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8/14/2019 Therapeutic Procedures 3853
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THERAPEUTIC
PROCEDURES
SELECTED TOPICS ON
COMMON NURSINGPROCEDURES
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UNIVERSAL PRECAUTIONS
HANDWASHING
BARRIER METHOD
STERILIZATION AND DISINFECTION IMMUNIZATION
ENVIRONMENTAL CONTROL AND
SANITATION ISOLATION
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THERAPEUTIC EXERCISES
ISOMETRIC
ISOTONIC
ROM
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CHEST PHYSIOTHERAPY
BREATHING
COUGHING\POSTURAL DRAINANGE
PERCUSSION AND VIBRATION INCENTIVE SPIROMETER
SUCTIONING
TRACHEOSTOMY CARE
OXYGEN THERAPY
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Chest Physiotherapy It is the combination of percussion, vibration, and
postural drainage Percussion is done for 1-2 minutes. If the patient has
tenacious secretions, this can be performed for 3-5minutes
Vibration is done during 5 exhalations Postural drainage is done for 15-20 minutes usually
performed 3-4 times a day. Instruct the client to increase fluid intake to liquefy
secretions This procedure should not be performed in clients
who are pregnant, with chest injuries, dizzy, withpulmonary embolism and abdominal surgery.
This procedure is done before meal or 90 minutesafter a meal
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Oxygen Therapy Indicated to clients who needs additional
oxygen, those clients who have reduced lung
diffusion of oxygen through the respiratorymembrane, heart failure leading toinadequate transport of oxygen.
Humidify the oxygen first before you
administer. Check for bubbles in the humidifier topromote adequate flow of oxygen
Check for kinks in the tubing
Position: semi-fowlers/ high fowlers position Place cautionary readings: “NO smoking:
Oxygen is in used” Instruct the client not to use woolen blankets
as this may create static electricity
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pulmonary function tests
tidal volume- 500 residual volume- 1200 expiratory reserve volume –1200
inspiratory reserve volume – 3100
Vital Capacity- tidal volume + IRV + ERV =
4800 Total Lung Capacity – Tidal Volume + IRV
+ERV +RV =6000 Forced Residual Capacity – ERV + RV
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incentive spirometry – hold 2-6 sec; 4-5
times/H
endotracheal tube- reposition Q8H; cuff 20mm Hg, humidification and aerosol, deflate
cuff occasionaly
visualization – X ray
Lung Scxan – 20-40mins isotopes in body for 8 H
laryngoscopy
Bronchoscopy Thoracentesis- consent, VS and baseline X-ray +
post Procedural
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Tracheostomy Care
tie new trache tie before removing theold tie to prevent accidentaldislodgement
use precut gauze and perform care ODat least.
soak iiner cannula in antiseptic soak
with hydrogen peroxide, rinse wellsuction prn, oral care prn
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Oxygen Delivery Equipment
cannula – 2-6 LPM – 24-45% Mask – 5-8 LPM – 40-60% parial rebreather – 6-10 LPM – 60-90%
non rebreather – 10-15 LPM – 95-100% tent – 4-8 LPM – 30-50 % Venturi mask –
2-3 LPM – 24-28% 4 LPM – 30% 6 LPM – 35% 8 LPM – 45%
14LPM – 55%
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Suctioning PURPOSE: To obtain sputum sample. NURSING ALERT:
Hyperoxygenate the patient before and after the procedure. Apply intermittent suction on withdrawal of the catheter. Do not suction the patient for more than 15 seconds. Thoracentesis PURPOSE: Aspiration of fluid and /or air from the pleural space. NURSING ALERT:
Check the consent. Position: Sitting on the side of the bed with feet on a chair, leaning
over a bedside table. If the patient unable to sit, the patient may lie inhis/her side with hands on the side resting on opposite shoulder.
Instruct the patient not to cough, breath deeply or move duringthe procedure.
After the procedure: Position the patient on the unaffected
side/puncture site up. Check for bleeding at the puncture site and monitor the
respiratory function. Notify the physician if signs of pneumothorax, air embolism and
pulmonary edema occur.
