Cardiopulmonary Arrest Simulation Lab

1. Risk factors that predispose a patient to sudden cardiac arrest include a. Previous cardiac arrestb. Hx of MIc. short QT intervals on ECGd. hx of abnormal heart rhythm (example: ventricular fib. or tachycardia) e. HTN especially pulmonary HTNf. hx of myocardial aneurysmg. cardimyopathic hypertrophy (enlarged heart, especially left ventricle)h. CVDi. Diabetesj. illicit drug use (especially cocaine)k. electrolyte imbalances (hyperkalemia) –> sudden dysrhythmia/arrhythmial. tamponadem. blunt force trauma to the chestn. electric shock

2. Assessment findings that establish a patient is in cardiopulmonary arrest: a. Altered level of consciousness (lack of response)b. Absence of breath or labored breathing/agonal gaspingc. Cyanosis around mouth/tongued. No pulse

3. The steps of BLS include: compressions (circulation), airway and breathing. Assessing the patient is done first. You should look to see if the patient is breathing or gasping and if they have an altered LOC/if they can respond. Compressions are done now so that there won’t be a delay in circulating the blood and getting oxygen to the heart and brain. Chest compressions are the foundation of CPR. The next step is airway. This must be done before breaths are given to ensure air is reaching the lungs. Breathing is done next. 2 breaths are given for every 30 compressions. This gets oxygen to the patient’s heart and brain, which is key to survival.

4. Describe these rhythms: a. Ventricular tachycardia: very fast heart rhythm. It originates in one of the 2 ventricles of

th e heart and dramatically decreases CO. b. Pulseless ventricular tachycardia: same as the above but CO has decreased so much it’s

no longer effective so there is no pulse cardiac arrestc. Ventricular fibrillation: the ventricles of the heart are no longer have synched

contractions which causes a decrease in CO

5. Immediate steps to take for ventricular tachycardia or fibrillation are CPR, AED, epinephrine and intubation.

6. Safety measures to take when a patient is defibrillated are to make sure the patient and the surroundings are dry (to decrease chance of electrocuting patient or others), do not touch the patient or the bed (again to decrease chance of accidentally shocking self or others), shout all clear once you have assured the area is dry and no one is touching the patient or bed.

7. The progression of defib. if the patient doesn’t respond to the first attempt is as follows: increase the charge from 200 to 300 J. If this doesn’t work increase to 360 J. If the first 3 steps don’t work, then start CPR, intubate the patient and start an IV line. The following meds should be given in this order: epinephrine, amiodarone/lidocaine, magnesium and pronestyl. After epinephrine is given defib. the patient again at 360 J. Then proceed with other drugs with a shock in between each drug given.

8. Common medications used to treat pulseless ventricular tachycardia and ventricular fibrillation include:

a. VF: i. Epinephrine: jump starts the heart by initiating fight-or-flight response cause the

heart to beat faster increasing CO more blood to vital organs such as the heart and brain

1. Dosage: 1 mg IV push every 3-5 minutes with no max dosage2. Vasopressin can be given instead of epinephrine. 40 units IV push can

be givenii. amiodarone/lidocaine

iii. magnesiumiv. pronestylv. the antidysrhthmic drugs are alternated with shock because the drugs increase

the fibrillation threshold and the shock helps break the cycle of fibrillationb. pulseless VT:

i. defibrillation is the only real solutionii. if left untreated asystole or VF can occur. Start VF tx if this occurs

9. The interaction between CV medication and defib. are that the drugs jump start the heart, keep blood flowing which helps vital organs receive oxygen, helps the heart respond better to the shock.

10. It is necessary to assess the patients pulse if the ECG shows sinus rhythm because the monitor can show a rhythm even if the patient doesn’t have a pulse, there can be a problem with the leads, and the heart needs time to recover after shock and might send electric impulses but not beat, if this happens CPR must be done

11. Family can be present during a code but it depends on the situation. If someone on staff can be with the family during the time of code to keep them calm, it can be helpful to the family members mentally and emotionally to see what is going on and in the case of death, that everything possible was done. If the family member wishes to stay during a code and the staff member can be present then it can be beneficial depending on the situation. However, if a staff member cannot be present then the patient could become hysterical and cause delays/complications during the code.