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  1. 1.
  2. 2. CARDIAC ARREST<br />Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness usually results from an electrical disturbance in heart that disrupts its pumping action, stopping blood flow to the rest of the body.<br />
  3. 3. ETIOLOGICAL FACTORS<br />I. CORONARY ARTERY ABNORMALITIES<br />A. Coronary atherosclerosis<br />Acute or transient myocardial ischemia<br />Acute myocardial infarction<br />Chronic atherosclerosis<br />
  4. 4. B. Congenital abnormalities of coronary arteries<br />Anomalous origin from pulmonary artery<br />Other coronary arteriovenous fistula<br />Origin of a left coronary branch from right or noncoronary sinus of Valsalva<br />Origin of right coronary artery from left sinus of Valsalva<br />Hypoplastic or aplastic coronary arteries<br />Coronary-intracardiac shunt<br />
  5. 5. C. Coronary artery embolism<br />Aortic or mitral endocarditis<br />Prosthetic aortic or mitral valves<br />Abnormal native valves or left ventricular mural thrombus<br />Platelet embolism<br />
  6. 6. D. Coronary arteritis<br />progressive systemic sclerosis, giant cell arteritis<br />Mucocutaneous lymph node syndrome (Kawasaki disease)<br />Syphilitic coronary ostialstenosis<br />
  7. 7. E. Miscellaneous mechanical obstruction of coronary arteries<br />Coronary artery dissection in Marfan syndrome<br />Coronary artery dissection in pregnancy<br />Prolapse of aortic valve myxomatous polyps into coronary ostia<br />Dissection or rupture of sinus of Valsalva<br />
  8. 8. F. Functional obstruction of coronary arteries<br />Coronary artery spasm with or without atherosclerosis<br />Myocardial bridges<br />
  9. 9. II. HYPERTROPHY OF VENTRICULAR MYOCARDIUM<br />Left ventricular hypertrophy associated with coronary heart disease<br />Hypertensive heart disease without significant coronary atherosclerosis<br />Hypertrophic myocardium secondary to valvular heart disease<br />Hypertrophic cardiomyopathy<br />Primary or secondary pulmonary hypertension<br />
  10. 10. III. MYOCARDIAL DISEASES AND HEART FAILURE<br />A. Chronic congestive heart failure<br />Ischemic cardiomyopathy<br />Idiopathic dilated cardiomyopathy<br />Alcoholic cardiomyopathy<br />Hypertensive cardiomyopathy<br />Postmyocarditis cardiomyopathy<br />Peripartum cardiomyopathy<br />
  11. 11. B. Acute and subacute cardiac failure<br />Massive acute myocardial infarction<br />Acute myocarditis<br />Acute alcoholic cardiac dysfunction<br />Takotsubo syndrome (uncertain sudden death risk)<br />Bail-valve embolism in aortic stenosis or prosthesis<br />Mechanical disruptions of cardiac structures<br />Acute pulmonary edema in noncompliant ventricles<br />
  12. 12. IV. INFLAMMATORY, INFILTRATIVE, NEOPLASTIC, AND DEGENERATIVE PROCESSES<br />A. Viral myocarditis, with or without ventricular dysfunction<br />B. Myocarditis associated with the vasculitides<br />C. Sarcoidosis<br />D. Progressive systemic sclerosis<br />E. Amyloidosis<br />
  13. 13. F. Hemochromatosis<br />G. Idiopathic giant cell myocarditis<br />H. Chagas' disease<br />I. Cardiac ganglionitis<br />J. Arrhythmogenic right ventricular dysplasia; right ventricular cardiomyopathy<br />K, Neuromuscular diseases<br />M. Obstructive intracavitary tumors<br />
  14. 14. V DISEASES OF THE CARDIAC VALVES<br />Valvular aortic stenosis/insufficiency<br />Mitral valve disruption Mitral valve prolapse<br />Endocarditis<br />Prosthetic valve dysfunction<br />
  15. 15. VI. CONGENITAL HEART DISEASE<br />A. Congenital aortic or pulmonic valve stenosis<br />B. Right-to-left shunts with Eisenmenger physiology<br />C. Late after surgical repair of congenital lesions (e.g., tetralogyof Fallot)<br />
