Welcome to Scribd. Sign in or start your free trial to enjoy unlimited e-books, audiobooks & documents.Find out more
Standard view
Full view
of .
Look up keyword
Like this
0 of .
Results for:
No results containing your search query
P. 1




|Views: 32|Likes:
Published by julialeo

More info:

Published by: julialeo on Jun 12, 2009
Copyright:Attribution Non-commercial


Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less





The stress of suddenly having to respond, diagnose,
and treat a patient having a cardiovascular emergency
can be daunting. We are expected to think clearly and
act decisively. Unfortunately, we are calling on skills
and knowledge that we may use infrequently.

The first three chapters reviewed the building blocks
necessary to manage cardiovascular emergencies. This
chapter integrates the building blocks into a powerful
yet simple approach to the initial emergency care of
any patient.

The strength of this universal framework rests in it\u2019s
ability to quickly triage patients into one of three main
categories: stable, unstable and pulseless (dead).
Treating pulseless and unstable patients can be chaotic
or systematic. For stable patients, time is on your side.

Cardiac emergencies often appear and feel
overwhelming. This chapter is included to enable you
to view and respond to these events using a framework
to create order out of the chaos.

Quick Look
Overview - p. 78
Universal Algorithm - p. 79
Stable, Unstable or Dead - p. 84
Case Study - p. 88
Summary - p. 89
Chapter Quiz - p. 90
The classification of the constituents of a chaos,
nothing less here is essayed.
Herman Melville, from Moby
Triage and Response
\u00a9 2004 Nursecom Educational Technologies. All rights reserved. Permissions to be requested of the author at
tracyb@nursecom.com. All feedback is gratefully welcomed at the same email address.
Chapter 4:Tr iage and Resp ons e
OverviewThe overall objectives of emergency cardiac care center on preserving life, maintaining

abilities and preventing further complications. Presented with the wide array of
primary mechanisms that lead to acute cardiac events, most of us are left feeling either
overwhelmed or at least a bit nervous when called upon quickly to manage
emergencies. Hurst\u2019s \u201cThe Heart\u201d, an overview of cardiac pathologies is 2700 pages in
size. It is no wonder that many find acute cardiac care daunting.

But just as most of Hurst\u2019s \u201cThe Heart\u201d is about non-emergency cardiac conditions, so will most presentations of cardiac pathologies also afford us time to consult, confer and assess further. For these patients who are not in any imminent danger, time is on your side. Unfortunately, these patients also present with the largest range of issues where the full scope of cardiac medicine is called upon.

The episodes that warrant immediate concern are those that require an urgent or
emergent response. As mentioned in chapter 2, for those in ventricular fibrillation, the
likelihood of a returning pulse diminishes by 7-10% for each minute that the arrest
persists. Time to treatment is the most important determinant of a successful

Figure 4.1 Cardiac Emergency

With time such an important consideration and the possible outcome for the patient
quite ominous, a systematic and simple course of action is necessary. In order to
optimize time to response, responses must be concise and efficient. Because cardiac
emergencies are not a daily occurrence even for practitioners in busy emergency
departments, the steps must be easy to remember.

Universal Algorithm for Cardiac Emergencies
Universal Algorithm for Cardiac Emergencies

Cardiac emergencies can be defined as pathological cardiovascular events that require
an urgent response to sustain life or to prevent serious complications. Patients
experiencing cardiac emergencies are usually either hemodynamically unstable or are
in the midst of a cardiac arrest. The universal algorithm provided in figure 4.2 (page 80)
addresses the essentials necessary to manage cardiac emergencies.

This algorithm begins with a suspected or potential acute cardiac event. This may
present in many ways. For example, the patient may be unresponsive, not breathing
and pulseless (appears to be dead). Unstable (alive) patients often present with signs
and symptoms of poor cardiac output. Most patients present with non-critical signs
and symptoms such as chest pain relieved with rest or non-lethal dysrhythmias. These
patients are hemodynamically stable.

Basic Life Support Algorithm

To determine the nature and the seriousness of the cardiac event (if indeed it is a cardiac
event), the basic life support (BLS) algorithm is first performed, albeit unconsciously at
times (see figure 4.3 on page 81). Assuming that all health care professionals have
completed a Standard First Aid course or CPR prior, we will not go into great detail
examining the BLS algorithm. However, BLS forms the core initial actions of any
critical care episode, and its major steps require mentioning.

While the focus of this book is to manage cardiac emergencies in a hospital setting, the vast majority of acute cardiac events take place outside of hospital. Wherever you and the patient might be, first determine that the scene is safe for you to respond. For

example, if noxious gas or downed electrical wires are present, it is prudent to limit the casualties by not adding to them (with yourself ). Take measures to make the scene safe. Calling 911 may be the only response available.

If the scene is safe, the next crucial step is to determine if the patient is responsive. If the patient is unresponsive, immediately call for help. This may be accomplished by calling 911, pushing the emergency call button or calling \u201cCode Blue\u201d.

Determining that the patient is responsive also immediately answers the question, \u201cIs the patient alive?\u201d An unresponsive patient needs help regardless of the cause. A patient may be unresponsive due to hypoglycemia, post-seizure recovery, a stroke, respiratory failure, hypothermia, shock or being pulseless. While the topic here is cardiac arrest, other possible causes of unresponsiveness should be considered.

You're Reading a Free Preview

/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->