Cardiac Emergencies

Respiratory and Cardiac
Emergencies
Objectives
At the completion of this unit, learners will be able to:

 Describe various conditions classified as cardiac emergencies.
 Predict the risk factors that may result in cardiac emergencies.
 Discuss pathophysiological and ecological changes leading to cardiac arrest.
 Identify the tools for BCLS in an ER and in patient care setting versus arrest
situation outside health care facilities.
 Demonstrate a basic understanding of management of cardiac arrest in an in
patient care setting.
 Demonstrate commonly used drugs in management of cardiac arrest.
 Describe complication of CPR.
Cardiac Emergencies
 Cardiac emergencies are life threatening situations that must be

recognized immediately to avoid delay in the treatment and to
minimize morbidity and mortality.
 Patient may present with severe chest pain, hypertension,
dysrhythmia, or cardiopulmonary arrest.
Cardiac Emergencies
 Myocardial Infarction
 Angina Pectoris
 Sudden cardiac Arrest
 Cardiac Tamponade
 Cardiogenic Shock
Sudden Cardiac Death
 When heart ceases to beat effectively and breathing soon ceases, a

person is said to have experienced sudden cardiac death.
 In order to meet the criteria for this diagnosis, the circulatory
collapse must be;
 Unexpected.
 It must relate in some manner to heart problems.

 It should occur with minimal warning or complete absence of
prelude symptoms.
Cardiac Arrest
 Cardiac arrest is also known as cardiopulmonary arrest or

circulatory arrest.
 It is the end of normal circulation of the blood due to failure of the
heart to contract.
Causes
 Coronary heart disease

 Non IHD
 Cardiomyopathy
 Hypertensive Heart disease.
 CHF
 Cardiac rhythm disturbances.
 Trauma
 Pulmonary embolism.
Cardiac Tamponade
 An acute type of pericardial effusion, characterized by fluid

accumulation in the pericardium.
Causes
 Pericardial Effusion.
 Pericarditis
 Heart tumors
 Hypothyroidism
 Kidney failure
 Leukemia.
 CV line, radiation therapy, surgery.
 Sytemic lupus erythematous.
Cardiogenic Shock
 Cardiogenic shock is characterized by a decreased pumping ability

of the heart that causes a shock like state.
 It is commonly associated with acute myocardial infarction.
Risk factors
 Coronary heart disease

 Arrhythmias (Atrial Fibrillation, Long QT syndrome)
 Heart Damage
 Congenital Heart problems
 Heart Failure
 Age and Sex
 Race and ethnicity.
 Family History.
Continued
 Respiratory arrest
 Diabetes
 Medicines like antibiotics, diuretics and heart medicines.
 Trauma to chest.
 Smoking
 HTN
 Hyperlipidemia
Pathophysiological and ecological changes leading to cardiac arrest
Hyper
Hypoxia acidosis kalemia
Increase in H ions Increase

intracellular sodium ions
reverse sodium
calcium
exchanger Cardiac
Arrythmias
or Arrest
 Hypoxia will lead to increase CO2 level in cells, leading to
acidosis(low PH).
 NHE ensures extrusion of H+ ions while to maintain
electroneutrality, Na+ are transported interior of the cell.
 In hyperkalemic situation, the sodium gates are inhibited(Na /K
pump ceases).
 The Increase in Na+ ions level activates the reverse mechanism of
NCE.
 This increases the ventricular arrythmias plus deprive oxygen level
causes myocardial damage, leading to cardiac arrest.
Ecological Factors
 Air pollution, causes 80 percent of deaths, results in ischemic heart

disease and stroke.(WHO)
 Lead arsenic and cadmium are key chemicals in environment
causing progression of CVD.
 Smoking and Diabetes, key factor to changes in pathophysiology
resulting in CVD.
 Changes in blood pressure, lipids, vascular function and
antheriosclerosis effects the CVS, resulting from above factors.
Tools For BCLS
 Well trained staff (master Trained in BCLS)  Suction

 ECG Machine  Salines
 Defibrillator or AED  Atropine, epinephrine.
 Resuscitation masks(for adults and children, 2 each).  Amiodarone
 Gloves  Naloxone.
 An Oropharyngeal.
 Oxygen cylinder.
Outside patient setting
While you are outside setting,

 Make sure you are on safe site.
 Call the emergency if cardiac arrest, as there are no equipments
available.
 Call for help too.
 Begin the compressions.
Management
 Early recognition.
 Early CPR
 Early Defibrillation.
Medication
 Epinephrine, amiodarone and atropine.
 Vasopressin (can be effective for systole increase).
Management Of Cardiac Arrest
 Asses the patient for response.

