They also increase the workload of the heart at a time when its capability is decreased because of postresuscitation myocardial dysfunction. NURSMISC - Which Of The Following Medication Routes Would Be The Most Appropriate To Use In | Course Hero. A balloon catheter is introduced via the femoral artery, percutaneously or by arteriotomy, retrograde into the thoracic aorta just distal to the left subclavian artery. Other survivable causes of traumatic cardiac arrest include cardiac tamponade Cardiac Tamponade Cardiac tamponade is accumulation of blood in the pericardial sac of sufficient volume and pressure to impair cardiac filling. Despite widespread and long-standing use, no drug or drug combination has been definitively shown to increase neurologically intact survival to hospital discharge in patients with cardiac arrest. An alert adult patient.
Terms in this set (20). Let us complete them for you. The decision to do cardiac catheterization Cardiac Catheterization Cardiac catheterization is the passage of a catheter through peripheral arteries or veins into cardiac chambers, the pulmonary artery, and coronary arteries and veins. While assisting a paramedic in the attempted resuscitation. Prompt defibrillation is the only intervention for cardiac arrest, other than high-quality CPR, that has been shown to improve survival; however, the success of defibrillation is time dependent, with about a 10% decline in success after each minute of VF (or pulseless VT).
Postresuscitation rapid supraventricular tachycardias occur frequently because of high levels of beta-adrenergic catecholamines (both endogenous and exogenous) during cardiac arrest and resuscitation. Postresuscitative care should begin immediately after spontaneous circulation is determined. Her blood pressure is 144/84 mm Hg and her heart rate is 110 beats/min. NIPRIDE RTU, Nitropress|. While assisting a paramedic in the attempted resuscitation poster. The operations manager for a well drilling company must recommend whether to. A breath is given every 6 seconds (10 breaths/minute) without interrupting chest compression in adults; infants and children are given breaths every 2 to 3 seconds (20 to 30 breaths/minute).
Which of the following clinical signs would necessitate the administration of naloxone (Narcan)? However, thoracotomy Thoracotomy Thoracotomy is surgical opening of the chest. A) Expressed as grams of salt per liter, what is the approximate salinity of Mono Lake? Immediately load the patient into the ambulance, begin transport, and reattempt to contact medical control when you receive a cell signal. While assisting a paramedic in the attempted resuscitation council. Recall that geriatric patients often have slower absorption and elimination times, which may necessitate modification and the dosing of certain drugs. These rhythms should be treated if extreme, prolonged, or associated with hypotension or signs of coronary ischemia. B. administer the nitroglycerin unless he has taken Viagra within the past 72 hours.
Cricoid pressure is not recommended. Guidelines for health care professionals from the AHA are followed (see figure Adult comprehensive emergency cardiac care Adult comprehensive emergency cardiac care). If MAP remains < 70 mm Hg in patients who may have sustained a myocardial infarction (MI), intra-aortic balloon counterpulsation should be considered. To maximize the likelihood of a good outcome, clinicians must provide good supportive care (eg, manage blood pressure, temperature, and cardiac rhythm) and treat underlying conditions, particularly acute coronary syndromes Overview of Acute Coronary Syndromes (ACS) Acute coronary syndromes result from acute obstruction of a coronary artery. The following is an English-language resource that may be useful. For mechanical measures regarding resuscitation in children, see table Guide to Pediatric Resuscitation—Mechanical Measures Guide to Pediatric Resuscitation—Mechanical Measures. Cardiopulmonary Resuscitation (CPR) in Adults - Critical Care Medicine. EMTs respond to a known heroin user who is unresponsive. Course Hero uses AI to attempt to automatically extract content from documents to surface to you and others so you can study better, e. g., in search results, to enrich docs, and more.
If no one responds, the rescuer first activates the emergency response system and then begins basic life support by giving 30 chest compressions at a rate of 100 to 120/minute and a depth of 5 to 6 cm, allowing the chest wall to return to full height between compressions, and then opening the airway (lifting the chin and tilting back the forehead) and giving 2 rescue breaths. Chapter 12, Shock EMT. 0 mg IV repeated every 3 to 5 minutes, followed by 500- to 1000-mL (20 mL/kg for children) infusion of 0. An esmolol IV infusion is given, beginning at 50 mcg/kg/min. Sodium bicarbonate is no longer recommended unless cardiac arrest is caused by hyperkalemia, severe metabolic acidosis, or tricyclic antidepressant overdose. A. Pediatric patients. However, chest compression and defibrillation take precedence over endotracheal intubation. Alternatives are epinephrine and the peripheral vasoconstrictors norepinephrine and phenylephrine (see table Drugs for Resuscitation Drugs for Resuscitation*). Atreza, Atropine Care, Atropisol, Isopto Atropine, Ocu-Tropine, Sal-Tropine|. After taking diphenhydramine (Benadryl) for an allergic reaction, a person begins experiencing drowsiness and a dry mouth. Patients who had arrest caused by VF or VT not associated with acute MI are candidates for an implantable cardioverter-defibrillator (ICD). For internal cooling, chilled IV fluids (4° C) can be rapidly infused to lower body temperature, but this method may be problematic in patients who cannot tolerate much additional fluid volume.
