Please enable JavaScript.

Coggle requires JavaScript to display documents.

Cardiopulmonary arrest (CODE), Arterial pressure monitoring, Pulmonary…

- - - - threatened airway
      - RR <8 or >28
      - Spo2 <90%
      - HR <40 or >140
      - SBP >180 or <90
      - urine output <50ml/4hrs (12.5/hr)
      - acute mental status change
      - Staff has significant concert
- - - - -systemic inflammatory response syndrome (SIRS) (not infection but looks like sepsis)
      - -clotting
      - -lung, bowel, and renal injury
      - -impaired immunity (treat underlying aggressively)
      - -impaired vasoregulation (overcompensate after)
      - -myocardial dysfunction (MI, dysrhythmias, decreased EF/CO)
      - -adrenal dysfunction (hormone change, not responding to tissue, change blood sugar)
- - - - Noninvasive and invasive techniques
        
        Nursing
        
        sedation, analgesia, and paralysis meds
        
        shivering management : sedate and/or paralyze (Mg, buspirone, dexmedetomidine, meperidine, propofol)
        
        Electrolyte management: especially K
        
        Rewarming: monitor BP and glucose
- - - - inflate PAOP balloon (red=stop sign so don't use it)
  - - - SvO2
  - - - infusions (IV fluids are clear so it's for meds)
  - - - core temp/CO
  - - - CVP pressure
  - - - continuous CO
  - - - PA pressure
  - - - pacing wires
  - - - Function
- - - - more than 0.12
- - - - more than 3 in a row considered v tach
  - - - amiodarone
- - - - CPR for at least 3 min after defib regardless or rhythm change
      - epinephrine 1 mg every 3-5 min IV
      - repeat defib every 2-5 min
      - amiodarone IV bolus or lidocaine IV
      - EARLY DEFIBRILLATION 120-200J
    - - determine stability
      - unstable: synchronized cardioversion, adenosine
      - stable: adenosine, procainamide, amiodarone, cardioversion
- - - - confirm in 2 leads
      - CPR for 2 min
      - epinephrine 1 mg every 3-5 minutets with CPR between doses
      - NO SHOCK
  - - - H and Ts
        
        hypoxia
        
        hydrogen ions (acidosis)
        
        hyper/hypokalemia
        
        hypothermia
        
        Toxins
        
        tamponade,cadiac
        
        tension pneumothorax
        
        thrombosis (pulmonary or cardiac)
    - - must treat underlying cause for successful treatment
      - treat as asystole until cause found
- - - - teaching, assessment and monitor
    - - monitor pacer function (note pacer spikes)
      - passive ROM of affected arm
      - basic wound care + signs of infection
      - lifting restrictions (follow orders)(usually no lifting over 10 lb for 2 months
      - avoid large magnets, welding, MRIs, constricting clothing
      - may set off metal detectors
      - give ABX
- - - - tip of cath lies against inside wall of right ventricle
        
        infection rates
    - - central line management
      - daily xray to confirm placement
      - secure pacemaker box to pt or bed
      - continous cardiac monitoring
      - battery change per protocol - keep 9V batteries on hand
      - maintain secure connections with catheter, pacemaker and leads
      - disconnect leads to change battereis or defibrillate
      - set rate and output
      - assess pulse, VS, LOC, etc
  - - - cardiac and VS monitor
      - pain management and sedation
      - bed rest
      - teaching
      - burn care to skin when pads are removed
  - - - pacing lead through chest wall
      - usually discontinued a few days after surgery by pulling wire
- - - - progressively longer PR interval until a QRS is dropped
    - - same as brady
  - - - more ominous. may lead to complete heart block. PR interval normal or prolonged but consistent with dropped QRS
      - normal PR then randomly drop 1 or more in a row
    - - same as brady
  - - - PR longer than normal
        
        longer than .2 sec/5 boxes
      - looks sinus but is slowly getting longer
    - - usually benign so none
  - - - atria 60-100, ventricle 20-40. no association or pattern between P and QRS
    - - same as brady
  - - - HR 150-300, QRS normal width, no P
    - - vagal menuevers, adenosine, calcium or beta blockers, synchronized cardioversion
    - - synchronized cardioversion, adenosine
- - - - cardioversion
    - - rate control and metoprolol/amiodarone to stabilize
      - drips: amiotorone, ismalol, and heparin
    - - calcium channel blocker, digoxin, or amiodarone and anticoagulation for life
    - - must anticoagulate with heparin and/or get echo before trying to retube pt to sinus
- - - - set energy (120-200 for biphasic, 360 for monophasic)
      - "CLEAR"
      - Turn on and ensure connections
      - press fire
      - Place pads (anterior/posterior or sternal/lateral)
      - CPR for 2 min THEN check rhythm and pulse
      - Do not delay for anything!
  - - - must wear vest at all times
      - change battery daily
      - charge second battery daily
      - only remove to shower
      - attend to tone/vibrations
- - - - 30-50% 2 year mortality after SCD without ICD
      - 2% year mortality with ICD
    - - repeat VT/VF that can't be treated or pt noncompliance
    - - reversible cause of dysrhythmia
    - - psychosocial support and evaluation (stress life saver)
- - - - Increased: ??
      - Decreased:??
- - - - atropine 0.5mg IV, repeat every 3-5min up to 3 mg
      - pacing
      - drips: dopamine, epinephraine
- - - - meds: beta or calcium channel blockers