Cardiac arrest bsc

Cardiac Arrest for B Sc and Msc Nursing

1. By :- Baljinder Singh M. SC. (Medical surgical Nursing)

2. CARDIAC ARREST S udden stop in effective blood circulation due to the failure of the heart to contract effectively.  Medical personnel may refer to an unexpected cardiac arrest as a  sudden cardiac arrest  ( SCA ).

3. PATHOPHYSIOLOGY RISK FACTORS, ETIOLOGY CONDUCTION ABNORMALITY IN HEART INABILITY OF HEART TO CONTRACT PROPERLY DECREASED CARDIAC OUTPUT DECREASED TISSUE PERFUSION COMPROMISED FUNCTION OF HEART SIGN AND SYMPTOMS

4. SIGN AND SYMPTOMS   loss of pulse Absence of BP Unconscious Seizures Chocking Dilatation of pupil

5. DIAGNOSIS Assessment of signs and symptoms E.C.G Serum Electrolytes Cardiac Biomarkers ABG Analysis Chest X-Ray

6. THREE BASIC ECG PATTERNS WITH CARDIAC ARREST 1. VENTRICULAR FIBRILLATION

7. 2. VENTRICULAR ASYSTOLE

8. MANAGEMENT Early assessment CPR Defibrillation Medications Post cardiac care

9. TREATMENT “Chain of Survival” Early access. Early CPR. Early defibrillation. Early advanced life support.

10. “Chain of Survival” First link – Early access Call for Help ! Patient evaluation Determine if conscious or not, by placing one hand on patient’s forehead and shaking shoulders gently with another hand. In case of SCA patient will not respond .

11. “Chain of Survival” Second link – Early CPR Steps preceding Cardiopulmonary Resuscitation (CPR ) Determine A,B,C of Basic Cardiac Life Support (BCLS). * A for Airway. * B for Breathing. * C for Circulation.

12. Airway * Head tilt * Finger sweep. * Jaw Thrust. “Chain of Survival” Second link – Early CPR

13. Breathing * Look – Down the line of chest to to see it rise and fall. * Listen – at mouth and nose for breathing sounds. * Feel – for expired air at patients mouth and nose. “Chain of Survival” Second link – Early CPR

14. Circulation * Feel - carotids “Chain of Survival” Second link – Early CPR

15. Cardiac compressions Locate correct chest compression site, 2 - fingers above xiphoid. Place heel of other hand on the lower end of breast bone. Fingers off the chest wall. “Chain of Survival” Second link – Early CPR

16. Once SCA is confirmed ………… Patient should be placed on hard surface. Start CPR. Give 2 expired breaths, followed by 30 compressions . Continue 30:2 cycles for CPR both for 1- & 2 -rescuers Compression rate – atleast 100 per minute “Chain of Survival” Second link – Early CPR

17. Mouth to mouth ventilation Remove any obvious obstruction. Open airway. Pinch victims nose. Give mouth to mouth ventilation. Repeat breaths. “Chain of Survival” Second link – Early CPR

18. “Chain of Survival” Second link – Early CPR

19. “Chain of Survival” Third link – Early Defibrillation CPR saves time The most common cause of SCA is VF, a lethal rhythm The only effective treatment is defibrillation

20. PADDLE PLACEMENT 2 nd intercostal space to right of sternum 5 th left intercostal space on anterior axillary line

21. PADDLE PLACEMENT

22. SHOCK PROTOCOL VF/ pulseless ventricular tachycardia (VT) Deliver 1 shock, immediately resume CPR, beginning with chest compressions - 5 cycles Analyze the cardiac rhythm deliver another shock if indicated

23. ENERGY DURING DEFIBRILLATION Start with 120 J Increase to 200J, 360 J Pressure = 20 to 25 pounds

24. “Chain of Survival” Third link – Early Defibrillation VF Defibrillation NSR Defibrillation Electrical Current Stops VF Sudden Cardiac Arrest (SCA)

25. “Chain of Survival” Fourth link – Early ACLS For advanced Cardiac Life support (ACLS) shift the patient to the nearest hospital. Treat victim with medicine and advanced therapies. Sudden Cardiac Arrest (SCA)

26. NURSING MANAGEMENT

27. NURSING MANAGEMENT ASSESSMENT : Observe sign and symptoms Observe pulse Assess A, B, C Call for help START CPR

28. Immediate care after CPR Level of consciousness Vital signs ECG  CVP  Urine output  ABG value

29. NURSING DIAGNOSIS Decreased cardiac output r/t cardiac arrest, dysrhythmia . Assess vital signs, CVP, urinary output and peripheral pulses. Assess heart rate and rhythm (ECG). Oxygen administration as hypoxia can lead to further dysrhytmias . Administer drugs, antidysrhythmic medication as ordered. Administer fluid therapy as ordered.

30. NURSING DIAGNOSIS Impaired tissue perfusion r/t to decreased cardiac output . Note the color and temperature of the skin. Monitor peripheral pulses Monitor urine out put Provide warm environment.

31. NURSING DIAGNOSIS MANAGEMENT Risk for ineffective respiratory pattern r/t disease condition . Assess respiratory rate. Auscultate breath sounds. Fowler’s position if difficulty. Monitor pulse oximetry and ABG analysis. Report any abnormality. Continuous monitoring for the first half hour of defibrillation.

32. NURSING DIAGNOSIS Risk for fluid electrolyte imbalance r/t physiological changes. Monitor intake and output. Administer fluid and diuretics. Monitor electrolytes daily and replace as ordered. Monitor BUN, creatinine and urine electrolytes daily.

33. NURSING DIAGNOSIS Risk for complications r/t disease process, procedure performed and defibrillation . Assess level of consciousness. Reorient the time, place and person. Assess vital signs and ECG continuously. Initiate IV antidysrhythmics therapy as prescribed Administer IV fluid to correct fluid electrolyte imbalances

34. NURSING DIAGNOSIS Anxiety r/t fear about unknown outcome . Prepare patient and family and explain what is expected. Clarify any misconceptions. Provide adequate rest to the patient. Encourage to ask questions related to equipments, monitoring, treatment.

35. SUMMARY Definition of cardiac arrest Difference b/w heart attack and cardiac arrest Etiology of cardiac arrest Risk factors of cardiac arrest Sign and symptoms of patient with cardiac arrest Diagnosis of patient with cardiac arrest Management of patient with cardiac arrest

36. REFERENCES Braunwald et al:Principle of Internal Medicine1508,1513 16 th edition Woods et al:``Cardiac Nursing’’LIPPINCOTT Brunner& Siddharth , Medical Surgical Nursing’’ Meg Gulanick et al:Nursing Care Plan 200,204