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Cardiac Arrest

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					                                                                  Primary Health Care Services

                                                        Date of last review       2009

    Community Health Centre Clinical Practice Guidelines for Primary Care Nurses

                                       Cardiac arrest
1. Presentation:
        Client who presents with or develops cardiac arrest.


2. Purpose:
        To provide rapid assessment and interventions for clients presenting with cardiac
        arrest.


3. Definition:

          Absent or inadequate contraction of the left ventricle of the heart that immediately
          causes body- wide circulatory failure

Cardiac arrest (or sudden cardiac arrest, sudden cardiac death) is a medical emergency.


4. Etiology:
          Cardiac arrest may have a variety of causes – heart disease, drowning, stroke,
          electrocution, suffocation, drug overdose, motor vehicle or other injury. The most
          common causes of cardiac arrest are electrical problems in the heart with ventricular
          fibrillation representing the major type. In ventricular fibrillation, there is loss of
          coordinated ventricular contractions leading to immediate loss of effective output of
          blood by the heart, resulting in circulatory arrest. A medical emergency with absent or
          inadequate contraction of the left ventricle of the heart that immediately causes body
          wide circulatory failure.

5. Signs and Symptoms:
The signs and symptoms can include
       loss of consciousness
       rapid shallow breathing progressing to apnea (absence of breathing);
       profoundly low blood pressure (hypotension) with no pulses that can be felt over major
        arteries;
       absence of heart sounds.
   6. Assessment:
          Check respirations
          Check pulse
          Check for Medical Alert bracelet or medal.

   7. Intervention:
             Check for unresponsiveness and activate the emergency response system.
             Have someone Dial 9-911 immediately, request an ambulance and notify the on-site
             physician.

Initiate BLS interventions:
         Airway Place an oropharyngeal airway, clear obstructions and suction as required.
         Breathing Ventilate using pocket mask or bag valve mask and oxygen.
         Circulation Once pulselessness established, start chest compressions.
         Defibrillation
               o Attach AED and follow instructions or defibrillator and follow policies specific to
                  your facility.
If pulse is present:
         Maintain ABCs
         Start an IV of NaCl TKVO

Care of the patient is to be immediately transferred to the EMS upon their arrival.
At no time should transport of the patient be delayed for treatment. Treatment will continue
en route as per EMS protocols.
Following departure of patient, contact the Emergency Department to advise that the patient is being
transported and provide a report to the receiving nurse.

   8. Referral to Physician:
             For any patient with cardiac arrest notify the on-site physician if any and/or call 9-911

   9. Follow-up:
             Will be done by receiving hospital.
FRAMEWORK FOR DECISION-MAKING

      Adult BLS Algorithm
Pediatric BLS Algorithm
    Healthcare provider summary of steps of CPR for adults, children and infants 
                             Adults and older 
                                                               Child                   Infant 
                                      child 
              CPR                                         (1 year old to         (less than 1 year 
                                 (puberty and 
                                                               older)                    old) 
                                     older) 
     Establish that the 
                                Activate your 
       victim does not 
                                  emergency 
            respond                                       Activate your emergency response 
                            response system as 
         Activate your                                    system after giving 5 cycles of CPR 
                             soon as the victim 
           emergency 
                                    is found 
       response system 
      Open the airway 
      Use head tilt‐chin               Head tilt‐chin lift (suspected trauma: jaw trust) 
               lift 
      Check breathing 
      If the victim is not 
                                             Open the airway, look, listen and feel 
       breathing, give 2 
                                   Take at least 5 seconds and no more than 10 seconds 
      breaths that make 
         the chest rise 
                                                         Give 2 breaths 
        First 2 breaths 
                                                        (1 second each) 
                                                                                 Brachial pulse(if 
                                                      Carotid pulse (if no 
          Check pulse                                                           no pulse or pulse 
                                Carotid pulse          pulse or pulse is< 
      At least 5 seconds                                                         is< 60 bpm with 
                              (if no pulse, start  60 bpm with signs 
      and no more than                                                             signs of poor 
                                      CPR)             of poor perfusion, 
           10 seconds                                                             perfusion, start 
                                                             start CPR 
                                                                                         CPR 
     Start CPR 
           Compressio                                                          Just below nipple 
                              Center of breastbone between nipples 
               n location                                                      line on breastbone 
                                                                                      2 fingers 
           Compressio        Heel of 1 hand, other hand on top(or 1                 (2 thumb‐
                n method                hand for small victims)                  encircling hands 
                                                                               for 2‐rescuer CPR) 
           Compressio
                               1½ to 2 inches                        to ½ depth of chest 
                 n depth 
           Compressio                                             
                  n rate                                 100 per minute 
           Compressio
                                      30:2 
                     n‐                                           30:2 for 1 rescuer CPR 
                               (1 or 2 rescuer 
               ventilation                                       (15:2 for 2 rescuer CPR) 
                                      CPR) 
                   ratio 
                                                                
 
                                  NURSES PRACTICE GUIDELINES
                                         Cardiac Arrest


  Cardiac arrest at________               Respiratory arrest at _______

   911 called at __________               On-site physician notified

   Airway oropharyngeal size ________

   Ventilation with oxygen started at _____   Pocket mask       Bag valve mask
Stopped at__________

   Chest compressions started at___________stopped at__________________

   AED or defibrillator analyzed at_____ _____ _____ _____ _____ _____ ____

   AED or defibrillator shocked at _____ _____ _____ _____ _____ _____ ____

   IV NaCL started at_____ size ________ site_______

   Vitals signs __________ __________ __________ __________ __________ __________
__________ __________ __________ __________ __________

   Medications given _______________________________________________

   Prepare patient for transfer

   Complete transfer sheet

   Phone report to the receiving hospital at _____



Nurse signature: _______________________              Date: ____________
                                         REFERENCES



Hearth and stroke, BLS for Healthcare Providers 2005.
      Retrieved May 31, 2008 from
      http://www.aclsclasses.com/blsalgorithm.pdf

Heart and stroke foundation, warning signs 2008. Retrieved May 31, 2008 from
      http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483917/k.8E6D/Warning_signals.htm.

Province of New Brunswick, Provincial Medical Protocol, Adult Protocol: Cardiac arrest overview,
      Policy and Procedure Manual, Last updated September 20, 2007

WebMD eMedecine Health, definition of cardiac arrest 2008. Retrieved May 31, 2008 from
    http://www.emedicinehealth.com/script/main/art.asp?articlekey=11095

				
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