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.
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
I sometimes am a bit too quick to just "answer" the questions on this BB. LOL product of being a student. My pinning is in 2 days so I need to make that transition to "helping" the students and not being one of them and handing out answers.
Sorry, didnt see your reply. Would they be relivant because it could mean a possible clot?
Yes it could be but also maybe electrolyte imbalance which can present itself with mulitple ectopics so as part of the advanced life support you would be excluding the causes.
Hypoxia - dealt with by good airway mgt
Hypovolaemia - you would be giving fluid thinking about possible bleeds
Hypothermia - not likely in a hospital environment
Hypo / hyper Kalaemia - look at previous electrolyte results, what was the K previously is this a likely cause and take into account the ectopics
Thromboembolic - a difficult one to exclude, but look at risk factors, previous events. Do they have poor mobility and have they had thrombo-phrophylaxis
Tension Pneum - check air entry and chest movement
Tamponade - this one is clutching at straws unless trauma or cardiac surgery
Toxic - anything they may have taken or we have given them think about cardiac medications, tri-cyclics anti-depressents that kind of stuff
I love doing this stuff, thanks for making my little brain work
I sometimes am a bit too quick to just "answer" the questions on this BB. LOL product of being a student. My pinning is in 2 days so I need to make that transition to "helping" the students and not being one of them and handing out answers.
you'll get used to it, although not everyone looks for the answers like PoahBear, it's those students that expect to be told everything that I have most fun with. I tell them nothing outright and make them work for every scrap of information Bless them it must be infuriating to have me as their instructor
No thank you! you have made me think also. When I graduate I am interested in CCU/ICU but Im alittle nervouse about CCU. Cardiac patients seem sooo challenging. One munite they can be fine and the next completely going down hill. What are some of the big concerns with these types of patients should I be aware of while working with them? Our class doesnt usually do clinicals on CCU/ICU just Med Surg so I havent gotten the opportunity to actually work with these types of patinets.
It sounds like pulseless electrical activity. I would be interested in more background on the pt, such as admiting diagnosis, since with PEA the root cause MUST be corrected. Meanwhile, push code button, get the bed down, start taking care of ABCs.
No thank you! you have made me think also. When I graduate I am interested in CCU/ICU but Im alittle nervouse about CCU. Cardiac patients seem sooo challenging. One munite they can be fine and the next completely going down hill. What are some of the big concerns with these types of patients should I be aware of while working with them? Our class doesnt usually do clinicals on CCU/ICU just Med Surg so I havent gotten the opportunity to actually work with these types of patinets.
Pooh I just spent 160 hours in a CCU preceptorship (my senior clinical). It was extremely interesting and though I was freaked out the first week. I did really well and know that this is where I want to end up. I took ACLS before hand and it really helped. I suggest that you do this if you have the time and the money. PM me if you have any questions. I did everything except take post open hearts or balloon pump patients on my own or conscious sedation. The great thing is I had a great resource at my finger tips (my preceptor), but once she saw my level of competency she was fine with letting me go and be "the nurse" and just coming to her for questions or to double check things or for help with new procedures.
Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.
Oh and poah by the way IM a MSICU/ER Sup. and usually if your in the ICU or CCU you guys generally are on the code team!!! Just a thought dont know what else to say, very tired just worked a swing shift covering for some one I got to work a great 12 PM to 12 AM. LOL its wonderful just tireing!!!llol
Just a thought here....I understand that once a patient is pulseless and in need of CPR that is the #1 priority BUT I can't help but think that the increased number of PVC's should have alerted you to look more closely at the patient and the EKG to rule out causes of them. If that were taken into account it could have possibly intervened prior to the patient coding...
uhhh, another often overlooked H is HYPOGLYCEMIA--not likely going to cause pulseless V-tach, or v-fib, etc. but will make for an obtunded patient.
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?
PVC's are usually an early indication of low oxygen level. Check their 02 sat and keep it above 95. If you start seeing more of these, you can bet that the heart muscle is starting to get more PO'd and you'd better check an EKG and see what's going on. If your patient is having PVC's, and is unresponsive, you do your ABC's and you VOMIT (Vitals, Oxygen, Monitor, IV and Treat)
pvc's are usually an early indication of low oxygen level. check their 02 sat and keep it above 95. if you start seeing more of these, you can bet that the heart muscle is starting to get more po'd and you'd better check an ekg and see what's going on. if your patient is having pvc's, and is unresponsive, you do your abc's and you vomit (vitals, oxygen, monitor, iv and treat)
actually, in my practice, i've found that pac's seem to be more associated with hypoxia than pvc's. the pvc's may be a key clue, because if you've ever watched a monitor, you might notice that patients who have severe hypoglycemia often times have increased pvc's. i've noticed this many times, including in my most recent shift just a couple nights ago. i went in and checked on the pt. and he was clammy and said he thought that his sugar was low, because he also felt "shaky." bg was 27, he was alert enough to take some juice, milk, and graham crackers, and after that, he was good to go, and no more pvc's, the rest of the night.
you'll get used to it, although not everyone looks for the answers like PoahBear, it's those students that expect to be told everything that I have most fun with. I tell them nothing outright and make them work for every scrap of information 
Bless them it must be infuriating to have me as their instructor 
smk1, LPN
2,195 Posts
I sometimes am a bit too quick to just "answer" the questions on this BB. LOL product of being a student. My pinning is in 2 days so I need to make that transition to "helping" the students and not being one of them and handing out answers.