NUR 426 Lecture Notes - Lecture 15: Torsades De Pointes, Bag Valve Mask, Cardiac Arrhythmia

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5 Jan 2018
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Adult and Pediatric Emergency Drugs
Cardiac Emergency Medications
Types of cardiac emergencies
Acute Myocardial Infarction/Acute Coronary Syndromes
Disturbances in heart rate & rhythms
o Symptomatic Bradycardia
o Unstable Tachycardia
o Dysrhythmias
Lethal Rhythms
o Ventricular Tachycardia (VT)
o Ventricular Fibrillation (VF)
o Asystole
o Pulseless Electrical Activity (PEA)
Foundations needed in Cardiac-Pulmonary
arrest situation
Oxygen Therapy
Ventilation
Performance of optimal CPR
Application of electrical therapy
(defibrillation if required)
Following established treatment
algorithms
Knowledge of pharmacologic agents
Emergency Drugs for Cardiac Disorders
Oxygen
Aspirin decreases platelet aggregation
Nitroglycerin vasodilator, make sure their blood pressure is above 90 systolic before
giving; tell them to sit or lie down
Morphine Sulfate dilates arteries; increased oxygen supply (good for someone who
has chest pain ex: Experiencing MI)
Atropine Sulfate speeds up the heart; used to treat symptomatic bradycardia
(lethargy, dizzy), can treat heart block but depends
Adenosine used to treat SVT (A-tach); works between the SA and the AV node
Diltiazem calcium channel blocker; decrease contraction, relax smooth muscle
Amiodarone anti-arrhythmic; work on the ventricle and atrium
Lidocaine work on the ventricles; used to be given for V-tach and V-fib
Procainamide anti-arrhythi; auses torsades de poites; orks o the otto of
the heart
Magnesium Sulfate gie for torsades de poite; prologed QT eas lo Mg leel
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Epinephrine stimulates the heartbeat, number one drug for V-fib and pulseless V-tach
Sodium Bicarbonate give if someone is acidotic
* Sodium Bicarbonate and dopamine will cause necrosis if it infiltrates
Emergency Drugs for cardiac disorders: Oxygen
Essential to life, used as emergency drug
Has benefits along with adverse effects
Lack of O2 - Brain death within 6 min
Known as first line drug for all events
Acts as a pulmonary vasodilator
Nursing Pearls
o Pulse Ox digital display of O2 sat
o Maintain oxygenation at or above 94%
o Room air is 21%
o 1-6 liters for simple face mask
o Higher concentrations need a mask
Oxygen devices of choice
o For adults - nasal cannula, venti-mask, rebreather masks, CPAP, Bi-PAP
o For children Children use face tent with high O2 flow, simple face mask, face
tents
Use caution with COPD patients but never withhold oxygen from a patient who needs it
Promote optimal oxygenation & ventilation before administering any pharmacologic
agents
FiO2 = fraction of inspired oxygen
o When using a bag valve mask need flow rate of 15 liters (L) of O2
* if someone is in cardiac arrest and regain pulse and rhythm, the use of therapeutic hypothermia saves
brain tissue when the body is cooled down.
* after cardiac arrest keep them cool for 24-48 hours in a coma until they are slowly brought back
Emergency Drugs for Cardiac Disorders: Aspirin
Indications:
o Decreases platelet aggregation
o Onset of chest pain for acute coronary syndromes and MI
o Acute ischemic stroke
Dose:
o 160 325mg tablet needs to be chewed
o Can be given rectally 300 mg suppository
Contraindication:
o Cerebral hemorrhage on CT
o Recent GI Bleed
Emergency Drugs for Cardiac Disorders: Nitroglycerin
Indications: Dilates coronary arteries and improves blood flow to an ischemic
myocardium
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o Angina Pectoris (Chest Pain)
o Myocardial Infarction (Heart Attack)
o First line for acute cardiogenic pulmonary edema decrease preload &
afterload
Dose:
o 0.3 0.4 SL (Spray 0.4/dose)
o 3 doses 5 min apart
o IV NTG 5-10 mcg/min titrate to chest paint and B/P
Contraindications:
o B/P systolic under 90/hypotension
o Concomitant use with drugs used for erectile dysfunction (Viagra, Cialis)
(causes profound hypotension may be refractory to TX)
Emergency Drugs for Cardiac Disorders: Morphine Sulfate (Narcotic analgesic)
Indications:
o Chest pain associated with MI
o Cardiogenic pulmonary edema
o Relieves pain
o Dilates venous vessels
o Reduces the workload on the heart
Dose:
o standard is 1-4 mg IV over 1-5 minutes
Reversal Agent:
o Narcan 0.4 2 mg IV every 2 minutes as indicated
Nursing - close monitoring and assessment of patient
Emergency Drugs for cardiac disorders: Atropine Sulfate (parasympathetic)
Indications:
o Treatment of hemodynamically significant bradycardia
o Some types of heart block
o Inhibits action of vagus nerve
Dose:
o 0.5mg IV/IO every 3 -5 min until desired HR is achieved
o ET Tube 2-3mg diluted in 10 ml NS
o Max dose is 3 mg
Pediatric dose:
o 0.02mg/kg IV or IO
Minimum single dose is 0.1mg
Maximum single dose is 0.5mg
Maximum total dose is 1mg in a child and 3 mg in an adolescent
In infants less than 6 months:
o heart rates lower than 100 must be treated
o Heart rates less than 60 require CPR
o Always restore adequate ventilation and oxygenation
o Neonates HR less than 80 - TX with epi 0.01mg/kg IV or IO every 3-5 min (should
be given prior to atropine)
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