Code Mnagment %5bRepaired%5d (1).pdf - Ms Azmat Jehan Khan RN,BScN MScN Assistant Professor AKUSONAM 1 Code Management and Review of Critical Care Drugs

Ms. Azmat Jehan Khan RN,BScN, MScN Assistant Professor AKUSONAM 1

Code Management and Review of Critical Care Drugs

OBJECTIVES 1. Life threatening Dysrhythmias 2. Indications for initiating Cardio Pulmonary Resuscitation 3. Roles of care givers in managing cardiopulmonary arrest situations. 4. Utilization of crash cart and defibrillator Part B 1. Medications used in code managements 2. Documentation during a code. 3. Post resuscitation management 4. Psychosocial, legal and ethical issues 5. Involvement of the family during a code

What is Dysrhythmia • A cardiac dysrhythmia is an abnormal heart beat: the rhythm may be irregular in its pacing or the heart rate may be low or high. • Tachy-arrhythmias and Brady-arrhythmias • Some dysrhythmias are potentially life threatening while other dysrhythmias (such as sinus arrhythmia) and normal. • The most common life - threatening arrhythmia is ventricular fibrillation, which is an erratic, disorganized firing of impulses from the ventricles (the heart's lower chambers). American heart Association, 2010 1/25/2017 4

Why Dysrhythmias occur….  A disturbance between electrical conductivity & the mechanical response of the myocardium.  A disturbance in impulse formation -abnormal rate -ectopic focus  A disturbance in impulse conduction -delays and blocks Combination of several mechanisms 1/25/2017 5

Dysrhythmias Any deviation from the normal rhythm of the heart May Cause:  Sudden death  Syncope  Heart failure  Dizziness  Palpitations  No symptoms

Life Threatening Arrhythmias There are two main types of arrhythmia 1. Bradyarrhythmias:  Failure of impulse generation: Sinus node dysfunction  Failure of impulse propagation: AV conduction abnormality (2 nd and 3 rd degree heart block) 2. Tachyarrhythmias:  Supraventricular – SVT – Atrial Flutter – Atrial Fibrillation  Ventricular – VT – VF

Dysrhythmia Diagnosis  Electrocardiograms,  Stress tests,  Echocardiograms,  Holter monitors,  Electrophysiology studies,  Cardiac catheterization 1/25/2017 8

Recognition and Management Treat the Patient ... not the Monitor !!!! Evaluate the patient’s symptoms and clinical signs • Ventilation • Oxygenation • Heart rate • Blood pressure • Level of consciousness • Look for signs of inadequate organ perfusion (AHA 2010) 1/25/2017 9

1/25/2017 10 Lets practice some ECGs

Atrioventricular (AV) Blocks 1/25/2017 11

First Degree AV Block  Rhythm:  Rate:  P Waves:  P-R Interval:  (Q)RS Complex:  Regular; can be irregular  Usually 60-100 BPM; Rhythm dep.  Upright/Normal  > 0.20 s (200 ms); Constant  0.04-.12 s (40-120 ms) 1/25/2017 12