Cardiac Arrest

1
Cardiac Arrest

• By Kristi Eilers and Hali Saucier, N441 Senior
  Seminar

2
What is V-fib? What does a patient with V-fib
look like?
3
Ventricular Fibrillation

• ventricle quivers.
• No effective contraction
• No cardiac output.
• Pt is unresponsive, pulseless, apneic.

Lewis S.L., Heitkemper M.M., Dirkesen S.R.,
OBrien P.G., Bucher L. (2007). Medical
surgical nursing Assessment and management of
clinical problems (7th ed.). St. Louis Mosby
Elsevier.
4
Fill in the blank The mitral valve separates
the __________and the __________.
5

• The mitral valve separates the left atrium and
  the left ventricle.

6
What is MVP?(and no, were not talking about
sports!)
7
Mitral Valve Prolapse

• One or both cusps of the mitral valve fall back
  into LA during contraction
• Congenital defect
• May have a murmur
• Can lead to heart failure
• SCD is a rare complication of MVP

Lewis S.L., Heitkemper M.M., Dirkesen S.R.,
OBrien P.G., Bucher L. (2007). Medical
surgical nursing Assessment and management of
clinical problems (7th ed.). St. Louis Mosby
Elsevier.
8
What is the difference between A-fib and
A-flutter?
9
Atrial dysrhythmias

• A-fib
• Disorganized electrical activity due to multiple
  ectopic foci.
• High atrial rate, not all the signals get
  through.
• Most common dysrhythmia
• A-flutter
• Atrial tachydysrhythmia
• sawtooth pattern
• Regular, flutter waves
• Originates from a single ectopic source

Lewis S.L., Heitkemper M.M., Dirkesen S.R.,
OBrien P.G., Bucher L. (2007). Medical
surgical nursing Assessment and management of
clinical problems (7th ed.). St. Louis Mosby
Elsevier.
10
What type of drug is dopamine? What does it do?
11
Dopamine

• ß-adrenergic agonist
• ?HR
• ?CO
• ?BP

12
What type of drug is lidocaine? What does it do?
13
Lidocaine

• Antidysrhythmic drug
• Sodium channel blocker (decreases conduction
  velocity)
• Also used as a local anesthetic

14
What is the equation for cardiac output?
15
CO HR X SV
16
What is sudden cardiac death or cardiac arrest?
What are the risk factors?
17
Sudden Cardiac Death

• Unexpected death from cardiac causes within 1
  hour of the onset of symptoms.
• Abrupt disruption of cardiac function, producing
  and abrupt loss of CO and cerebral blood flow.
• 300,000 deaths per year
• Caused by acute ventricular dysrhythmias, or
  primary left ventricular outflow obstruction
  (aortic stenosis)
• AKA cardiac arrest
• Still referred to as SCD even if victim survives

(Copstead Banasik, 2005) (Lewis, 2007)
18
Risk factors for SCD

• CAD (especially hx of MI)
• Family hx
• Arrhythmias
• Birth defects of heart or blood vessels, or an
  enlarged heart (MVP)
• Heart failure
• Recreational drug use (cocaine)

19
Labs

• Acute Coronary syndrome/MI
• CK-MB
• Troponin
• Myoglobin
• Lipid panel
• CBC
• C-reactive protein
• Homocysteine
• BNP evaluate HF
• PT/INR (coumadin)
• Digoxin level
• K hyperkalemia?ST-segment depression.
  Hypokalemia?dig toxicity, dysrhythmias
• Mg low Mg can aggravate arrhythmias. High
  retards conduction.
• ABGs to evaluate oxygenation
• Blood glucose MI can increase glucose levels
  because of stress to body

Pagana K.D., Pagana T. J. (2006). Mosbys
manual of diagnostic and laboratory tests (3rd
ed.). St. Louis Mosby Elsevier.
20
Lidocaine Toxicity?

• S/s HA, drowsiness, tremor, paresthesia,
  tinnitus, nystagmus, blurred vision, slurred
  speech, dizziness, confusion, disorientation,
  hyperactivity, coma, seizures.
• Toxicity is 5mg/L, severe toxicity is greater
  than 9mg/L. (K.Ks level was 16.8)
• Toxicity symptoms persist for as long as drug
  levels are toxic in the blood (Peralta, 2007).
• Half-life The amount of time it takes for the
  drug level to decrease by 50 (Deglin
  Vallerand, 2007).
• Terminal half-life of lidocaine 2 hrs

Wooten, J.M., Earnest, J., Reyes, J. (2000).
Review of common adverse effects of selected
antiarrhythmic drugs. Critical Care Nusing
Quarterly, 22(4), 23-38.
21
An ICD monitors the heartbeat and delivers shock
when it detects lethal dysrhythmia.
Implantable Cardioverter Defibrillator
22
Discharge Instructions for ICD

