Pt. on vent in cardiac arrest - would she continue breathing? - page 2
by jetson 11,992 Views | 13 Comments
Pardon my ignorance but what would happen? It seems as if the respirations would continue, heartbeat or no...Is that right? Would appreciate any insight - thanks.... Read More
- 0Nov 15, '11 by NCRNMDMThe ventilator has nothing to do with the heart, and it is not regulated by the heart. When a ventilator is set up, it is programed to give a certain number of respirations per minute, to deliver a certain concentration of oxygen, to deliver breaths at a certain pressure, etc. Unless the ventilator malfunctions, or is turned off, it will continue to deliver breaths for that patient no matter what their heart does. Ventilators are used in cases when patients cannot breath on their own for whatever reason (they could be sedated and paralyzed, they could have a brain injury, the medical staff could be letting them, "rest," by decreasing their work of breathing, etc). When a patient goes into cardiac arrest, the ventilator is disconnected, and an ambu bag is connected to the endotracheal tube. The ambu bag is used to breathe for the patient, and it also delivers oxygen to the patient. If the code is successful and the patient regains vital signs, they will be placed on the ventilator again. If a patient goes into cardiac arrest and dies, and the ventilator isn't disconnected, it will continue to provide ventilation to them despite the fact that they have no pulse. So, yes, in theory you could leave someone on the vent during a code and it would continue to breathe for them, but you have more control over breaths per minute and oxygenation with an ambu bag during a code situation.
- 0Nov 15, '11 by ukstudentQuote from peterdaveAs per the terms of service, no one here can give medical advice. Please talk to the Doctors in charge of this patients care. They are the ones to answer this question.If doctor tell the patient has cardiac arrest after putting up for 3 days on ventilator and we have reversed the arrest by giving shock and still the patient has been put on ventilator with full support and high dosage of drugs. And if there is movement in the eye balls and eye lashes are up and down , what does it mean?
- 0Nov 20, '11 by turnforthenurseRNVents are set so that the respiratory rate will not drop below a certain number. There are different modes, too. Some are full assist while other modes allow the patient to do some of the breathing but again, the vent will still delivery a set amount of breaths/min. If the vent is set to deliver 15 breaths/min, it will do just that, unless there is a malfunction of the patient becomes disconnected. Vents don't monitor a patient's rhythm, so that's why you need to check...you can't just rely on seeing the patient breathing as a way of thinking the patient is A-OK.
- 1Nov 20, '11 by PetERNurseI think the OP question has been answered.
However some have stated some other issues which should be addressed.
If a patient arrests while on the ventilator, the ventilator will continue breathing at whatever you have programmed it to do. It is well documented that many CPA patients are manually (ambubag) over-ventilated during CPR, even though we all know what the appropriate RR should be. Here, if a patient on the vent has CPA, we will leave them on the vent, decreasing RR to 8 bpm and Vt to 10-15 ml/kg. This allows us one less thing to worry about during the code, and ensures the patient is not being over-ventilated, which directly decreases coronary and cerebral perfusion pressure, which decrease chance of ROSC. 100% FiO2 has not been shown to significantly improve outcome when compared to 21% FiO2, so that is less of a concern than the actual rate and Vt. In fact, supranormal post-resuscitation PaO2 increases in-hospital mortality.
As previously stated, an art line will allow for early recognition of CPA, especially with things like PEA/EMD. However, EtCO2 is your best monitor for effective compressions and ROSC.