The alpha-adrenergic effects may augment coronary diastolic pressure, thereby increasing subendocardial perfusion during chest compressions. Aspirin is beneficial to patients suspected of having a heart attack because it: A. causes direct coronary vasodilation. American Heart Association 2020 CPR and ECC Guidelines: These guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) are based on the most recent review of resuscitation science, protocols, and education. See also the American Heart Association [AHA] 2020 guidelines for CPR and emergency cardiovascular care. Airway and Breathing. Read more) are an option because CPR does not need to be stopped and they have less potential for lethal complications; however, they may have a lower rate of successful placement because no discrete femoral arterial pulsations are available to guide insertion.
Amiodarone 300 mg can be given once if a third attempt at defibrillation is unsuccessful after epinephrine, followed by 1 dose of 150 mg. Chemical... read more in resuscitated patients. EMT- Chapter 13. pondeele000. Nasogastric intubation to relieve gastric distention is delayed until suction equipment is available because regurgitation with aspiration of gastric contents may occur during insertion.
Tension pneumothorax should be considered in a patient who has achieved return of spontaneous circulation after prolonged CPR, and subsequently becomes difficult to ventilate, or who is hypoxic and suddenly rearrests. Read more) are preferred alternatives, especially in children, as they can be placed quickly to avoid delay in administration of the first dose of epinephrine. Dilantin, Dilantin Infatabs, Dilantin-125, Phenytek|. Advanced cardiac life support (ACLS) with definitive airway and rhythm control. Current ICDs are implanted similarly to pacemakers and have intracardiac leads and sometimes subcutaneous electrodes. EMT- Chapter 12- Pharmacology.
Serious myocardial injury caused by compression is highly unlikely, with the possible exception of injury to a preexisting ventricular aneurysm. While there is limited evidence supporting specific numbers in physiologic monitoring, it is generally accepted that an end-tidal carbon dioxide level of 10 to 20 mm Hg is associated with adequate CPR. During administration of a drug via endotracheal tube, compression should be briefly stopped. Drugs Mentioned In This Article. 9 mmol/L); electrolytes, especially potassium, should be within the normal range. The term "pharmacology" is MOST accurately defined as: A. Postresuscitation laboratory studies include arterial blood gases (ABG), complete blood count (CBC), and blood chemistries, including electrolytes, glucose, BUN (blood urea nitrogen), creatinine, and cardiac markers. In such settings, immediate pericardiocentesis or thoracotomy is done (see figure Pericardiocentesis Treatment Pericarditis is inflammation of the pericardium, often with fluid accumulation in the pericardial space. 5 mg/kg, followed by a second dose of 0. Ventilation rate and volume should be titrated to an end-tidal carbon dioxide reading of 35 to 40 mm Hg.
If VF persists, amiodarone 300 mg IV is given. Lung injury is rare, but pneumothorax Pneumothorax (Traumatic) Traumatic pneumothorax is air in the pleural space resulting from trauma and causing partial or complete lung collapse. Postshock rhythm is not checked until after 2 minutes of chest compressions. You carry epinephrine auto-injectors on your ambulance and have been trained and approved by your medical director to administer them. Wait 5 minutes and reassess her blood pressure. Read more (VT) is treated the same as VF.
Speed, efficiency, and proper application of CPR with the fewest possible interruptions determine successful outcome; the rare exception is profound hypothermia caused by cold water immersion, when successful resuscitation may be accomplished even after prolonged arrest (up to 60 minutes). Most patients' needs for IV fluid and drugs can be met with a percutaneous peripheral venous catheter. This preview shows page 2 - 5 out of 12 pages. Which of the following medication routes would be the MOST appropriate to use in an unresponsive patient when intravenous access cannot be obtained? Bernard SA, Gray TW, Buist MD, et al: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. The EMT administers the correct drug, but gives it by the wrong route. GHY 1012. emmacoppedge123. Defibrillation at the same energy level or higher is attempted 1 to 2 minutes after each drug administration. CPR should be continued until the cardiopulmonary system is stabilized, the patient is pronounced dead, or a lone rescuer is physically unable to continue. The epinephrine auto-injector delivers a preset amount of the drug. These findings are an example of a(n): A. untoward effect. What do paramedics actually do?
Epinephrine also increases the likelihood of successful defibrillation.