Cardiopulmonary Arrest

Chapter 9 Cardiopulmonary Arrest



Cardiopulmonary arrest is not an unusual occurrence in the emergency department. Causes can range from the expected terminal event of chronic or acute illnesses to sudden cardiac death. Hypoxemia secondary to severe respiratory insufficiency, intentional or accidental drug overdose, or neurologic insult can also result in unexpected cardiopulmonary arrest. Traumatic cardiopulmonary arrest is a less common and more difficult to manage cause of arrest.


The goal of basic life support (BLS) is to restore effective circulation and oxygenation and to maintain intact neurologic function. Emphasis is placed on the immediate initiation of the following steps:




The ABCs of BLS have been replaced by CAB—compressions, airway, breathing—to reflect the growing evidence that chest compressions are the most important aspect of early resuscitation efforts. In addition, airway management takes time and can delay the initiation of effective chest compressions.1


Most victims of cardiopulmonary arrest initially experience ventricular fibrillation. Chest compressions can maintain some level of cardiac output but will not convert this life-threatening rhythm; defibrillation is the only definitive treatment. The interval from collapse to defibrillation is one of the most important determinants of survival from cardiopulmonary arrest.1 The automatic external defibrillator (AED) is useful for early defibrillation in that no specific rhythm interpretation is required by the operator. The AED will determine whether the rhythm is “shockable” or not.


It is assumed that the reader is familiar with the principles of BLS and techniques of high-quality chest compressions. Specific BLS guidelines and advanced cardiac life support (ACLS) treatment algorithms can be found on the American Heart Association’s website. All emergency nurses should obtain and maintain certification in ACLS.




Management of Cardiopulmonary Arrest







Defibrillation






Shocks can be delivered through paddles or self-adhesive disposable pads applied to anterior-posterior or anterior-anterior position.









American Heart Association guidelines note if there is any evidence of an implantable cardioverter defibrillator (ICD) or permanent pacemaker, defibrillation should not be delayed by pad or paddle placement. It is recommended to avoid placing the pads or paddles over the implanted device.1




The energy level for the initial shock with a biphasic defibrillator is 120 to 200 joules; if using a monophasic defibrillator, use 360 joules. If unsure as to whether the defibrillator is biphasic or monophasic, deliver the shock at 200 joules. Deliver subsequent shocks at the energy level that was previously successful.


Ensure that all personnel are “clear” of the patient, bed, and equipment before delivering shocks.



Drugs




The drugs most commonly used during resuscitation from cardiopulmonary arrest are epinephrine, vasopressin, and amiodarone.


Epinephrine, 1 mg, either IV or IO, is given every 3 to 5 minutes during cardiopulmonary arrest in the adult.





Vasopressin (Pitressin), 40 units, either IV or IO, can replace either the first or the second dose of epinephrine.



The recommended initial dose of amiodarone is 300 mg, either intravenously or intraosseously; this may be followed by a single 150-mg dose.






Follow bolus injections of drugs with a 20-mL bolus of IV fluid; elevate the extremity for 10 to 20 seconds following administration to facilitate delivery to the central circulation.2


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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Cardiopulmonary Arrest

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