Cardiac Arrest

  1. General information: sudden, unexpected cessation of breathing and adequate circulation of blood by the heart
  2. Medical management
    1. Cardiopulmonary resuscitation (CPR); see below
    2. Drug therapy
      1. Lidocaine, procainamide, verapamil
      2. Dopamine (Intropin), isoproterenol (Isuprel), norepinephrine (Levophed): see also Drugs Used to Treat Shock, Table 4.9
      3. Epinephrine to enhance myocardial automaticity, excitability, conductivity, and contractility
      4. Atropine sulfate to reduce vagus nerve's control over the heart, thus increasing the heart rate
      5. Sodium bicarbonate: administered during first few moments of a cardiac arrest to correct respiratory and metabolic acidosis
      6. Calcium chloride: calcium ions help the heart beat more effectively by enhancing the myocardium's contractile force
    3. Defibrillation (electrical countershock)
  3. Assessment findings: unresponsiveness, cessation of respiration, pallor, cyanosis, absence of heart sounds/blood pressure/palpable pulses, dilation of pupils, ventricular fibrillation (if client on a monitor)
  4. Nursing interventions: monitored arrest caused by ventricular fibrillation
    1. Begin precordial thump and, if successful, administer lidocaine.
    2. If unsuccessful, defibrillation.
    3. If defibrillation unsuccessful, initiate CPR immediately.
    4. Assist with administration of and monitor effects of additional emergency drugs.

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