Cardiovascular Surgery – Caring for the Patient
Cardiac arrest, is defined as the sudden, unexpected cessation of the heartbeat and circulation.
This occurs when the heart action stops entirely or the heart fibrillates. Causes of sudden cardiac death include the following:
Carbon monoxide poisoning.
Cardiac Arrest - Resuscitation
The absence of peripheral pulses and heart sounds is all that is necessary to make the diagnosis. There is a period of about four minutes between the cessation of circulation and the onset of irreversible brain damage.
For this reason, it is imperative that resuscitation begins immediately. Resuscitation requires that two basic life support functions be restored:
Blood must be pumped through the body
Oxygen and carbon dioxide exchange must occur.
Restoration of one without the other is not adequate.
The Role of the Nurse in Cardiac Arrest
The role of the nursing paraprofessional in cardiac arrest is one of extreme importance in saving a life, as the paraprofessional may be the first one to observe the emergency.
It is necessary to have a well-planned course of action in mind at all times, in order to be prepared for an emergency. The nursing paraprofessional must:
Be proficient in cardiopulmonary resuscitation (CPR).
Be familiar with local standard operating procedures (SOP) for "CODE" (onset of cardiac arrest) procedures, including whom to call and how to reach them.
Be able to locate and operate emergency equipment.
Be ready to assist in the activities of code management at the direction of the physician or professional nurse.
Standard Items Required for Cardiac Arrest
The following items are required for a sudden event of cardiac arrest. Nurses need to be familiar with all items listed below:
Intravenous infusion equipment.
Needles and syringes.
Intubation equipment, oral airways.
Assorted dressing materials.
There should be a defibrillator/cardiac monitor available if one is not located on or near the crash cart.
The Identification of Cardiac Arrest
Sudden cardiac arrest and the ensuing hectic activity involved in management can be a frightening and anxiety producing experience for nursing personnel who are unaccustomed to this type of event.
A basic understanding of what takes place during cardiac arrest will do much to alleviate that anxiety.
When a cardiac arrest has been identified:
The person who witnesses the event or discovers the patient will call for help from his co-workers and immediately initiate CPR.
The co-workers will respond by initiating the procedures for "calling" a code. They will then obtain the emergency equipment, take it to the location of the code, and relieve or assist the individual performing CPR.
Cardiac Arrest – Help Arrives
As help begins to arrive to treat the patient, several things begin to happen simultaneously:
An IV "lifeline" will be initiated.
Blood pressure readings will be obtained.
The patient is connected to the cardiac monitor.
Baseline blood work is drawn to assess the patient's status.
An ambu bag and oxygen will replace mouth-to-mouth resuscitation.
Cardiac Arrest – The Physician’s Role
The physician in charge will make decisions based on his observations of the patient's condition and the response to CPR. If there is no response to CPR, the code continues, and again, several things happen simultaneously:
The patient will be intubated.
Appropriate emergency drugs will be administered.
Cardiopulmonary resuscitation is continued while the electrical activity of the heart is observed on the cardiac monitor. If appropriate to the patient's condition, the patient will be defibrillated.
Blood samples are drawn repeatedly to monitor the effectiveness of the treatment. Acid-base balance and adequacy of oxygenation are of extreme concern.
These procedures continue until the patient is stabilized or the physician makes the determination to declare the patient dead.
Cardiac Arrest – Major Roles
The seeming confusion of people is actually a coordinated effort by a group of people, each performing a particular task. The major roles are as follows:
A physician will direct the activities, "managing" the code.
A nurse will administer IV medications at the direction of the physician in charge.
A nurse will monitor blood pressure and obtain blood samples. One individual will perform chest compressions. One individual will administer artificial ventilation. This is normally the anesthesia specialist, who has intubated the patient.
One individual will act as a recorder, charting the exact time of each action performed and each medication given. One or more individuals act as "runners," taking specimens to the lab, obtaining needed supplies, receiving lab reports, and so forth.
Cardiac Arrest - Conclusion
Remember, the purpose of a "code" is to attempt resuscitation of a patient whose heart has stopped pumping effectively (fibrillation) or stopped pumping altogether. Keep this purpose in mind at all times, and be aware of your role as a nurse.
Perhaps the most valuable piece of advice to be given during an instance of cardiac arrest is to remain calm. If you are to become “flustered” by the event, you greatly decrease the chances of your patient’s survival.
Finally, always remember the golden rule when it comes to cardiac arrest – if in doubt, call for help immediately.
END of UNIT
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