Ii.cardiac Arrest

CARDIAC ARREST • • •

Occurs when the heart ceases to produce an effective pulse and blood circulation. Maybe caused by a cardiac electrical event, heart rate is too fast (ventricular tachycardia or ventricular fibrillation) or too slow (bradycardia or AV block) or no heart rate at all (asystole). Pulseless Electrical Activity (PEA)- Electrical activity is prevent but theirs is ineffective cardiac contraction or circulating volume. Can be caused by hypovolemia, cardiac tamponade, hypothermia, massive pulmonary embolism, medication overdoses, significant acidosis and massive acute myocardial infarction.

Clinical Manifestation • • • • •

Consciousness, pulse, blood pressure are lost immediately. Ineffective Respiratory gasping occur. Dilation of pupils within 45 seconds. Seizures Risk for irreversible brain damage and death.

Emergency Management Cardiopulmornary Resuscitation The ABCD’s of basic cardiopulmonary resuscitation are consists of the following steps: 1. 2. 3. 4.

Airway- Maintaning an open airway. Breathing- Providing artificial ventilation by rescue breathing. Circulation- Promoting artificial circulation by external cardiac compression Defibrillation- Restoring the heartbeat.

Defibrillation is a treatment of choice rather than CPR if the patient is monitored or immediately placed on the monitor using the multifunction pads or the quick-look paddles and the ECG shows ventricular tachycardia or ventricular fibrillation.

Medications used in Cardiopulmonary Resuscitation Agent and Action Oxygen- Improves tissue oxygenation and corrects hypoxemia.

Indications Patients with acute cardiac ischemia or suspected hypoxemia.

Epinephrine (Adrenalin) Increases systemic vascular resistance and blood pressures, improves coronary and cerebral perfusion and myocardial contractility. Atropine Blocks parasympathetic action, increases SA node automaticity and AV conduction.

Patient with cardiac arrest caused by asystole or pulseless electrical activity. Caused by ventricular tachycardia or ventricular fibrillation.

Sodium Bicarbonate Corrects metabolic acidosis

Given to correct metabolic acidosis thai is refractory to standard advanced cardiac life support interventions.

Magnesium Promotes adequate functioning of the cellular sodium-potassium pump

Given to patient with torsades de pointes.

Vasopressin (Pitressin) Increases inotropic action (contraction) of the heart.

An alternative to epinephrine when cardiac arrest is caused by ventricular tachycardia or fibrillation.

Patient with symptomatic bradycardia.

Prevention Intraoperative precautions include the following: • • • • • • • • •

ECG and temperature monitoring No stimulation during induction Maintenance of an adequate airway Oxygen and carbon dioxide monitoring Arterial blood pressure monitoring Medications Appropriate positioning Gentle handling of tissues Skillful anesthetic adminstration

Nursing Considerations -use 100% FiCO2 during resuscitation. -monitor dose by end tidal CO2 or pulse oximeter. -adminster by IVP or ET tube -Avoid adding to IV lines that contain alkaline solution.

-give rapidly as 2.0-2.5 mg IVP or ET tube. -0.5 mg in adult can cause the HR to decrease to a worse bradycardia. -monitor patient for reflexive tachycardia. -initial dose is 1 mEq/kg IV, then administer the dose based on thebase deficit calculated from arterial blood gas values. -may give diluted over 2 minutes or IVP. -monitor for hypotension, asystole, bradycardia, respiratory paralysis. -give 40 U IV one time only.