Question about unresponsive patient.

[poohbear1968]

i have a question....and yes it is from class. however we have freedom to find this answer any way we can using any source:)

you find your patient pulseless and unresponsive. the only abnormality that you notice on the ekg monitor was multifocal pvc's increasein in number over the last 2 hours. describe your interventions.

so im not just looking for an answer i am going to tell you what i think i should do first then perhaps you can let me know if im going in the right direction.

i dont think that at this point the pvc's are of importance. i would hit the code button or call light for assisstance immediately and then i should make sure the patients airway is open. then give the patient o2 because chances are respiratory will most likely begin bagging to oxygenate the patient. i would then begin cpr using good, hard, compressions. by this time i hope the code team would be there to take over.

are the pvc's important in the interventions that would be done? or is the most important thing at this point to begin cpr.

[XB9S, BSN, MSN, EdD, RN, APN]

Hi Poahbear, you are quite right any patient that is pulseless and unresponsive then the priority is ABC and starting resuscitation.

The rhythm will be important in deciding shockable or not and if faced with a patient who had been having multiple ectopics prior to arrest then It may be indicitive for your reversible causes.

Think about 4 H's and 4'Ts and much as I hate to quote it again the UK resuscitation council is an excellent resource for answering questions about resuscitation managment

http://www.resus.org.uk

[SuesquatchRN, BSN, RN]

I would start compressions before starting O2.

[poohbear1968]

Hi Sharrie! Thanks for the quick response. I hope I dont sound like an idiot but....What are the 4H's and 4T's? I graduate in 62 days from the ADN program and I have never heard this. My area of interest is ICU and Im hoping to be working and gaining more knowledge real soon. Anyway would a patient with multifoa PVC's be "shockable"?

Poohbear:)

[XB9S, BSN, MSN, EdD, RN, APN]

Check your PM's Poohbear.

H's and T's are reversible causes of cardiac arrest. Have a look at the site and it will take you through them. As far as your question, all resuscitation questions are going to be easy to answer as there are strict well research guidlines to help you deal with them Look at the resus guidlines and your answer will be there.

The only shockable cardiac arrest rhythms are VF or VT. Anything else with a rhythm but no pulse is treated as PEA

[Noryn]

I think you are right, call the code, lay the bed down and start CPR. After the code team arrives you can mention the increasing frequency of the pvc's. I wouldnt say they are not important but at that moment in time the most important thing is oxygenation and circulation. Also treating what rhythm they care currently in.

[XB9S, BSN, MSN, EdD, RN, APN]

Just to follow up a bit.

You find your patient pulsless and collapsed.

Resuscitation Guidlines state:

Call for help and assess patient

Signs of life (Airway / Breathing and Circulation)

If not (and you have stated pulseless)

put out the arrest (code) call

CPR 30:2 with airway adjuncts

Apply defibrillator / monitor and assess rhythm if shockable and in appropraite care the defibrillate

then onto Advanced life support as appropraite.

As I have already mentioned once into the ALS scenario you will need to be thinking about reversible causes of cardiac arrest. These are catagorised into the 4 h's and 4 T's

Hypothermia

Hypoxia

Hypovolemia

Hypo / HyperKalaemia (electrolyte disturbance)

Thromboembolic

Toxic (poisons / OD)

Tamponade

Tension Pneumo

SO yes start ABC and resuscitation then as part of ALS guidence start to think about these causes.

Can you think of anything that will cause multiple ectopics prior to cardiac arrest?

http://www.resus.org.uk/pages/alsalgo.pdf

Hope this is helpful

[poohbear1968]

Thanks again Sherri, I was researching after last post and I found the H's and T's.

P.S. Great Site!

[XB9S, BSN, MSN, EdD, RN, APN]

you are very welcome, why do you think the ectopics may be relevent?

[smk1, LPN]

unless they are causing runs of vtach i wouldn't think they are a priority. ABC/cpr call the code and getting a defib attached are important.

[XB9S, BSN, MSN, EdD, RN, APN]

SMK1 I quite agree with you, but just wanted the OP to have a think about possible causes and post resuscitation care, also they may have been indicitive of what could have caused the cardiac arrest so would be relevent in reversible causes

[poohbear1968]

Sorry, didnt see your reply. Would they be relivant because it could mean a possible clot?