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ENEMA
They act by distending the intestines that
increases peristalsis and expulsion of feces
and flatus. Enemas serve the following purpose:
Relief of constipation
Relief of flatulence
Lowers down body temperature
Evacuates feces in preparation for diagnostic
procedures
Administration of medications
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ENEMA
Take note of the general principles of Enema: Tube: lubricate and insert 3-4 inches Position: adult- left lateral; infants and
children- dorsal recumbent Administration- administer the enema in a
minimum of 15 minutes duration. Conatainer’s Height- 12 inches above the
rectum Temperature- 42°C or less
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types: carminative – expel flatus – 60 –180 ml. retention oil – 1 –3 hours(LUBRICANTS) BULK FORMERS-METAMUCIL-12 HOURS-INC.OFI wetting/stool softeners- Colace(days) Chemical hypertonic irritant-increases peristalsis-
castor oil, Bisacodyl, Cascara)-SUPPOSITORIES-30
MIN Saline- Epson salts, milk of mg(rapid)/mg citrate return flow – haris flushing , colon irrigation fleet – commercial
oil 1-3 H retention others – 5 to 10 mins.
cleansing- irritating( hypertonic osmotic)) high 1000 ml low 500 ml
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T = 40-43 ‘ C ( 105 – 110 ‘ F
CHILDREN 37.7 ( 100 ‘ F)
APPROXIMATELY 30 CM ( 12 INCHES) BUTHIGH IN CLEANSING ( 30 – 45 CM. ) 12 TO
18 CM.
INSERT 7 – 10 CM ( 3-4 INCH)-ADULT 5 – 7.5 CM. –CHILD
2.5 – 3.5 – INFANT
IF FEELING OF FULLNESS – CLAMP – 30
SECS
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amount
18 mos – 50-200 ml
18 mos – 5 y – 200-300 ml 5 – 12 years – 300 – 500 ml
12 – above – 500 – 1000 ml.
rectal tubes infants-10-12F
toddler – 14 –16F
school age – 16-18F
adult – 22 – 30F
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ENEMAS- PRESCRIBED
AMOUNT AND TIME
HYPERTONIC – 5-10MINS – VARIESHYPOTONIC(TAP)-15-20MIN – 500-
1000ML ISOTONIC(SALINE)-15-20MIN- 50MLSOAP SUDS- 10-15MIN- + 3-5 ML.
SOAP
oil( MINERAL/COTTONSEED) – 30-60MIN- 90-120ML.
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COLOSTOMY CARE
ostomy – divert and drain fecal material temporary ( trauma / inflammatory
condition)
permanent ( Cancer / congenital or Birthdefects
stoma – red , initial slight bleeding -
normal, no redness or irritation 2 to 5inches sorrounding the areano burningsensation
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parts: periostomal seal
adhesive square –solid wafer disk skin barrier
liquid skin sealant
drainable end pouch ( Can be washable)
pouch belt
face plate
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ileostomy – no irrigation , wet fecal
material , appliance all the time ,
meticulous skin care,prevent skinbreakdown, constant flow not regulated,
bag emptied half full
colostomy – solid , can irrigate , can bebowel trained , pouch may not be worn
and emptied after every defecation
avoid gas forming foods and nuts , butcan have any food at tolerated after 6
weeks… yogurt recommended
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dry skin before applying appliance
karaya – barrier to prevent
contamination with excretaappliance can be up to 2 weeks
broadwell 48 – 72 hours to check for
periostomal skin24-48 hours if eroded / ulcerated
refer to enterostomal therapy nurse
with deodorant ( Charcoal filter Disk)
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Catheterization, urinary
PURPOSE: To determine residual urine
and obtain sterile specimen. It can be a
straight catheter, suprapubic, indwelling
catheter, and external device catheter.
NURSING ALERT:
Know the necessary facts:
Principles Male Female
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Principles Male Female
Position Supine Dorsal recumbent
Length of tube 40 cm./ 15.75 in. 22cm./ 8.66
in.
French number or Circumference #14- 16 #18
Length of tube to
be inserted 2-3 in. 6-9 in.
