Emergency Nursing Pt.2

1
Chapter 33

• Emergency Nursing Pt.2

2
Advanced Life Support

• Interpretation of ECG
• Administration of drugs
• Drug choices based on cardiac output, blood
  pressure, and presence of arrhythmias

3
CPCR Protocols

• Common drugs used in CPCR
• Atropine
• Epinephrine
• Naloxone
• Lidocaine
• Magnesium chloride or sulfate

4
CPCR Protocols

• ECG
• Allows recognition of speci?c arrhythmias so that
  appropriate drugs are administered
• Allows for response to therapy to be assessed

5
Three Arrhythmias Seen During an Arrest

• Asystole (flat-line)
• Treated with atropine and/or epinephrine
  repeated doses if no response is observed
• Electromechanical dissociation (EMD)
• Treated with naloxone, megadose atropine, or
  epinephrine

6
Three Arrhythmias Seen During an Arrest

• Ventricular ?brillation
• Treatment is by electrical de?brillation using an
  electrical de?brillator
• Chemical de?brillation may be attempted using
  drugs such as magnesium chloride
• A strong precordial thump is potentially
  effective as a last resort

Ventricular tachycardia (on the left of the ECG)
suddenly degenerates into ventricular
fibrillation (on the right side of the ECG).
7
An electrical defibrillator and ECG should be
located on top of the crash cart for treatment of
ventricular fibrillation during cardiac arrest.
8
CPCR Protocols

• Drug administration
• May be ineffective due to poor perfusion
• A central vein catheter is the CPCR drug
  administration route of preference during
  closed-chest CPCR

9
CPCR Protocols

• 2nd option for Drug Delivery
• Intratracheal
• LEAN
• NAVEL
• Double the IV dose
• Third option for Drug delivery
• Peripheral
• Intraosseous
• Last option - Intracardiac as last resort
• Difficult to hit a flaccid heart
• More damage may occur
• Use 1/10 of the IV dose

10
A polypropylene catheter passed through an
endotracheal tube can be used for the
intratracheal administration of some drugs during
CPCR.
11
Prolonged Life Support

• Post-resuscitation goals
• Correct underlying cause of arrest
• Correct problems caused by the arrest and the
  trauma of the resuscitation

12
Central Nervous System Support

• Avoid hypothermia
• Avoid hypoglycemia or hyperglycemia
• Perform serial neurological exams PLR, corneal,
  palpebral, response to stimuli

13
Central Nervous System Support

• Mannitol
• An osmotic diuretic
• Sometimes used in the management of cerebral
  edema and acute renal failure

14
Cardiovascular System Support

• Monitor heart rate
• Bradycardiaatropine or glycopyrrolate
• Sinus tachycardiamay result from fear, anxiety,
  pain, hypotension, hypoxia
• Ventricular arrhythmiascheck for pulse/heart
  beat asynchronicity

15
Cardiovascular System Support

• Monitor blood pressure
• Monitor urine production
• Keep patient on oxygen

16
Respiratory System Support

• Common respiratory complications
• Pulmonary edema due to congestive heart failure
• Noncardiogenic edema associated with hypoxia

17
Respiratory System Support

• Vigorous chest compressions from CPCR
• May result in pulmonary contusions, rib
  fractures, atelectasis, and/or edema
• Therapy
• Oxygen supplementation
• Ventilation support
• Monitoring of arterial blood gases
• Pulse oximetry and/or capnography

18
CPCR Protocols

• Laboratory markers to monitor
• Blood glucose
• Lactate
• Packed cell volume
• Total protein
• Electrolytes

19
Prolonged Life Support

• Commonly used drugs
• Furosemide (Lasix)
• Treats pulmonary edema and acute kidney failure
• Glucocorticosteroids
• Controversial
• May be bene?cial in stabilizing cellular
  membranes
• Capable of rapid action against the oxygen-free
  radicals created during reperfusion injury

20
Prolonged Life Support

• Commonly used drugs
• Dobutamine
• Positive inotropic drug
• Improves the contractility of heart muscle
• Dopamine
• Increases renal perfusion in canine patients at
  low doses
• Increases systemic blood pressure at higher
  dosages

21
Prolonged Life Support

• Commonly used drugs
• Sodium bicarbonate
• Treatment for severe life-threatening acidosis
• Adverse effect can outweigh benefits
• Restore circulation and perfusion before
  supplementation with fluid therapy

22
Prolonged Life Support

• Commonly used drugs
• Lidocaine
• Treatment of ventricular arrhythmias
• Short acting
• Contraindicated in ventricular escape and
  isolated premature ventricular complexes
• Monitor ECG closely

23
Prognosis

• UC Davis study survival rate at 1 wk for cardiac
  resuscitation patients
• Dogs 3.8
• Cats 2.3