Float Nurse

Near, far, wherever you are  I believe that the heart does go on…  09:53  Placed on monitor Initial rhythm 09:55 CPR Unsuccessful IV access attempt Unsuccessful IV access attempt CPR Rhythm 10:00 CPR Intubated 7.5 ET tube.  Tube placement confirmed CPR Rhythm 10:02 Epinephrine 2mg via ET tube Successful IO placement in right tibia CPR in progress CPR Rhythm 10:05 Vasopressin 40 units IO CPR in progress CPR Rhythm Check 10:09 Epinephrine 1mg IO NS fluid bolus started CPR Rhythm 10:11 Sodium Bicarbonate IO CPR in progress Adequate ventilations CPR Rhythm Check 10:15 Epinephrine 1mg IO CPR in progress CPR Rhythm 10:19 Epinephrine 1mg IO CPR in progress CPR Rhythm Check 10:24 Epinephrine 1mg IO CPR in progress CPR Rhythm 10:27  Epinephrine 1mg IO Continued CPR Final rhythm 10:28  Code ended Once more you open th...

Cardiac Arrest Associated With Pregnancy ·          Maternal mortality rate 13.95 deaths per 100 000 maternities ·          There were 8 cardiac arrests with a frequency 1:20 000. ·          Most common causes of maternal death from cardiac disease are myocardial infarction, followed by aortic dissection ·          Providers have 2 potential patients: the mother and the fetus ·          Best hope of fetal survival is maternal survival Key Interventions to Prevent Arrest ·          Place patient in the full left-lateral position ·          Give 100% oxygen. ·          Intravenous (IV) access above the diaphragm ·       ...

Continuing with the above senario.   6/25/12 11:34.   The patient is orally intubated.  Bilateral breath sounds are noted and the end-tidal CO2 detector is positive.   No gurgling noises are noted over the epigastrium.  A STAT portable chest X-ray is ordered.  Magnesium 2gm IV is given as CPR is continued.  The patient remains pulseless and apneic.   EKG Waveform Caused by CPR 31.  What are agonal  respirations ? 32. During CPR the rescuer notices that the patient's PETCO2 increases and remains between 35-45mm Hg.  What might a potential cause of this? 33.   What drugs may be administered via the ET route? a.  b.  c.  d.  e.  34. What devise has been shown to be the most effective at monitoring on going correct ET tube placement? 35.  Describe the changes in technique when performing CPR on a victim who has an advance ...

Continuing with the above senario.  6/25/12 11:30. Vasopressin is given and CPR is continued in order to circulate the medication. Although ventilations are adequate, preparations are made to intubate the patient. Given the patient's malnourished appearance, his blood sugar is checked and found to be 62. An amp of D50 is administered. EKG waveform caused by compressions .   21.  If multiple rescuers are available how often should they rotate the task of compressions? 22. What is the advantage of performing CPR prior to defibrillating a patient in VF/VT? 23. What are some advantages of placing an endotracheal tube? a.  b.  c.  d.  e.  f.  24. Describe the correct hand placement when performing chest compressions. 25. If a bystander is not trained in CPR, what is an acceptable technique for performing CPR? Continuing with the above scenario. 6/...

Continuing with the above scenario.   6/25/12 11:26.  CPR is in progress and ventilations remain adequate with good chest rise so intubation is deferred at this time.  11. What is the first vasoconstrictor that is administered during a pulseless arrest? 12. After the initial defibrillation, what are the subsequent joule settings in the treatment of pulseless VT/VF? a. Monophasic b. Biphasic 13. Name three advantage of using an oropharyngeal airway (OPA) on an unconscious victim in cardiac arrest? a. b. c. 14. What are some precautions that should be observed before applying the defibrillator pads to the patient? a. b. c. d. e. 15. During the treatment of pulseless VF/VT, how often can epinephrine be repeated? 6/25/12 11:28. Epinephrine has been given followed by a rhythm check. The patient remains in this refractory rhythm. A second defibrillation is given at 300J is given without a change in the rhythm. CPR is resumed. ...

06/25/12 11:15  A 70 year old man was brought to the emergency room by his concerned neighbors who stopped by to check on him.   He is lethargic and appears malnourished and dehydrated with sunken eyes, temporomandibular wasting, and a generally thin frail appearance.  His only know medical problem is hypertension.  His neighbors have noted that he has become more reclusive since the death of his wife 8 months ago. 06/25/12 11:21  As he is being examined he loses consciousness and his breathing becomes agonal in nature.   A code blue is announced and CPR is initiated.   He is placed on the defibrillator monitor and the following rhythm is observed: 1.  Identify the following rhythm. a.     Monmorphic VT b.     Wide complex tachycardia c.     Polymorphic VT d.     Torsades de pointe 2.  What is the initial treatment of choice for t...