2. CARDIAC EMERGENCIES IN THE GI LAB DANIEL ROSENTHAL RN PRESIDENT WORKPLACE NURSES

3. OBJECTIVES IDENTIFY COMMON EMERGENCIES ENCOUNTERED IMPLEMENT MEASURES TO RESOLVE EMERGENCY SITUATIONS DISCUSS HIGHLIGHTS OF GUIDELINES 2005 CHANGES

4. COMMON OCCURRENCES PATIENT FEELS WEAK PATIENT “PASSES OUT” PATIENT FALLS HYPOTENSIVE BRADYCARDIC LOW SPO2 SLOW RESPIRATIONS UNRESPONSIVE HYPERTENSIVE HYPERTENSIVE TACHYCARDIC TACHYCARDIC PRE PROCEDURE POST PROCEDURE

5. 6 H’S & 7 T’S HYPOTHERMIA HYPOGLYCEMIA HYPOVOLEMIA H+ ION IMBALANCE HYPO/HYPER ELECTROLYTE HYPOXIA TABLETS/TOXINS TAMPONADE TENSION PNEUMO TRAUMA THROMBUS- CORONARY THROMBUS- CEREBRAL THROMBUS-PE

6. OK COACH! NOWWHAT?

7. ASSESS YOUR PATIENT! AIRWAY : OPEN THE AIRWAY BREATHING: GIVE 2 BREATHS CIRCULATION: CHECK PULSE DETERMINE IDENTIFIABLE TREATABLE REVERSIBLE CAUSE

8. EMS! ACTIVATE EMERGENCY PLAN AND CALL EMS!

9. Secondary survey Place airway device - oral airway, Ambu bag,O2delivery device Confirm open airway – chest rises Confirm oxygenation SPO2, CO2 monitoring Confirm circulation – pulse check, ECG monitoring Rhythm identification- shock VF/VT

10. Secondary survey Establish IV access – give ordered meds Check for Bleeding Differential Diagnosis – identifiable reversible cause

11. Identifiable treatable causes H’s & T’s Hypovolemia Hypo/hyperglycemia Hypoxia H+ ion imbalance Hypo/hyper electrolyte status Hypothermia Toxins/tablets Tamponade Tension pneumothorax Thrombosis 1. Coronary 2. Cerebral 3. Pulmonary

12. 2005 ECC Guidelines Good CPR = Good Outcomes We need to focus on more circulation and minimize interruptions to compressions.

13. STUDY DATA SHOWS THAT IN CODES >50% OF THE TIME THERE ARE NO COMPRESSIONS BEING GIVEN!

14. HIGHLIGHTS OF 2005 GUIDELINES EMPHASIVE CIRCULATION NO JAW THRUST FOR NON-MEDICAL PROVIDERS. Airway/breathing higher GIVE BREATHS OVER 1 SECOND – UNTIL THE CHEST BEGINS TO RISE HYPEVENTILATION KILLS!

15. LONGER CYCLES (FOR ALL AGES) 30COMPRESSIONS 2 VENTILATIONS WITHOUT ADVANCED AIRWAY

16. CONTINUE COMPRESSIONS UNTIL THE PATIENT MOVES EMS ARRIVES THE PATIENT IS PRONOUNCED ONLY INTERRUPTIONS SHOULD BE 10 SECONDS OR LESS AND THEN ONLY FOR ADVANCED PROCEDURES.

17. FOR MORE INFORMATION: DAN ROSENTHAL RN WORKPLACE NURSES 54 Derbes Drive Gretna, LA 70053 (504) 367-5355 workplacenurse@juno.com