 Check pulse and respiration.
 If arrest, call cardiac team and begin CPR.
 Give 2 breaths after 30 compressions for adult.( 15 for children)
 Connect Cardiac monitor and document all the event.
 Monitor the ABGs.
 Perform ECG
 IV Cannula.
 On ECG the Rythym will be either shockable or non shockable.
 Shockable( Ventricular Febrillation) can be treated with
Defibrillator shock.
 Used AED to deliver shock. Resume CPR after SHOCK. Check
the rhythm after 5 cycles and give shock again if necessary.
Continue CPR.
 1mg IV epinephrine. Repeat every 3 to 5 minutes.
 You can also give 1 dose of vasopressin to replace the first or
2nd dose of epinephrine.
 Check rhythm, begin CPR again.
 Again deliver shock.
 If arrhythmia is not stopping, give amiodarone this time 300mg IV
once, then consider additional 150mg
 Or lidocaine (1-1.5 mg per kg once, then o.5 to 0.75 mg per kg
IV).
 Consider magnesium doses also.
For non shockable
 After 5 cycle, you give epinephrine 1mg IV , repeating every 3 to 5

minutes without any shock.
 Check rhythm if shockable begin the process of CPR for
Shockable CA otherwise repeat the same process.
Medication in Cardiac Arrest
 Epinephrine
Epinephrine hydrochloride produces beneficial effects in
patients during cardiac arrest, primarily because of its α-adrenergic
receptor-stimulating (i.e, vasoconstrictor) properties. The α-
adrenergic effects of epinephrine can increase coronary and cerebral
perfusion pressure during CPR. The value and safety of the β-
adrenergic effects of epinephrine are controversial because they may
increase myocardial work and reduce subendocardial perfusion.
Vasopressin
Vasopressin is a non-adrenergic peripheral vasoconstrictor that
also causes coronary and renal vasoconstriction.
One dose of vasopressin 40 U IV/IO may replace either the
first or second dose of epinephrine in the treatment of pulseless arrest
(Class Indeterminate).
Atropine
Atropine sulfate reverses cholinergic-mediated decreases in
heart rate, systemic vascular resistance, and blood pressure. No
prospective controlled studies support the use of atropine in asystole
or slow PEA arrest.
Amiodarone:
IV amiodarone affects sodium, potassium, and calcium
channels as well as α- and β-adrenergic blocking properties. It can be
considered for the treatment of VF or pulseless VT unresponsive to
shock delivery, CPR, and a vasopressor.
Lidocaine as an alternative treatment of amiodarone, an
antiarrhythmic drug.
Nursing Management
 Asses the general condition of patient.

 Monitor airway breathing and circulation.
 Administer oxygen.
 Closely monitor ECG changes of the patient.
 Continous cardiac monitoring of patient.
 Monitor oxygen saturation level frequently.
 Monitor lab values.
 Keep the defibrillator and emergency tray ready at patients side.
 Teach co-workers and patient relatives about CPR
 Provide psychological support to patient.
Complications of CPR:
 Broken chest bones

 Neurological problems
 Vomiting and aspiration
 Internal bleeding
 Damage airways
 Collapsed lungs
 Liver and spleen injuries
 Abdominal distensions.
SCENARIO
Mr. Kashif Raheem, a 52 years old accountant was admitted to ICU

this morning after experiencing a brief episode of CP and SOB. His
father died from MI at 50 and mother is IDDM. He smokes 3 packs
cigarettes per day. He is overweight too 110 lbs.
After dinner, the monitor alarms and you find the patient
unresponsive.
What will be your reactions??
References
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103633/
 https://icm-experimental.springeropen.com/articles/10.1186/s4063
5-020-00307-1
 https://www.health.ny.gov/environmental/cpr/cpr_regulations.htm#
:~:text=Resuscitation%20equipment%20contents%20include%3A
%20two,and%20gloves%20after%20one%20use
.

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Respiratory and Cardiac

At the completion of this unit, learners will be able to:

 Cardiac emergencies are life threatening situations that must be

 When heart ceases to beat effectively and breathing soon ceases, a

 It must relate in some manner to heart problems.

 Cardiac arrest is also known as cardiopulmonary arrest or

 Coronary heart disease

 An acute type of pericardial effusion, characterized by fluid

 Cardiogenic shock is characterized by a decreased pumping ability

 Coronary heart disease

Increase in H ions Increase

 Air pollution, causes 80 percent of deaths, results in ischemic heart

 Well trained staff (master Trained in BCLS)  Suction

While you are outside setting,

 Asses the patient for response.

 After 5 cycle, you give epinephrine 1mg IV , repeating every 3 to 5

 Asses the general condition of patient.

 Broken chest bones

Mr. Kashif Raheem, a 52 years old accountant was admitted to ICU

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