Cardiac Arrest for B Sc and Msc Nursing

1. By :-
Baljinder Singh
M. SC. (Medical
surgical Nursing)

2. CARDIAC ARREST
Sudden stop in effective
blood circulation due to the
failure of the heart to
contract effectively.
 Medical personnel may
refer to an unexpected
cardiac arrest as a sudden
cardiac arrest (SCA).

3. PATHOPHYSIOLOGY
RISK FACTORS, ETIOLOGY
CONDUCTION ABNORMALITY IN HEART
INABILITY OF HEART TO CONTRACT
PROPERLY
DECREASED CARDIAC OUTPUT
DECREASED TISSUE PERFUSION COMPROMISED FUNCTION OF HEART
SIGN AND SYMPTOMS

4. SIGN AND SYMPTOMS
 loss of pulse
Absence of BP
Unconscious
Seizures
Chocking
Dilatation of pupil

6. DIAGNOSIS
1. Assessment of signs and symptoms
2. E.C.G
3. Serum Electrolytes
4. Cardiac Biomarkers
5. ABG Analysis
6. Chest X-Ray

7. THREE BASIC ECG PATTERNS WITH CARDIAC
ARREST
1. VENTRICULAR FIBRILLATION

8. 2. VENTRICULAR ASYSTOLE

9. MANAGEMENT
Early assessment
CPR
Defibrillation
Medications
Post cardiac care

10. TREATMENT
“Chain of Survival”
 Early access.
 Early CPR.
 Early defibrillation.
 Early advanced life support.

11. “Chain of Survival” First link – Early
access
Call for Help !
Patient evaluation
 Determine if conscious or not, by
placing one hand on patient’s forehead
and shaking shoulders gently with
another hand.
 In case of SCA patient will not
respond.

12. “Chain of Survival” Second link –
Early CPR
Steps preceding Cardiopulmonary
Resuscitation (CPR)
 Determine A,B,C of Basic Cardiac Life Support
(BCLS).
* A for Airway.
* B for Breathing.
* C for Circulation.

13.  Airway
* Head tilt
* Finger sweep.
* Jaw Thrust.
“Chain of Survival” Second link –
Early CPR

14.  Breathing
* Look – Down the line of chest to
to see it rise and fall.
* Listen – at mouth and nose for
breathing sounds.
* Feel – for expired air at patients
mouth and nose.
“Chain of Survival” Second link –
Early CPR

15.  Circulation
* Feel - carotids
“Chain of Survival” Second link –
Early CPR

16. Cardiac compressions
 Locate correct chest compression
site, 2 - fingers above xiphoid.
 Place heel of other hand on the
lower end of breast bone.
 Fingers off the chest wall.
“Chain of Survival” Second link –
Early CPR

17. Once SCA is confirmed …………
 Patient should be placed on hard surface.
 Start CPR.
 Give 2 expired breaths, followed by 30 compressions.
 Continue 30:2 cycles for CPR both for 1- & 2 -rescuers
 Compression rate – atleast 100 per minute
“Chain of Survival” Second link – Early
CPR

18. Mouth to mouth ventilation
 Remove any obvious obstruction.
 Open airway.
 Pinch victims nose.
 Give mouth to mouth ventilation.
 Repeat breaths.
“Chain of Survival” Second link –
Early CPR

19. “Chain of Survival” Second link –
Early CPR

20. “Chain of Survival” Third link – Early
Defibrillation
 CPR saves time
 The most common cause of SCA is VF, a lethal rhythm
 The only effective treatment is defibrillation

21. PADDLE PLACEMENT
2nd intercostal space to right of sternum
5th left intercostal space on anterior
axillary line

22. PADDLE PLACEMENT

23. SHOCK PROTOCOL
VF/ pulseless ventricular tachycardia (VT)
Deliver 1 shock, immediately resume CPR,
beginning with chest compressions - 5 cycles
Analyze the cardiac rhythm deliver another
shock if indicated

24. ENERGY DURING DEFIBRILLATION
Start with 120 J
Increase to 200J, 360 J
Pressure = 20 to 25 pounds

25. “Chain of Survival” Third link – Early Defibrillation
VF Defibrillation NSR
Defibrillation Electrical Current Stops VF
Sudden Cardiac Arrest (SCA)

26. “Chain of Survival” Fourth link – Early ACLS
 For advanced Cardiac Life support (ACLS) shift
the patient to the nearest hospital.
 Treat victim with medicine and advanced
therapies.
Sudden Cardiac Arrest (SCA)

27. NURSING MANAGEMENT

28. NURSING MANAGEMENT
1) ASSESSMENT :
- Observe sign and symptoms
- Observe pulse
- Assess A, B, C
- Call for help
START CPR

29. Immediate care after CPR
Level of consciousness
Vital signs
ECG
 CVP
 Urine output
 ABG value

30. NURSING DIAGNOSIS
Decreased cardiac output r/t cardiac arrest, dysrhythmia.
Assess vital signs, CVP, urinary output and peripheral pulses.
Assess heart rate and rhythm (ECG).
Oxygen administration as hypoxia can lead to further dysrhytmias.
Administer drugs, antidysrhythmic medication as ordered.
Administer fluid therapy as ordered.

31. NURSING DIAGNOSIS
Impaired tissue perfusion r/t to decreased cardiac output.
Note the color and temperature of the skin.
Monitor peripheral pulses
Monitor urine out put
Provide warm environment.

32. NURSING DIAGNOSIS
MANAGEMENTRisk for ineffective respiratory pattern r/t disease
condition.
 Assess respiratory rate.
 Auscultate breath sounds.
 Fowler’s position if difficulty.
 Monitor pulse oximetry and ABG analysis. Report any
abnormality.
 Continuous monitoring for the first half hour of
defibrillation.

33. NURSING DIAGNOSIS
Risk for fluid electrolyte imbalance r/t physiological changes.
Monitor intake and output.
Administer fluid and diuretics.
Monitor electrolytes daily and replace as ordered.
Monitor BUN, creatinine and urine electrolytes daily.

34. NURSING DIAGNOSIS
Risk for complications r/t disease process, procedure performed
and defibrillation.
 Assess level of consciousness. Reorient the time, place and person.
 Assess vital signs and ECG continuously.
 Initiate IV antidysrhythmics therapy as prescribed
 Administer IV fluid to correct fluid electrolyte imbalances

35. NURSING DIAGNOSIS
Anxiety r/t fear about unknown outcome.
 Prepare patient and family and explain what is expected.
 Clarify any misconceptions.
 Provide adequate rest to the patient.
 Encourage to ask questions related to equipments, monitoring,
treatment.

36. SUMMARY
Definition of cardiac arrest
Difference b/w heart attack and cardiac arrest
Etiology of cardiac arrest
Risk factors of cardiac arrest
Sign and symptoms of patient with cardiac arrest
Diagnosis of patient with cardiac arrest
Management of patient with cardiac arrest

37. REFERENCES
Braunwald et al:Principle of Internal
Medicine1508,1513 16th edition
Woods et al:``Cardiac Nursing’’LIPPINCOTT
Brunner& Siddharth, Medical Surgical Nursing’’
Meg Gulanick et al:Nursing Care Plan 200,204