Balloon size 5-10 ml. (30 ml 5-10 ml
Can be used to
achieve hemostasis
of the prostatic area
following prostatectomy
Place to secure lower abdomen Inner thigh
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The procedure is sterile
Maintain a close system
The draining bag must always be
below the bladder
The catheter bag should not be
allowed to lie on the floor
Do not allow the drainage spout to
touch the collection receptacle or on the
toilet bowl when draining it
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CATHETER CHANGE
PLASTIC – 1 WEEK
LATEX – 2-3 WEEKS
SILICONE – 2-3 MOS.PVC – 4-6 WEEKS
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CLOSED INTERMITTENT
IRRIGATION
ASPIRATE FROM PORT
CBI -3 WAY FOLEY CAHETER
CATHETER IRRIGATION ONLY – 200ML.
BLADDER IRRIGATION – 1000ML
CLAMPS ON BOTH SIDES –ALTERNATELY RELEASED
S O S
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URINARY DIVERSIONS-
URINARY STOMA
ILEAL CONDUIT- EXTERNAL POUCH
KOCK POUCH – SMALL DRESSING
OVER STOMA; BLADDER WALLSUTURED TO THE ABDOMEN
SUPRAPUBIC CATHETER –
INTERMITTENT ATHETERIZATION q
3-4 HOURS
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NORMAL AMOUNT/ DAY
1-3 / 500-600ML
3-5 / 600-700ML
5-8 / 700-100OML8-14 / 800 – 1400ML
14 – ADULT / 1500 – 2500
CAN HOLD 500 – 750 ML
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Bladder training
Q2 hours and 30 mins void(Trigerring, Credesand valsalva)
NEUROGENIC BLADDERIntermitent Catheterization – 2-3 hours if
<150ml ----3-4 H
weaning-intermittent clamping
DTV 1-4 hours after removal
for incontinence – kegels exercises
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HEMODIALYSIS
DONE 3-5 HOURS – 2-3 TIMES A WEEK AV FISTULA-NO BP,VENIPUNCTURE OR
CONSTRICTIONS
PALPATE FOR A THRILL AND LISTEN FORBRUIT Q8H
MONITOR FOR HEMORRHAGE DISEQUILIBRIUM
SYNDROME,HEPATITIS,HEMORRHAGE,MUSCLE CRAMPS,AIR EMBOLISM ANDSEPSIS-COMPLICATIONS
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PERITONEAL DIALYSIS TENCKOFF,GORE-TEX CATHETER WEIGH BEFORE AND AFTER, WARM DIALYSATE CHON LOSS, INFECTION, -PERITONITIS(CLOUDY
OUTFLOW,BLEEDING) , FEVER , ABDL
TENDERNESS AND N & V PREVENT CONSTIPATION BY INCREASING FIBER IN
DIET,MAINTAIN STERILE PROCEDURE,FORPROBLEMS WITH OUT FLOW –REPOSITION
TYPES: CAPD(4-6H INDWELLING), AUTOMATED 30MINS EXCHANGES, INTERMITTENT- 4X A WEEK – 10H/DAY, CONTINOUS – 1 DAY INDWELLING
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DRESSINGS
PROTECT FROM INJURY , BACTERIALCONTAMINATION
PROVIDE HUMIDITY
INSULATION ABSORB DRAINAGE DEBRIDE THE WOUND PREVENT HEMORRHAGE SPLINT / IMMOBILIZE COMFORT
GUAZE, SYNTHETIC , SECURING, TEGADERM
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TYPES OF DRESSINGS
DRY TO DRY – TRAP NECROTIC DEBRISAND EXUDATE
WET TO DRY ( SALINE AND ANTI
MICROBIAL SOLUTION – SOFTEN DEBRISAS IT DRIES, DILUTE EXUDATE WET TO DAMP – WOUND DEBRIDED IF
GAUZE REMOVED( VARIATION @
DRYING) WET TO WET – KEEP MOIST – WOUND
BATHED – MOISTURE DILUTES VISCIOUSEXUDATE
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WOUND HEALING
HEMOSTASIS---FIBRIN----
PHAGOCYTOSIS----( INFLAMMATION
PHASE 3-4DAYS
FIBROBLAST—COLLAGEN---CAPILLARIES----GRANULATION TISSUE---
ESCHAR---(PROLIFERATIVE 3 – 21 DAYS
MATURATION(PHASE 21 DAYS – 2 YEARS)
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pressure ulcer dressings
dry gauze stage II-IV
tegaderm film/ hydrocolloid – SI - SII
