Page 688 - ACCCN's Critical Care Nursing

Resuscitation 665

FIGURE 24.5 Ventricular tachycardia.

FIGURE 24.6 Ventricular fibrillation.

FIGURE 24.7 Asystole.

(adults) of an isotonic solution followed by at least 1
TABLE 24.7 Causes of pulseless electrical activity 7 minute of continuous external cardiac compressions.
Where there is difficulty accessing a peripheral vein,
The four Hs The four Ts selected medications may be administered via an IO
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route. Tracheal administration of medication is no
l Hypoxia l Tamponade
l Hypovolaemia l Tension pneumothorax longer recommended as the dose delivered is unpredict-
l Hypo/hyperthermia l Toxins/poisons/drugs able and the optimal dose is unknown. 20
l Hypo/hyperkalaemia and metabolic l Thrombosis:
disorders pulmonary/coronary Intraosseous infusion involves the insertion of a metal
needle with trocar (usually utilising a drill) into the
bone marrow and provides a rapid, safe and reliable
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central venous route remains the optimal method, but access to the circulation. The marrow sinusoids of
the decision to access peripheral versus central cannula- long bones are a non-collapsible venous system in
tion will depend on the skill of the operator. Peripheral direct connection with the systemic circulation, allowing
venous cannulation is the quickest and easiest method, drugs to reach the central circulation as quickly as medi-
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however, the patient in cardiac arrest may have inacces- cations injected into central veins. Intraosseal access
20
sible peripheral veins. Should a decision be made to is safe and effective for use in patients of all age
insert a central line during a cardiac arrest, this must groups. 72,73 General blood specimens such as biochem-
not take precedence over defibrillation attempts, CPR istry values, blood cultures, haemoglobin and cross-
or airway maintenance. Medications inserted into a match studies can also be taken from the marrow at
peripheral line should be flushed with at least 20 mL cannulation. 17