RESUMO
Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
Assuntos
Bradicardia , Eletrocardiografia , Humanos , Bradicardia/etiologia , Bradicardia/diagnóstico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Masculino , FemininoRESUMO
Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
RESUMO
Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
Assuntos
Arritmias Cardíacas , Eletrocardiografia , Humanos , Arritmias Cardíacas/diagnósticoRESUMO
Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
Assuntos
Arritmias Cardíacas , Bradicardia , Humanos , Bradicardia/diagnóstico , Bradicardia/etiologia , Arritmias Cardíacas/diagnóstico , EletrocardiografiaRESUMO
Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
Assuntos
Esforço Físico , Síncope , Masculino , Humanos , Síncope/etiologia , Eletrocardiografia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologiaRESUMO
Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
Assuntos
Arritmias Cardíacas , Eletrocardiografia , Feminino , HumanosRESUMO
Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
RESUMO
Editor's note: This article is one in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm. To see all the articles in the series, go to http://links.lww.com/AJN/A207.
Assuntos
Arritmias Cardíacas/complicações , Taquicardia/complicações , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia/métodos , Humanos , Masculino , Taquicardia/fisiopatologia , Adulto JovemRESUMO
Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
Assuntos
Morte Súbita Cardíaca , Eletrocardiografia , Eletrólitos/administração & dosagem , Papel do Profissional de Enfermagem , Torsades de Pointes/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Serviço Hospitalar de Emergência , Feminino , Humanos , Unidades de Terapia Intensiva , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar , Fumarato de Quetiapina/efeitos adversos , Fumarato de Quetiapina/uso terapêutico , Retorno da Circulação Espontânea , Inconsciência/etiologiaRESUMO
Shock from all causes carries a high mortality. Rapid and intentional intervention to resuscitate can reduce mortality and organ injury. Approaches to fluid resuscitation, vasopressor use as well as commonly assessed laboratory values are reviewed in this paper.
Assuntos
Choque Séptico , Hidratação , Humanos , Ressuscitação , Choque Séptico/tratamento farmacológico , Vasoconstritores/uso terapêuticoRESUMO
and that reference citations are not used in the synopsis. A devastating complication of cardiac arrest is hypoxic-ischemic injury, which leads to neurologic dysfunction and subsequently high mortality. Post-cardiac arrest care is complex and requires a multimodal approach to manage hemodynamic instability as well as provide neuroprotection. Targeted temperature management is recommended by the American Heart Association as well as the International Liaison Committee on Resuscitation as a class 1 intervention for postarrest neuroprotection in patients who remain unresponsive after cardiac arrest.
Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Hipotermia Induzida , American Heart Association , Parada Cardíaca/terapia , Humanos , NeuroproteçãoRESUMO
Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/enfermagem , Dispneia/diagnóstico , Dispneia/enfermagem , Eletrocardiografia/enfermagem , Enfermagem em Emergência/métodos , Eletrocardiografia/métodos , HumanosRESUMO
Editor's note: This is the second installment in a new series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
Assuntos
Dispneia/etiologia , Taquicardia Sinusal/diagnóstico , Antibacterianos/administração & dosagem , Tosse/etiologia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Taquicardia Sinusal/terapiaRESUMO
Editor's note: This is the first in a new series on electrocardiography (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
Assuntos
Bradicardia , Eletrocardiografia , Fadiga/etiologia , Tiroxina/uso terapêutico , Bradicardia/diagnóstico , Bradicardia/tratamento farmacológico , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Regulação da Temperatura Corporal , Lesões Encefálicas/prevenção & controle , Parada Cardíaca/terapia , Hipotermia Induzida/métodos , Regulação da Temperatura Corporal/efeitos dos fármacos , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/fisiopatologia , Ondas Encefálicas , Buspirona/uso terapêutico , Eletroencefalografia , Parada Cardíaca/diagnóstico , Parada Cardíaca/fisiopatologia , Humanos , Hipotermia Induzida/efeitos adversos , Neurotransmissores/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Estremecimento , Resultado do TratamentoRESUMO
BACKGROUND: Development of ventricular fibrillation or pulseless ventricular tachycardia after an initial rhythm of pulseless electrical activity or asystole is associated with significantly increased cardiac arrest mortality. OBJECTIVE: To examine differences in epinephrine administration during cardiac arrest between patients who had a secondary ventricular fibrillation or ventricular tachycardia develop and patients who did not. METHODS: Data were collected for 2 groups of patients with in-hospital cardiac arrest and an initial rhythm of pulseless electrical activity or asystole: those who had a secondary ventricular fibrillation or ventricular tachycardia develop (cases) and those who did not (controls). Dosing of epinephrine during cardiac arrest and other variables were compared between cases and controls. RESULTS: Of the 215 patients identified with an initial rhythm of pulseless electrical activity or asystole, 51 (23.7%) had a secondary ventricular fibrillation or ventricular tachycardia develop. Throughout the total duration of arrest, including periods of return of spontaneous circulation, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.4 minutes compared with 1 mg every 5 minutes in controls (P= .001). For the total duration of pulselessness, excluding periods of return of spontaneous circulation during the arrest, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.1 minutes versus 1 mg every 4.3 minutes in controls (P= .001). CONCLUSION: More frequent administration of epinephrine during cardiac arrest is associated with development of secondary ventricular fibrillation or ventricular tachycardia.
