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 specific 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 fibrillation  Treatment is by electrical defibrillation using an electrical defibrillator  Chemical defibrillation 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).

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  2 nd 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

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  Bradycardia—atropine or glycopyrrolate  Sinus tachycardia—may result from fear, anxiety, pain, hypotension, hypoxia  Ventricular arrhythmias—check 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 beneficial 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

Prognosis  UC Davis study: survival rate at 1 wk for cardiac resuscitation patients:  Dogs:3.8%  Cats:2.3%