Chapter 21: Resuscitation
Topics
● The Pathophysiology of Cardiac Arrest
● Patient Assessment
● Improving Cardiac Arrest Survival
The Pathophysiology of Cardiac Arrest
● Function of the heart is to pump blood
○ Electrical functions and mechanical functions must work together
○ Electrical stimulation causes muscle to contract
○ Pumping muscle requires oxygenated blood
○ Without oxygenated blood, pumping fails
Mechanical Failure of the Heart
● Loss of normal heart muscle structure
● Myocardial infarction
● Chronic hypertension
● Loss of normal heart valve function
● Direct trauma
● Pulseless electrical activity (PEA) indicates mechanical failure
Electrical Dysfunction of the Heart
● Cardiac conduction pathway coordinates electrical conduction through the heart
● Asystole is complete failure of the electrical system
● Disruption of heart’s electrical function generally results in dysthythmia
● Dysrhthimas:
○ Unusually slow rhythm
○ Unusually fast rhythm
○ Ventricular tachycardia (V-tach)
○ Ventricular fibrillation (VF)
● Dysrhythmias can lead to sudden cardiac arrest
● VF and V-tach are correctable
Sudden vs. Asphyxial Cardiac Arrest
● Sudden cardiac arrest
○ Abrupt onset of dysrhythmia
○ Acute blunt trauma to the chest causes commotio cordis
○ Oxygen levels are relatively normal at beginning
● Asphyxial cardiac arrest
○ Heart stopped pumping due to systemic hypoxia
○ Result of low oxygen levels in the blood
○ Appears with more warning than sudden cardiac arrest
○ Quality ventilations are important during CPR
, Agonal Respirations
● Agonal breathing occurs as a primary reflex during cardiac arrest
● Small amount of oxygen allows medulla to send impulses to respiratory muscles
● A downward spiral will end in death unless someone intervenes
Effects of Cardiac Arrest
● Heart fails to pump
● Blood stops moving
● Cells are robbed of essential oxygen and nutrients
● Organs are damaged
● Organs eventually fail
● Organism will die if uncorrected
● Goal is to intervene as early as possible
Pediatric Cardiac Arrest
● Cardiac arrests in children are generally asphyxia in nature
● Caused by choking, shock, or respiratory problem
● Cardiac arrest in children is usually a predictable outcome after steady decompensation
Patient Assessment
● Preceptual narrowing
○ Focusing only on the patient
● Use situational awareness
● Primary assessment identifies three key features of cardiac arrest:
○ Unresponsiveness
○ Apnea
○ Absence of pulse
● If cardiac arrest is identified, begin chest compressions immediately
Sudden Unexpected Infant Death Syndrome (SUIDS)
● Three commonly reported types of SUID:
○ Sudden infant death snydrome (SIDS)
○ Unknown cause
○ Accidental suffocation and strangulation in bed
● Typical SUIDS patient
○ Cardiac slowdown and sleep apnea
○ Eventually will stop breathing and not start again
○ Episode will be fatal if infant not reached in time
● Unless there is rigor mortis, provide resuscitation
● Provide emotional support to the parents
Improving Cardiac Arrest Survival
Chain of Survival
● Five elements
Topics
● The Pathophysiology of Cardiac Arrest
● Patient Assessment
● Improving Cardiac Arrest Survival
The Pathophysiology of Cardiac Arrest
● Function of the heart is to pump blood
○ Electrical functions and mechanical functions must work together
○ Electrical stimulation causes muscle to contract
○ Pumping muscle requires oxygenated blood
○ Without oxygenated blood, pumping fails
Mechanical Failure of the Heart
● Loss of normal heart muscle structure
● Myocardial infarction
● Chronic hypertension
● Loss of normal heart valve function
● Direct trauma
● Pulseless electrical activity (PEA) indicates mechanical failure
Electrical Dysfunction of the Heart
● Cardiac conduction pathway coordinates electrical conduction through the heart
● Asystole is complete failure of the electrical system
● Disruption of heart’s electrical function generally results in dysthythmia
● Dysrhthimas:
○ Unusually slow rhythm
○ Unusually fast rhythm
○ Ventricular tachycardia (V-tach)
○ Ventricular fibrillation (VF)
● Dysrhythmias can lead to sudden cardiac arrest
● VF and V-tach are correctable
Sudden vs. Asphyxial Cardiac Arrest
● Sudden cardiac arrest
○ Abrupt onset of dysrhythmia
○ Acute blunt trauma to the chest causes commotio cordis
○ Oxygen levels are relatively normal at beginning
● Asphyxial cardiac arrest
○ Heart stopped pumping due to systemic hypoxia
○ Result of low oxygen levels in the blood
○ Appears with more warning than sudden cardiac arrest
○ Quality ventilations are important during CPR
, Agonal Respirations
● Agonal breathing occurs as a primary reflex during cardiac arrest
● Small amount of oxygen allows medulla to send impulses to respiratory muscles
● A downward spiral will end in death unless someone intervenes
Effects of Cardiac Arrest
● Heart fails to pump
● Blood stops moving
● Cells are robbed of essential oxygen and nutrients
● Organs are damaged
● Organs eventually fail
● Organism will die if uncorrected
● Goal is to intervene as early as possible
Pediatric Cardiac Arrest
● Cardiac arrests in children are generally asphyxia in nature
● Caused by choking, shock, or respiratory problem
● Cardiac arrest in children is usually a predictable outcome after steady decompensation
Patient Assessment
● Preceptual narrowing
○ Focusing only on the patient
● Use situational awareness
● Primary assessment identifies three key features of cardiac arrest:
○ Unresponsiveness
○ Apnea
○ Absence of pulse
● If cardiac arrest is identified, begin chest compressions immediately
Sudden Unexpected Infant Death Syndrome (SUIDS)
● Three commonly reported types of SUID:
○ Sudden infant death snydrome (SIDS)
○ Unknown cause
○ Accidental suffocation and strangulation in bed
● Typical SUIDS patient
○ Cardiac slowdown and sleep apnea
○ Eventually will stop breathing and not start again
○ Episode will be fatal if infant not reached in time
● Unless there is rigor mortis, provide resuscitation
● Provide emotional support to the parents
Improving Cardiac Arrest Survival
Chain of Survival
● Five elements
