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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 5 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 8 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 17 CPCR Protocols Laboratory Blood markers to monitor glucose Lactate Packed Total cell volume protein Electrolytes 18 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 19 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 22 Prognosis UC Davis study: survival rate at 1 wk for cardiac resuscitation patients: Dogs: 3.8% Cats: 2.3%