Absorptive Dressing IIIHydrogel – II - III
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WOUND CARE
PRIMARY
SECONDARY- INCREASED INFECTION
INCREASED TIME INCREASED ESCHAR(
PRESSURE SORES) TERTIARY- ABD. DRAINAGE
EXUDATES – SUPPURATION PUS – ABCESS( PYOGENIC BACTERIA)
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SURGICAL DRAINS
PENROSE – OPEN ENDS
CLOSED WOUND DRAINAGE ( SUCTION) –
DECREASE ENTRY OF MICROBES-
HEMOVAC / JACK PRATT TO RESERVOIR D/C 3-7 DAYS POST – OP
PACKAGE – FACILITATE GRANULATION
IRRIGATION LAVAGE - STERILE
CHEST TUBES AND
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CHEST TUBES AND
DRAINAGE SYSTEMS
1-DRAINAGE 2-WATERSEAL 3-COLLECTION/SUCTION
SEALED PATENCY-AFTER 3 DAYSREEXPANDED
FLUCTUATIONS IN WATER SEALCHAMBER
RUBBER TIPPED CLAMPS/ FORCEPS;VASELINIZED GAUZE;EXTRA BOTTLE
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NUTRITIONAL
SUPPORT
NGT-GAVAGE AND
LAVAGE
TPN
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Nasogastric Tube Insertion Purposes:
Gastric Gavage- gastric feeding Gastric Lavage- stomach irrigation For decompression Medication and supplemental fluid administration
Principles: Position: High-Fowler’s position Length of tube to be inserted: measured from
the tip of the nose to the tip of the earlobe to
the xiphoid process (approximately 50cm. Lubricate the tip of the tube by a water
soluble lubricant before insertion Secure the NGT by taping to the bridge of the
nose
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Gastroenteral Feedings This is the administration of formula through a tube
placed into the GIT, either by Nasogastric route or surgically created slit on the abdominal wall.
Remember these principles: Position: fowler’s or sitting position Prior to feeding, assess the bowel sounds and
residual content
Assess for tube placement and patency: Introduce 5-20 ml of air into the NGT and auscultate. Gurgling
sounds must be auscultated. X-ray most accurate Aspirate gastric content Immerse the tip of the tube in water, no bubbles must be
produced. Height of feeding: 12 inches above the patient’s point
of insertion Instill 60 ml of water into the NGT after feeding to
cleanse the lumen of the tube
TOTAL PARENTERAL
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TOTAL PARENTERAL
NUTRITION
peripheral< 2 weeks – phlebitis
PIC – Basilic / cephalic
PCC – subclavianTriple Lumen- infuse and draw
blood;TPN;Medications
Atrial- Hickman/Biovac and Groshong;Huber needle port
TOTAL PARENTERAL
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TOTAL PARENTERAL
NUTRITION
TPN-IV with bacterial filter(2-3L) TNA – 1 liter/D-no filter If no available solution D10W –ok –initial at
50ml/hr
hyperglycemia- hyperosmolar(HA, N andVomiting,fever, chills, malaise)
Infection ( IV tubing and filter Q24changed,solutions refrigerated and warmed
just prior to administration Pneumothorax
C
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Heat and Cold Therapy An intervention the reduces inflammation Principles: Cold application is generally safer than heat
application. Heat application usually requires a doctor’s
order
Cold application is done within 72 hours after an injury, while heat application is done after 72 hours.
The application of heat and cold is done at a
maximun of 30 minutes (an average of 15-20minutes) Check the area applications are done every
15 minutes.
