Resuscitation Flashcards
Possible reasons for the need for resuscitation
- Cardiac arrest (MI, VF)
- Respiratory arrest
- Shock leading to inadequate tissue perfusion
- Trauma compromising circulation
- Drug toxicity causing respiratory depression
- Severe hypo/hyperthermia leading to circulatory collapse
Immediate nursing management for VF
- Begin CPR immediately and attach a defibrillator.
- Defibrillation: Deliver a shock (150 J) as soon as VF is identified.
- Drugs (Post-Shock): While continuing CPR, administer adrenaline (1mg) 1:10,000 every 3–5 minutes. Consider amiodarone 300 mg after the second shock, followed by 150 mg if needed.
- Airway and Breathing: Secure the airway (bag-valve-mask) and provide oxygen to maintain saturation >94%.
Cycle: Alternate defibrillation and CPR every 2 minutes, reassess rhythm after each cycle.
Immediate nursing management for VT (Pulseless)
- Defibrillation: Deliver a shock (150 J) as soon as VF is identified.
- Drugs (Post-Shock): While continuing CPR, administer adrenaline (1mg) 1:10,000 every 3–5 minutes. Consider amiodarone 300 mg after the second shock, followed by 150 mg if needed.
- Airway and Breathing: Secure the airway (bag-valve-mask) and provide oxygen to maintain saturation >94%.
Cycle: Alternate defibrillation and CPR every 2 minutes, reassess rhythm after each cycle.
Immediate nursing management for PEA
Electrical activity is present on the monitor, but there is no mechanical contraction or pulse.
CPR: Start immediately. DO NOT defibrillate.
Identify and Treat Causes (H’s and T’s): The priority is identifying reversible causes
Give adrenaline 1mg every 3-5mins
Airway and Breathing: Secure the airway and ensure oxygenation.
Reassess Rhythm and Pulse every 2 minutes during CPR.
Immediate nursing management for asystole
Flatline with no electrical or mechanical activity.
CPR: Start immediately. DO NOT defibrillate.
Confirm the Rhythm: Ensure the leads are connected, check for fine VF, and rule out equipment malfunction.
Drugs:
Adrenaline 1 mg IV every 3–5 minutes.
Identify and Treat Causes (H’s and T’s): Same as for PEA.
Airway and Breathing: Secure the airway and provide oxygenation.
Continue cycles of CPR and drug administration until ROSC or determination of futility.
Common Reversible Causes of PEA (6Hs and 6Ts)
6Hs:
1. Hypovolemia
- treatment: fluid resus
- Hypoxia
- treatment: ventilation - Hydrogen ion-acidosis
- treatment: sodium bicarbonate 1mEq/kg - Hyperkalemia
- treatment: remove potassium/dialysis - Hypokalemia
- treatment: replace potassium - Hypothermia
- treatment: warm patient
6Ts
1. Tablets (overdose, accidents)
- treatment: antidote
- Tamponade cardiac
- treatment: pericardiocentesis - Tension pneumothorax
- treatment: needle compression of chest - Thrombosis coronary (ACS)
- treatment: resuscitation, revascularisation, PCI - Thrombosis pulmonary
- treatment: thrombolytics/surgery
Adrenaline/epinephrine (Indications, drugs classes, preparation)
Class: Adrenergic agonist
Indications:
Cardiac arrest (VF, VT, PEA, asystole)
Anaphylaxis
Severe asthma
Septic shock (as a vasopressor)
Preparation:
Cardiac arrest: 1 mg IV/IO every 3–5 minutes during CPR
Anaphylaxis: 0.5 mg IM (1:1,000 solution) every 5–15 minutes if needed.
IV infusion: Dilute 1 mg in 1000 mL of normal saline or 5% dextrose.
Amiodarone (Indications, drugs classes, preparation)
Class: Antiarrhythmic
Indications:
Ventricular fibrillation (VF) or pulseless VT refractory to defibrillation / Stable ventricular or supraventricular arrhythmias
Preparation:
Cardiac arrest: 300 mg IV push after the second defibrillation, followed by 150 mg IV push if VF/VT persists.
