Page 217 - Critical Care Nursing Demystified

202 CRITICAL CARE NURSING DeMYSTIFIED

Cardiac Arrest: Your Worst Nightmare

Arrest in VT or VF

7 In a pulseless VT and VF, effective defibrillation is to be done as soon as the
arrest occurs. Survival depends on early recognition and defibrillation. The theory
behind defibrillation is that it depolarizes all cardiac cells at once, allowing the
SA node pacemaker to try to regroup and capture the heart into an NSR.
Pads are applied to the chest under the right clavicle and in the left apex of the
heart. A shock is delivered after calling “all clear?” Three shocks are delivered and
if the rhythm is unchanged, CPR and drugs are initiated along with continued
shocks. Drugs usually given include epinephrine or vasopressin; lidocaine, amio-
darone, or magnesium could also be ordered. Epinephrine is commonly used in
almost every arrest scenario, so it is one of the drugs the nurse can get ready right
away. CPR and defibrillation continues until the patient reverts to NSR or CPR
and defibrillation is stopped if the patient’s heart cannot be revived. Sodium
bicarbonate can be given but only after a set of ABGs indicates acidosis.

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Because there is no electrical discharge from the heart, effective CPR is the
treatment for asystole. Treating the underlying cause is important, so every effort
to identify this is important. After intubation and a patent IV is established,
epinephrine is administered and can be repeated every 3 to 5 minutes. One
dose of vasopressin can be given in lieu of the first or second dose of epineph-
rine, after which an IV push of atropine can be given. This continues until an
external or temporary transvenous pacemaker is inserted to spark the heart
from within. Asystole carries a high mortality rate, but resuscitation will con-
tinue until the patient’s rhythm returns or resuscitation attempts stopped.

Induced Hypothermia
The American Heart Association advises inducing hypothermia for unconscious
adults who receive CPR within 10 minutes of their down time (arrest). Mild
hypothermia is induced with ice packs to the groin and axilla. Iced saline can
also be administered via a nasogastric tube until a cool blanket can be obtained.
While caring for the patient post-arrest, the nurse insures sedation and moni-
tors cooling and neuromuscular paralysis. Complications of hypothermia
include acid-base and fluid/electrolyte disturbances, hypotension, pneumonia,
sepsis, further dysrhythmias, hyperglycemia, and coagulopathies.