  16. 16. VII. ELECTROPHYSIOLOGICAL ABNORMALITIES<br />A. Abnormalities of the conducting system<br />1. Fibrosis of the His-Purkinje system<br />Primary degeneration <br />Secondary to fibrosis and calcification of the "cardiac skeleton" <br />Postviral conducting system fibrosis<br />Hereditary conducting system disease<br />2. Anomalous pathways of conduction <br />
  17. 17. B. Abnormalities of repolarization<br />1. Congenital abnormalities of QT interval duration<br />a. Congenital long-QT interval syndromes<br />b.Congenital short QT interval syndrome<br />
  18. 18. 2.Acquired (or provoked) long QT interval syndromes<br />a. Drug effect<br />b. Electrolyte abnormality<br />c. Toxic substances<br />d. Hypothermia<br />e. Central nervous system injury; subarachnoid hemorrhage<br />Brugada syndrome-<br /> right bundle branch block and ST segment elevations in the absence of ischemia<br />
  19. 19. C. Ventricular fibrillation of unknown or uncertain cause<br />1. Absence of identifiable structural or functional causes<br /> "Idiopathic" ventricular fibrillation<br /> polymorphicventricular tachycardia<br /> Nonspecific fibrofatty infiltration in previously healthyvictim<br />
  20. 20. VIII. ELECTRICAL INSTABILITY RELATED TO NEUROHUMORAL AND CENTRA! NERVOUS SYSTEM INFLUENCES<br />Catecholamine-dependent lethal arrhythmias<br /> Central nervous system related<br />Psychic stress, emotional extremes<br />Auditory related<br />"Voodoo death" in primitive cultures<br />Diseases of the cardiac nerves<br />Arrhythmia expression in congenital long-QT interval syndrome<br />
  21. 21. IX. SUDDEN INFANT DEATH SYNDROME AND SUDDEN DEATH IN CHILDREN<br />A. Sudden infant death syndrome<br />Immature respiratory control functions<br />Long-QT interval syndrome<br />Congenital heart disease<br />B. Sudden death in children<br />Eisenmenger syndrome, aortic stenosis, hypertrophic cardiomyopathy, pulmonary atresia<br />After corrective surgery for congenital heart disease<br />Genetic disorders of electrical function <br />
  22. 22. X. MISCELLANEOUS<br />A. Sudden death during extreme physical activity <br />B. Commotiocordis—blunt chest trauma<br />C. Mechanical interference with venous return<br />D. Dissecting aneurysm of the aorta<br />E. Toxic and metabolic disturbances <br />F. Mimics sudden cardiac death<br />
  23. 23. Risk factor<br />A family history<br />Smoking<br />High blood pressure<br />High blood cholesterol<br />Obesity<br />Diabetes<br />A sedentary lifestyle<br />Drinking too much alcohol<br />
  24. 24. Other factors :<br />A previous episode of cardiac arrest<br />A previous heart attack<br />A personal or family history of other forms of heart disease<br />Age<br />Being male<br />Using illegal drugs<br />Nutritional imbalance<br />
  25. 25. Symptoms<br />Sudden collapse<br />No pulse<br />No breathing<br />Loss of consciousness<br />
  26. 26. Warning signs<br />fatigue, fainting,<br /> blackouts, <br />dizziness,<br /> chest pain,<br /> shortness of breath, <br />weakness,<br /> palpitations or vomiting<br />
  27. 27. Pathophysiology<br />Contributing factors<br />Brady arrythmias<br />Tachyarrythmias<br />End of cascade<br />Cardiac arrest <br />
  28. 28. Tests and diagnosis<br />1)Electrocardiogram <br />2)Blood tests<br /><ul><li>Cardiac enzyme test. 
  29. 29. Electrolyte test. 
  30. 30. Drug test.</li></ul>3)  Hormone test.<br />4)Imaging tests<br /><ul><li>Chest X-ray. 
  31. 31. Nuclear scan. 
  32. 32. Echocardiogram. </li></li></ul><li>4) Other tests <br /><ul><li>Electrical system (electrophysiological) testing and mapping.
