Transcript Advanced Life Support

Chapter 33
Emergency Nursing Pt.2
Advanced Life Support

Interpretation of ECG

Administration of drugs

Drug choices based on cardiac output,
blood pressure, and presence of arrhythmias
2
CPCR Protocols
 Common
drugs used in CPCR
 Atropine
 Epinephrine
 Naloxone
 Lidocaine
 Magnesium
chloride or sulfate
3
CPCR Protocols
 ECG
 Allows
recognition of specific arrhythmias so
that appropriate drugs are administered
 Allows
for response to therapy to be assessed
4
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
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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).
6
An electrical defibrillator and ECG should be
located on top of the crash cart for treatment of
ventricular fibrillation during cardiac arrest.
CPCR Protocols
 Drug
administration
 May
A
be ineffective due to poor perfusion
central vein catheter is the CPCR drug
administration route of preference during closedchest CPCR
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CPCR Protocols
 2nd
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
9
A polypropylene catheter passed through an
endotracheal tube can be used for the intratracheal
administration of some drugs during CPCR.
Prolonged Life Support
 Post-resuscitation
 Correct
 Correct
goals
underlying cause of arrest
problems caused by the arrest and
the trauma of the resuscitation
11
Central Nervous System
Support
 Avoid
hypothermia
 Avoid
hypoglycemia or hyperglycemia
 Perform
serial neurological exams: PLR,
corneal, palpebral, response to stimuli
12
Central Nervous System
Support
 Mannitol
 An
osmotic diuretic
 Sometimes
used in the management of cerebral
edema and acute renal failure
13
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
14
Cardiovascular System
Support

Monitor blood pressure

Monitor urine production

Keep patient on oxygen
15
Respiratory System Support
 Common
respiratory complications
 Pulmonary
failure
edema due to congestive heart
 Noncardiogenic
hypoxia
edema associated with
16
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
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CPCR Protocols
 Laboratory
Blood
markers to monitor
glucose
Lactate
Packed
Total
cell volume
protein
Electrolytes
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Prolonged Life Support
 Commonly
used drugs
 Furosemide
 Treats
(Lasix)
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
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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
20
Prolonged Life Support
 Commonly
Sodium
used drugs
bicarbonate
Treatment
Adverse
Restore
for severe life-threatening acidosis
effect can outweigh benefits
circulation and perfusion before
supplementation with fluid therapy
21
Prolonged Life Support
 Commonly
used drugs
 Lidocaine
 Treatment
 Short
of ventricular arrhythmias
acting
 Contraindicated
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%