Chapter 33

Emergency Nursing Pt.2

2Advanced Life Support

Interpretation of ECG

Administration of drugs

Drug choices based on cardiac output, blood pressure, and presence of arrhythmias

3CPCR Protocols

Common drugs used in CPCRAtropineEpinephrineNaloxoneLidocaineMagnesium chloride or sulfate

4CPCR Protocols

ECGAllows recognition of specific arrhythmias

so that appropriate drugs are administered

Allows for response to therapy to be assessed

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

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).

An electrical defibrillator and ECG should be located on top of the crash cart for treatment of ventricular fibrillation during cardiac arrest.

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

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

A polypropylene catheter passed through an endotracheal tube can be used for the intratracheal administration of some drugs during CPCR.

11Prolonged Life Support

Post-resuscitation goalsCorrect underlying cause of arrestCorrect problems caused by the arrest and

the trauma of the resuscitation

12Central Nervous System Support

Avoid hypothermiaAvoid hypoglycemia or hyperglycemiaPerform serial neurological exams: PLR,

corneal, palpebral, response to stimuli

13Central Nervous System Support

MannitolAn osmotic diuretic

Sometimes used in the management of cerebral edema and acute renal failure

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

15Cardiovascular System Support

Monitor blood pressure

Monitor urine production

Keep patient on oxygen

16Respiratory System Support

Common respiratory complicationsPulmonary edema due to congestive heart

failure

Noncardiogenic edema associated with hypoxia

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

18CPCR Protocols

Laboratory markers to monitorBlood glucoseLactatePacked cell volumeTotal proteinElectrolytes

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

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

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

22Prolonged Life Support

Commonly used drugsLidocaine

Treatment of ventricular arrhythmiasShort actingContraindicated in ventricular escape and isolated

premature ventricular complexes Monitor ECG closely

Prognosis

UC Davis study: survival rate at 1 wk for cardiac resuscitation patients: Dogs:3.8% Cats: 2.3%