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KEY CONCEPTS

KEY CONCEPTS

  • Image not available. High-quality cardiopulmonary resuscitation with minimal interruptions in chest compressions should be delivered to all patients following cardiac arrest.

  • Image not available. The AHA algorithm for basic life support emphasizes circulation, airway, and breathing, forming the mnemonic “CAB."

  • Image not available. The purpose of using vasopressor therapy following cardiac arrest is to augment coronary and cerebral perfusion pressures.

  • Image not available. Vasopressin appears to offer no benefit as a substitute for epinephrine.

  • Image not available. Successful treatment of both pulseless electrical activity (PEA) and asystole depends on determining the underlying cause.

  • Image not available. Intraosseous administration is the preferred alternative route when IV access cannot be achieved.

PATIENT CARE PROCESS

Patient Care Process for Cardiac Arrest

Image not available.

Collect*

  • Patient characteristics (eg, sex, age)

  • Patient medical history (if available)

  • Current and past medications that could have contributed to the arrest or serve as a clue to the underlying medical history

  • Objective data

    • Presence of a pulse

    • Cardiac rhythm

Assess*

  • Is the patient responsive?

  • Is there a pulse present?

  • Are the ECG leads correctly placed on the patient?

  • Is the rhythm shockable?

Plan*

  • Activate EMS and obtain an AED if one is nearby (for out-of-hospital arrest)

  • Call for “code blue” and obtain crash cart (for in-hospital arrest)

  • Immediately begin chest compressions and follow BLS algorithm

  • Administer electrical therapy (ie, defibrillation) if indicated

  • Drug therapy per advanced cardiac life support (ACLS) algorithm if indicated

  • Monitor for the return of spontaneous circulation, cardiac rhythm, and pulse

Implement*

  • Perform high-quality chest compressions with minimal interruptions

  • Administer defibrillations and drug therapy as indicated by cardiac rhythm

Follow-up: Monitor and Evaluate*

  • Monitor end-tidal CO2 as an indicator of CPR quality

  • Implement postresuscitative care plan consisting of therapeutic hypothermia if indicated

  • ECG and PCI when an acute coronary syndrome is suspected

  • Review patient history for identification of other contributors or underlying cause of the arrest

  • Diligent monitoring of blood pressure, oxygen saturation, temperature, urine output, and glucose

  • Evaluate and monitor for seizure

*Collaborate with patient, caregivers, and other healthcare professionals.

PRECLASS ACTIVITY

Preclass Engaged Learning Activity

Review the American Heart Association (AHA) algorithms for BLS and ACLS. Create a table which lists the medications that are recommended in the guidelines that might be used, when they might be used, and what the intended purpose of their use is. All guidelines for cardiopulmonary resuscitation and emergency cardiac care can be found at American Heart Association Guidelines.

INTRODUCTION

Cardiac arrest is defined as the cessation of cardiac mechanical activity as confirmed by the absence of signs of circulation (eg, a detectable pulse, unresponsiveness, and apnea).1 While there is wide variation in the reported incidence of cardiac arrest, it is estimated that there are more than 350,000 people in the United States who are assessed by emergency medical services (EMS) for a suspected out-of-hospital cardiac arrest each year.1 Survival to hospital discharge following out-of-hospital cardiac arrest ...

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