• Information from table 36-9 in Lewis
  medical/surgical textbook
• Follow up with PCP
• Report any s/s of infection at the incision site
• Keep incision dry for 4 days
• Avoid lifting arm on ICD side above shoulder
  until approved by PCP
• Discuss resuming sexual activity with PCP. Its
  safe once the incision is healed.
• Avoid driving until cleared with PCP
• Avoid direct blows to ICD site
• Avoid large magnets and strong electromagnetic
  fields because they may interfere with the device
• Never have an MRI
• Inform airport security when traveling because it
  may set off the metal detector.
• IF your ICD fires, call health care provider
  immediately
• IF your ICD fires and you do not feel well,
  contact EMS
• Wear a medic alert ID or bracelet at all times
• Always carry the ICD identification card and a
  current list of your medications
• Family members should learn CPR.

23
Sexual Concerns

• According to a 2003 study in Critical Care
  Nursing
• Patients need written education tools specific to
  sexual issues for patients/partners
• Health care professionals need educational
  resources to pass on to patients
• 42.5 of ICD patients in the study reported a
  concern that sexual activity would trigger the
  device.
• 82 of subjects reported that their ICD had not
  fired during sex
• ICD firing only happened in 3 patients within a
  year (there were about 387 participants)

• TIPS
• ICD patients can resume sexual activity after
  incision is healed
• Alter positions to decrease physical activity and
  strain
• Slow down, make sex relaxing
• Alternative ways of expressing sexuality
  (touching, holding, etc.)
• Is there a better way to go? Dr. Carr ?

24
Nursing Diagnoses

• Fluid Volume Excess
• Knowledge deficit
• Ineffective Health-Maintenance
• Fear
• Risk for infection
• Confusion (possibly chronic)

25
Works Cited

• Ackley B.J. Ladwig G.B. (2006). Nursing
  diagnosis handbook A guide to planning care (7th
  ed.). St. Louis Mosby Elsevier.
• Channer, K., Morris, F. (2002). ABC of clinical
  electrocardiography Myocardial ischaemia.
  British Medical Journal, 324(7344) 10231026.
  Retrieved March 2, 2008 from http//www.pubmedcent
  ral.nih.gov/articlerender.fcgi?toolpmcentrezarti
  d112295720.
• Copstead L.C., Banasik J.L. (2005).
  Pathophysiology (3rd ed.). St. Louis Elsevier
  Saunders.
• Deglin J.H., Vallerand A.H. (2007). Daviss
  drug guide for nurses (10th ed.). Philadelphia
  F.A. Davis Company.
• Dougherty, C.M., Lewis, F.M., Thompson, E.A.,
  Baer, J.D., Kim, W. (2004). Short-term efficacy
  of a telephone intervention by expert nurses
  after an implantable cardioverter defibrillator.
  Pacing Clinical Electrophysiology, 27,
  1594-1602.
• Dougherty, C.M., Pyper, G.P., Benoliel, J.Q.
  (2004). Domains of concern of intimate partners
  of sudden cardiac arrest survivors after ICD
  implantation. Journal of Cardiovascular Nursing,
  19(1), 21-31.
• Kamphius, H., Verhoeven, N., De Leeuw, R.,
  Derksen, R., Hauer, R., Winnubst, J. (2004).
  ICD a qualitative study of patient experience
  the first year after implantation. Journal of
  Clinical Nusing, 13, 1008-1016.
• Lewis S.L., Heitkemper M.M., Dirkesen S.R.,
  OBrien P.G., Bucher L. (2007). Medical
  surgical nursing Assessment and management of
  clinical problems (7th ed.). St. Louis Mosby
  Elsevier.
• Mayo Clinic Staff (2006) Implantable
  cardioverter-defibrillators Controlling a
  chaotic heart. Retrieved March 2, 2008 from
  http//www.mayoclinic.com/print/implantable-cardio
  verter-defibrillator/HB00003/METHODprint
• Pagana K.D., Pagana T. J. (2006). Mosbys
  manual of diagnostic and laboratory tests (3rd
  ed.). St. Louis Mosby Elsevier.
• Peralta, Ruben. (2007) Lidocaine toxicity.
  Retrieved March 4, 2008 from http//www.emedicine.
  com/MED/topic1297.htm
• Peskine, A., Picq, C., Pradat-Diehl, P. (2004).
  Cerebral anoxia and disability. Brain Injury,
  18(12), 1243-1254.
• Steinke, E. (2003). Sexual concerns of patients
  and partners after an implantable cardioverter
  defibrillator. Dimensions of Critical Care
  Nursing, 22(2), 89-96.
• Wooten, J.M., Earnest, J., Reyes, J. (2000).
  Review of common adverse effects of selected
  antiarrhythmic drugs. Critical Care Nusing
  Quarterly, 22(4), 23-38.