Cardiopulmonary Arrest for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Cardiopulmonary Arrest for Certified Emergency Nursing (CEN)
Outline
Cardiopulmonary Arrest:
Definition/Etiology:
-Cessation of adequate heart function and respirations
-Without reversal will result in death
-Heart is not beating, lungs aren’t breathing
Causes:
- Cardiac
- MI, other
- Respiratory
- Obstruction, airway disease (asthma, COPD)
- PE
- Muscle weakness
- Trauma
- Hemorrhage and shock (poor prognosis)
- Structural damage
- Spinal cord injury
>60% of cardiac arrests caused by acute myocardial infarction (AMI)
Pathophysiology:
- Pump failure
- Unexpected interruption of mechanical activity
- Inefficient blood flow, no palpable pulses
Clinical Presentation:
- Preceding cardiopulmonary arrest – palpitations, shortness of breath, nausea, and chest pain
- cardiopulmonary arrest diagnosis – loss of Central pulse (including carotid/femoral on adults, brachial on infants) and spontaneous respirations
Collaborative Management:
BLS:
- Recognize
- Activate emergency response
- High quality chest compressions (Fast, hard, allow for chest recoil)
- Rescue breathing
- Rapid defibrillation
- When either a basic AED or more complex one in “basic mode,” the equipment knows when to shock. For ACLS, certified providers (could be nurses) can adjust/customize
ABCs:
- Airway – airway patency, do not delay compressions or defibrillation for advanced airway insertion
- Breathing – bag-mask ventilation (assess rise and fall of chest)
- Ratio chest compressions: ventilations = 30:1
- Advanced airway – q5-6 seconds
- No hyperventilation (increases intrathoracic pressure, decreases venous return to heart
- Circulation – defibrillation and medication
Defibrillation:
- Early defibrillation; immediately resume CPR
Medications:
- Epinephrine – 1mg IV/IO q3-5 minutes
- Amiodarone – 300mg (first dose); after 5 minutes – 150mg (second dose)
Correct causes of pump failure – think Hs and Ts:
Pregnancy Considerations
- Follow standard AHA Advanced Cardiovascular Life Support (ACLS) guidelines
- Provide chest compressions slightly higher anatomically
- Manually displace the uterus to the left to prevent or correct vena cava syndrome
- Initiate IV access above the level of diaphragm
- Remove fetal monitoring devices prior to defibrillation
- Identify and treat the contributing factors
- Consider emergency Cesarean section if no maternal return of spontaneous circulation within 4 minutes of arrest
Ultimate goal = return of spontaneous circulation (ROSC)
Evaluation | Patient Monitoring | Education:
After ROSC
- Temperature management/therapeutic hypothermia
- Improves neurologic recovery
- Target temperatures of 32–34°C for 12–24 hours
- Continuous core temperature observation (indwelling urinary catheter
- Control shivering (prevent increased body temperature)
- Sedation, analgesia, and neuromuscular blockade
- Monitor electrolytes and glucose and correct as needed
Linchpins: (Key Points)
The pump isn’t pumping – think mechanical failure
- Heart muscle is not pumping effectively
- Circulation impaired
- Need CPR (take over pumping action until cause of failure corrected)
- ROSC = targeted temperature management
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2017) Emergency Nursing Core Curriculum, 7th Edition. PA: Saunders
- Nelson, N. (2017). Cardiovascular Emergencies. In CEN Online Review. Emergency Nurses Association.
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System