CARDIAC ARREST

• Occurs when the heart ceases to produce an effective pulse and blood circulation.
• Maybe caused by a cardiac electrical event, heart rate is too fast (ventricular tachycardia or ventricular
fibrillation) or too slow (bradycardia or AV block) or no heart rate at all (asystole).
• Pulseless Electrical Activity (PEA)- Electrical activity is prevent but theirs is ineffective cardiac
contraction or circulating volume.
Can be caused by hypovolemia, cardiac tamponade, hypothermia, massive pulmonary embolism,
medication overdoses, significant acidosis and massive acute myocardial infarction.

Clinical Manifestation

• Consciousness, pulse, blood pressure are lost immediately.

• Ineffective Respiratory gasping occur.
• Dilation of pupils within 45 seconds.
• Seizures
• Risk for irreversible brain damage and death.

Emergency Management
Cardiopulmornary Resuscitation

The ABCD’s of basic cardiopulmonary resuscitation are consists of the following steps:

1. Airway- Maintaning an open airway.

2. Breathing- Providing artificial ventilation by rescue breathing.
3. Circulation- Promoting artificial circulation by external cardiac compression
4. Defibrillation- Restoring the heartbeat.

Defibrillation is a treatment of choice rather than CPR if the patient is monitored or

immediately placed on the monitor using the multifunction pads or the quick-look
paddles and the ECG shows ventricular tachycardia or ventricular fibrillation.
Medications used in Cardiopulmonary Resuscitation

Agent and Action Indications Nursing Considerations

Oxygen- Improves tissue
oxygenation and corrects
hypoxemia.
Epinephrine (Adrenalin)
Increases systemic vascular
resistance and blood pressures,
improves coronary and cerebral
perfusion and myocardial
contractility.
Atropine
Blocks parasympathetic action,
increases SA node automaticity and
AV conduction.
Sodium Bicarbonate
Corrects metabolic acidosis
Patients with acute cardiac ischemia
or suspected hypoxemia.
Patient with cardiac arrest caused by
asystole or pulseless electrical
activity.
Caused by ventricular tachycardia or
ventricular fibrillation.
Patient with symptomatic
bradycardia.
Given to correct metabolic acidosis
thai is refractory to standard
advanced cardiac life support
interventions.
-use 100% FiCO2 during
resuscitation.
-monitor dose by end tidal CO2 or
pulse oximeter.
-adminster by IVP or ET tube
-Avoid adding to IV lines that
contain alkaline solution.
-give rapidly as 2.0-2.5 mg IVP or
ET tube.
-0.5 mg in adult can cause the HR to
decrease to a worse bradycardia.
-monitor patient for reflexive
tachycardia.
-initial dose is 1 mEq/kg IV, then
administer the dose based on thebase
deficit calculated from arterial blood
gas values.

Magnesium
Promotes adequate functioning of
the cellular sodium-potassium pump
Vasopressin (Pitressin)
Increases inotropic action
(contraction) of the heart.
Given to patient with torsades de
pointes.
An alternative to epinephrine when
cardiac arrest is caused by
ventricular tachycardia or
fibrillation.
-may give diluted over 2 minutes or
IVP.
-monitor for hypotension, asystole,
bradycardia, respiratory paralysis.
-give 40 U IV one time only.

Prevention
Intraoperative precautions include the following:

• ECG and temperature monitoring

• No stimulation during induction
• Maintenance of an adequate airway
• Oxygen and carbon dioxide monitoring
• Arterial blood pressure monitoring
• Medications
• Appropriate positioning
• Gentle handling of tissues
• Skillful anesthetic adminstration