Infusion: 900 mg in 500 mL D5W over 24 hours.
Adenosine (Indications, drugs classes, preparation)
Class: Antiarrhythmic
Indications:
Paroxysmal supraventricular tachycardia (PSVT)
Diagnostic aid in wide-complex tachycardia
Preparation:
Rapid 6 mg IV bolus over 1–2 seconds, followed by a flush of 20 mL saline.
If ineffective, give 12 mg IV bolus after 1–2 minutes.
IV GTN (Indications, drugs classes, preparation)
Class: Nitrate (vasodilator)
Indications:
Acute coronary syndrome (unstable angina, myocardial infarction)
Acute pulmonary edema
Hypertensive emergencies
Nitrates are used to treat angina in three ways:
- To relieve an ongoing attack by using the medication at the start of the attack.
- To prevent attacks from occurring by using the medication just before an attack is expected to occur.
- To reduce the number of attacks that occur by using the medication regularly on a long-term basis.
Preparation:
Dilute 50 mg GTN in 500 mL D5W or normal saline for infusion.
Start at 5 mcg/min, titrate up every 3–5 minutes based on response.
Atropine (Indications, drugs classes, preparation)
Class: Anticholinergic
Indications:
Symptomatic bradycardia
Organophosphate poisoning
Pre-anesthesia to reduce secretions
Preparation:
Bradycardia: 0.5 mg IV bolus every 3–5 minutes (maximum 3 mg).
Organophosphate poisoning: 2–4 mg IV, repeat as needed.
Verapamil (Indications, drugs classes, preparation)
Class: Calcium channel blocker
Indications:
Irregular heart rhythms:
- Supraventricular tachycardia (SVT)
- Atrial fibrillation/flutter with rapid ventricular response
Prevent chest pain caused by angina
Hypertension (it lowers BP)
Preparation:
2.5–10 mg IV over 2 minutes, repeat after 15–30 minutes if needed (maximum 20 mg).
Dopamine (Indications, drugs classes, preparation)
Class: Inotropic agent and vasopressor
Indications:
Cardiogenic or septic shock
Symptomatic bradycardia unresponsive to atropine
To treat low BP
Preparation:
Dilute 200 mg in 500 mL D5W or normal saline.
Infusion: Start at 2–20 mcg/kg/min, titrate based on clinical response.
Magnesium sulphate (Indications, drugs classes, preparation)
Class: Electrolyte, antiarrhythmic
Indications:
Severe preeclampsia/eclampsia
Hypomagnesemia
MI/arrthymias
Phenytoin (Indications, drugs classes, preparation)
Class: Antiepileptic
Indications:
Seizure control (status epilepticus)
Prevention of seizures in neurosurgery
Preparation:
Loading dose: 15–20 mg/kg IV, not exceeding 50 mg/min.
Dilute with normal saline (not D5W) and administer through a large vein.
Aspirin (Indications, drugs classes, preparation)
Class: Antiplatelet agent
Indications:
Acute coronary syndrome
Stroke prevention
Preparation:
Chewable: 300 mg PO (loading dose in ACS).
Maintenance dose: 75–100 mg PO daily.
Hydrocortisone (Indications, drugs classes, preparation)
Class: Corticosteroid
Indications:
Adrenal insufficiency (Addisonian crisis)
Severe asthma/COPD exacerbations
Septic shock
Preparation:
IV bolus: 100–500 mg over 1–10 minutes.
Dilute in 10 mL sterile water for injection.
Frusemide (Indications, drugs classes, preparation)
Class: Loop diuretic
Indications:
Acute pulmonary edema
Heart failure
Hypertension
Preparation:
20–40 mg IV bolus, administer over 1–2 minutes.
For infusion: Dilute in 50 mL normal saline or D5W.