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Anti-embolism Stocking
Helps prevents thrombophlebitis by promotingvenous return from the legs It usually requires a doctor’s order The client’s extremeties must be properly
measured to assure therapeutic effect Apply stockings before getting out of bed. If the client forgot to wear the stockings, instructhimn or her to assume modifiedtrendelenburg’s position for 15-20 minutes
The stockings must be removed every 8hours for 20-30 minutes
Assess the skin integrity
DOSAGES AND
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DOSAGES AND
CALCULATION
CONVERSIONS MEDICATION DOSAGES
D/A X V = Q
INFUSIONS TOTAL VOLUME X DROP FACTOR
TIME IN HOUR ( 60 MIN.)
THERAPEUTIC DOSE
CLARKS RULE BSA COMPUTATION IV INFUSION FOR BURNS
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MEDICATION ADMINISTRATION
RIGHT DRUGRIGHT DOSAGE
RIGHT ROUTE
RIGHT TIMERIGHT PATIENT
RIGHT ATTITUDE
RIGHT DOCUMENTATION
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IV THERAPY
backflow means patent line
solutions for specific diseases and
contraindications of certain solutions
management and troubleshooting
check for phlebitis and infiltration
change line everydaykeep site sterile
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BLOOD TRANSFUSION
line – PNSS vital signs – baseline then Q15 x 4; Q30 x 2;
then q h
4 –6 hours blood typing and crossmatching watch out for blood transfusion reactions
hemolytic anaphylactic febrile hypervolemic septic
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Hygiene and comfortmeasures
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BEDMAKING- OD
PERINEAL CARE – FRONT TO BACK
OUTER TO INNER, ONE COTTONBALLPER STROKE
BEDBATHING AND ND SHAMPOO
FOOT, HAIR , SKIN AND NAIL CAREORAL CARE
EYE AND EAR CARE
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THERAPEUTIC BATH
SALINE – 4 ML- 500 ML OATMEAL/AVENO – SOOTHES SKIN
IRRITATION, LUBRICATES
CORNSTARCH- IN COLD WATER –SOOTHES IRRITATION
Na CHO3 – 4 ml. – 500 ml H2O cooling / relieves irritation
KMnO4 – tablets dissolved in H2O – clears anddisinfects
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Rotating Tourniquet
GET MEAN
APPLY PRESSURE TO 3 LIMBS ONE AT A
TIME RELEASE / ROTATE EVERY 5
MINUTES. PRESSURE IN ONE EXTREMITYFOR ONLY 15 MINUTES
DO NOT RELEASE SIMULTANEOUSLY
PATIENT IN ORTHOPNEIC / FOWLERSPOSITION
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CPR and ACPLS Protocols
0-1 MINUTE ; CARDIAC IRRITABILITY
0-4 MINUTES; BRAIN DAMAGE NOT
LIKELY
4-6 MINUTES; BRAIN DAMAGE POSSIBLE 6-10 MINUTES; BRAIN DAMAGE LIKELY
10 MINUTES-IRREVERSIBLE BRAIN
DAMAGE
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INFANTS
HTCL MANEUVER, JAW THRUST IFSPINAL INJURY IS SUSPECTED
INITIAL BREATHS – 2 – 1 1/2 SECS
SUBSEQUENT BREATHS 1 B/3 SECS; 20BPM USE 2 OR 3 FINGERS DEPTH:1/2 TO 1 INCH
COMPRESSION AT LEAST 100/MIN RATIO 5:1; CHECK AFTER 20 CYCLES FOREIGN BODY OBSTRUCTIONS:
BACKBLOWS AND CHEST THRUST
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CHILDREN
HTCL / JAW THRUST 2 BREATHS INITIAL DURATION OF 1- 1 ½SECS
SUBSEQUENT 1 BREATH EVERY 3
SECONDS 20 BREATHS/ MIN CAROTID ARTERY HEEL OF HAND 1 TO 1 1\2 INCH 100 BPM; CHECK AFTER 12 CYCLES ABDOMINAL THRUST- FOR AIRWAY
OBSTRUCTION
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ADULTS
HTCL / JAW THRUST INITIAL 2 BREATHS AT LEAST 2
SECS EACH
DEPRESS 1 ½ - 2 INCHES; RATE 60TO 100
RATIO 5:1
AFTER 4 CYCLES ;RECHECK FOR 10SECS
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