Assuntos
Epinefrina/uso terapêutico , Parada Cardíaca/tratamento farmacológico , Parada Cardíaca/epidemiologia , Taquicardia Ventricular/epidemiologia , Fibrilação Ventricular/epidemiologia , Idoso , Broncodilatadores/uso terapêutico , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Washington/epidemiologiaAssuntos
Reanimação Cardiopulmonar/normas , Cardioversão Elétrica/normas , Parada Cardíaca/diagnóstico , Parada Cardíaca/terapia , Pacientes Internados , Melhoria de Qualidade/normas , Respiração Artificial/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , American Heart Association , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Resultado do Tratamento , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: To evaluate whether implementation of a therapeutic hypothermia protocol on arrival in a community hospital improved survival and neurologic outcomes in patients initially found to have ventricular fibrillation, pulseless electrical activity, or asystole, and then successfully resuscitated from out-of-hospital cardiac arrest. DESIGN: A retrospective study of patients who presented after implementation of a therapeutic hypothermia protocol compared with those who presented before the protocol was implemented. SETTING: Harborview Medical Center, Seattle, WA. PATIENTS: A total of 491 consecutive adults with out-of-hospital, nontraumatic cardiac arrest who presented between January 1, 2000 and December 31, 2004. INTERVENTIONS: An active cooling therapeutic hypothermia protocol, using ice packs, cooling blankets, or cooling pads to achieve a temperature of 32 degrees C to 34 degrees C was initiated on November 18, 2002 for unconscious patients resuscitated from cardiac arrest. MEASUREMENTS AND MAIN RESULTS: Demographics and outcomes were obtained from medical records and an emergency medical database. The primary outcomes were survival and favorable neurologic outcome at discharge associated with the therapeutic hypothermia protocol. An adjusted analysis was performed, using a multivariate regression. During the therapeutic hypothermia period, 204 patients were brought to the emergency department; of these 204 patients, 132 (65%) ultimately achieved temperatures of <34 degrees C. Of the 72 patients who did not achieve goal temperatures: 40 (20%) died in the emergency department or shortly after being admitted to the hospital, 15 (7%) regained consciousness, four (2%) had contraindications, 13 (6%) had temperature increase or did not have documented use of the therapeutic hypothermia protocol. In the prior period, none of the 287 patients received active cooling. Patients admitted in the therapeutic hypothermia period had a mean esophageal temperature of 34.1 degrees C during the first 12 hrs compared with 35.2 degrees C in the pretherapeutic hypothermia period (p < .01). Survival to hospital discharge improved in the therapeutic hypothermia period in patients with an initial rhythm of ventricular fibrillation (odds ratio, 1.88, 95% confidence interval, 1.03-3.45), however not in patients with nonventricular fibrillation (odds ratio, 1.17, 95% confidence interval, 0.66-2.05). In adjusted analysis, ventricular fibrillation patients during the therapeutic hypothermia period trended toward improved survival (odds ratio, 1.71, 95% confidence interval, 0.85-3.46) and had favorable neurologic outcome (odds ratio, 2.62, 95% confidence interval, 1.1-6.27) compared with the earlier period. This benefit was not observed in patients whose initial rhythm was pulseless electrical activity or asystole. CONCLUSIONS: The therapeutic hypothermia period was associated with a significant improvement in neurologic outcomes in patients whose initial rhythm was ventricular fibrillation, but not in patients with other rhythms.