Tricky homework questions - HELP!

Nurses General Nursing

Published

You are reading page 2 of Tricky homework questions - HELP!

kwagner_51

592 Posts

Specializes in Geriatrics, Pediatrics, Home Health.
If a person is tamponading. There would be so much fluid around the heart, the heart would not be able to fill enough to pump out an adequate stroke volume. So it beats faster and faster to pump out what little it can. Largely decreased or next to no stroke volume = no pulse.

What good would 02 do if the patient's not breathing?

Think Basic Life Support.

A= Airway

B= Breathing

C= circulation

Make sure they have a patent airway, Bag them with O2 then start CPR.

I watched a code about 3 weeks ago, and this is how they did it. The Resp therapist was bagging long before anyone started CPR and there were 3 doctors in the room. The doc in charge gave the resp. therapist the ok to intubate, before the doc used any IC meds.

Remember, the brain can only go 3-5 min without O2. If we can get O2 into the b l o o d then do CPR the b l o o d being pumped from the heart is O2 saturated and may prevent brain damage .

At least that is the way I understand it. Am I wrong? Please advise.

Thanks!!

__________________________________________________

In His Grace,

Karen

Failure is NOT an option!!

begalli

1,277 Posts

Specializes in Critical Care/ICU.
A= Airway

B= Breathing

C= circulation

Make sure they have a patent airway, Bag them with O2 then start CPR.

Remember, the brain can only go 3-5 min without O2. If we can get O2 into the then do CPR the being pumped from the heart is O2 saturated and may prevent brain .

What was the patient's rhythm? Was it a perfusing rhythm?

You're right:

BLS =

Check responsiveness

not responsive?

CALL FOR HELP/AED/CRASH CART

Check for breathing

not breathing?

HEAD TILT/CHIN LIFT GIVE 2 BREATHS

Check circulation

no pulse?

START CHEST COMPRESSIONS

Ideally breaths and chest compressions should be taking place and according to AHA standards (two-person; 15:2 compressions to ventilations). Giving 02 to a person who doesn't have a pulse doesn't do much, actually doesn't do anything. You have to have a half-way decent beating heart to circulate the 02 to organs such as the brain.

EVERY code situation is different. Perhaps your patient still had a blood pressure that was circulating the 02 the RT was bagging in. You can bet that if the patient had no pressure those docs would have been calling for compressions, but more likely shocks, if a defibrillator was in the room.

2rntish

111 Posts

V Tach with a pulse is fairly common.

Some patients are stable...good BP, no SOB...just a little fluttering in the chest.

Some are unstable: chest pain, SOB, diaphoretic, hypotensive...

Some are pulseless.

You never have a pulse with V Fib...

TiffyRN, BSN, PhD

2,315 Posts

Specializes in Nurse Scientist-Research.

Maybe some current cardiac nurses can confirm, my ACLS is over 2 yrs old.

There is such a thing as pulseless V-tach (I've seen it), and there is a separate path to take on the ACLS algorithm if v-tach is pulseless or with a pulse. The short of it is that pulseless v-tach is to be treated the same as v-fib, and shocking would be the appropriate first action. However since your question doesn't allow defib I would choose the CPR hoping they meant a defibrillator would come on the crash cart. Compressions and bagging won't hurt pulseless v-tach/v-fib (in the absence of defibrillator) but it won't really help except to buy a little time. That heart needs electricity.

One more thing, I've never really heard it addressed but I'm pretty sure that a pulseless patient is not conscious. They don't have any pressure to perfuse the cerebral arteries. If you have a pulseless patient talking to you, check the patient's pulse again. Also defibrillating a conscious patient should not be done without sedation (though I'm sure it happens now and again).

MorganO

20 Posts

My answers

#1 is 1 Knowledge is vague

#2 is 1 "Time is muscle" the quicker the doc will consider thrombolytics, the more benefit the patient will have from the med. Pain can be managed with NTG if VS stabke

#3 Not sure

#4 CPR althought I would rather Defibrillate a pulseless VF Vtach patient I will do CPR until the patient can be defibrillated

+ Add a Comment