once the circuit is closed to reduce aerolization.
The decision making process
The decision to continue or stop resuscitation is not an easy one. At some point, healthcare workers have to make this critical decision. A lot team work is required in the CPR procedure. A single case of CPR might draw attention from other patients. Coronavirus pandemic has increased the need for CPR stretching health facilities and healthcare workers beyond their capacity. The rates of deaths due to the illnesses are on the rise, and some risk factors are based on age and comorbidity. Healthcare workers should assess the chances of survival of the victim as they try to determine whether or not to continue the resuscitation process.
It is important to address the needs of care with the patient and family. Institutions should provide guidelines and procedures to assist healthcare workers decide when to stop resuscitation for COVID-19 patients. The policies should be based on the risk factors and the chances of survival, and should be communicated to the victim’s family beforehand.
Covid-19 has increased the need for CPR certification. Statistics show that the number of CPR certified persons is way below the recommended number. Whenever a case of cardiac arrest occurs, the chance of survival of the victim depends on the availability of a CPR certified person. CPR training is available in online platforms whereby various accredited institutions provide the certification course. Cardiac arrest can occur anywhere and to anyone. With CPR skills you become an asset to your family, colleagues and strangers.
CPR classes are the best way to acquire CPR skills. Without the necessary training, it would be difficult to pull together the necessary confidence to save a life. The quality of CPR provided determines the chances of survival of the victim. CPR classes also provide knowledge on how to recognize the signs of cardiac arrest early enough to provide the required assistance and save the victims life. Most organizations require CPR certification especially during this COVID-19 pandemic. CPR skills are not only basic for healthcare workers but also other professions. The skills applies in CPR are easy to follow even for non professionals. The training is also open for anyone interested to join regardless of their levels of education and age.
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