chapter 33 emergency nursing pt.2. 2 advanced life support interpretation of ecg administration of...
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Chapter 33
Emergency Nursing Pt.2
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2Advanced Life Support
Interpretation of ECG
Administration of drugs
Drug choices based on cardiac output, blood pressure, and presence of arrhythmias
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3CPCR Protocols
Common drugs used in CPCRAtropineEpinephrineNaloxoneLidocaineMagnesium chloride or sulfate
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4CPCR Protocols
ECGAllows recognition of specific arrhythmias
so that appropriate drugs are administered
Allows for response to therapy to be assessed
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5Three 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
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6Three 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).
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An electrical defibrillator and ECG should be located on top of the crash cart for treatment of ventricular fibrillation during cardiac arrest.
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8CPCR Protocols
Drug administrationMay be ineffective due to poor perfusion
A central vein catheter is the CPCR drug administration route of preference during closed-chest CPCR
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9CPCR Protocols 2nd option for Drug Delivery
IntratrachealLEANNAVELDouble the IV dose
Third option for Drug deliveryPeripheral Intraosseous
Last option - Intracardiac as last resortDifficult to hit a flaccid heartMore damage may occurUse 1/10 of the IV dose
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A polypropylene catheter passed through an endotracheal tube can be used for the intratracheal administration of some drugs during CPCR.
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11Prolonged Life Support
Post-resuscitation goalsCorrect underlying cause of arrestCorrect problems caused by the arrest and
the trauma of the resuscitation
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12Central Nervous System Support
Avoid hypothermiaAvoid hypoglycemia or hyperglycemiaPerform serial neurological exams: PLR,
corneal, palpebral, response to stimuli
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13Central Nervous System Support
MannitolAn osmotic diuretic
Sometimes used in the management of cerebral edema and acute renal failure
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14Cardiovascular 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
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15Cardiovascular System Support
Monitor blood pressure
Monitor urine production
Keep patient on oxygen
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16Respiratory System Support
Common respiratory complicationsPulmonary edema due to congestive heart
failure
Noncardiogenic edema associated with hypoxia
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17Respiratory 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
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18CPCR Protocols
Laboratory markers to monitorBlood glucoseLactatePacked cell volumeTotal proteinElectrolytes
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19Prolonged Life Support
Commonly used drugsFurosemide (Lasix)
Treats pulmonary edema and acute kidney failure
GlucocorticosteroidsControversialMay be beneficial in stabilizing cellular membranesCapable of rapid action against the oxygen-free
radicals created during reperfusion injury
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20Prolonged Life Support
Commonly used drugsDobutamine
Positive inotropic drugImproves the contractility of heart muscle
DopamineIncreases renal perfusion in canine patients at low
dosesIncreases systemic blood pressure at higher
dosages
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21Prolonged Life Support
Commonly used drugsSodium bicarbonate
Treatment for severe life-threatening acidosisAdverse effect can outweigh benefitsRestore circulation and perfusion before
supplementation with fluid therapy
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22Prolonged Life Support
Commonly used drugsLidocaine
Treatment of ventricular arrhythmiasShort actingContraindicated in ventricular escape and isolated
premature ventricular complexes Monitor ECG closely
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Prognosis
UC Davis study: survival rate at 1 wk for cardiac resuscitation patients: Dogs:3.8% Cats: 2.3%