  33. 33. Ejection fraction testing. 
  34. 34. Coronary catheterization (angiogram). </li></li></ul><li>Treatments<br />CPR <br />
  35. 35. Emergency room management<br />Airway:<br />Endotracheal intubation.<br />Combitube<br />Laryngeal mask airway<br />Breathing:<br />
  36. 36. Circulation:<br />intravenous(I/V) access ,<br />attachment of monitors, electrodes/leads, <br />rhythm identification, <br />blood pressure and medication administration.<br />
  37. 37. VF and pulse less VT:<br />Pulseless electrical activity<br /> <br />Asystole:<br /> <br />Symptomatic bradycardia<br /> <br />Unstable tachycardia<br />
  38. 38. Defibrillation:<br />delivery of an electrical current to the heart through the chest wall by the use of external paddles, connected to cablesworksby completely depolarizing the heart disrupting the impulses causing dysrrythmia<br />
  39. 39. Automated external defibrillation<br />AED is an external defibrillator with rhythm analysis capabilities ,analyses patients rhythm and give counter shock.<br />
  40. 40. Implantable Cardioverter defibrillator <br />ICD is a device consist of a generator and at least one lead that can sense an intrinsic electrical activity and deliver an electrical impulse and terminates life threatening episodes of VT and VF. <br />
  41. 41. Cardio Version<br />Cardio version is the delivery of a counter shock that is synchronized with patient's cardiac rhythm and is mainly used in atrial fibrillation and atrial flutter.<br />
  42. 42. Drugs <br />Diltiazem<br />Dopamine:<br />Lidocaine;<br />Sodium bicarbonate<br />Norepinephrine (Noradrenalin):<br />Atropine<br />Verapamil<br />Vasopressin<br />procainamide<br />
  43. 43. SURGICAL MANAGEMENT<br />Coronary angioplasty. <br />Coronary bypass surgery. <br />Radiofrequency catheter ablation. <br />Corrective heart surgery.<br />Heart transplantation. <br />
  44. 44. Therapeutic hypothermia<br />Therapeutic hypothermia is the act of cooling a patient to 32 to 34 degrees Celsius (89.6 to 93.2 degrees Fahrenheit) in order to minimize the brain injury that often occurs after a cardiac arrest.<br />
  45. 45. NURSING MANAGEMENT<br />potential for Arrhythmias<br />Fluid Volume Excess<br />Anxiety related to fear of death<br />Activity intolerance<br />Risk for infection<br />Knowledge deficit<br />
  46. 46. BIBLIOGRAPHY <br /> <br />smeltzer,S.C and Bare,B.G (2011),Brunner and suddarth's text book of medical surgical nursing VOL I ,(12th edition).Philadelphia:lippincot Williams and wilkins publishers Pp 843- 845 .<br />Field,M.JandSoderberg,S.E ;(2006).Advanced cardiovascular life support-provider's manual.American heart association(lst edition)Pp 25-130.<br /> Libby , Bonow,Ziper ,Braunwalds Heart Diseases,A Text book of cardiovascular Medicine,eighth edition ,saunders publishers ,pp 933-970<br />sole,D.G and Klein.G; (2001).Introduction to critical care nursing (4 edition).philadelphia:ElsevierpublishersPp 223-225.<br />
  47. 47. Keen,J.H(1995).mannual of critical care nursing.st.Louis company.<br />Black,J.M and hawks,J.K.(2005).medical surgical nursing:clinical management for positive outcomes(7th edition).st.Louis:W.B Saunders company.Pp 345-348<br />Lewis ,Heitkemper ,Dirksen ,Medical Surgical Nursing ,6 th edition ,mosby publishers ,pp -834 – 836<br />E. Brooke Lerner, Michael R. Sayre, Jane H. Brice, Lynn J. White, Amy J. Santin, Anthony J. Billittier IV and Samuel D. Cloud Resuscitation, Online December 26, 2007<br />
  48. 48. Then ,with the perfect timing ,he silently leans forward and with a familiar and practiced gesture, offer his arm and smiles <br /> Extract from :wise traveller relationships.<br />Thank u….<br />nidheesha<br /> 1styrmsc nursing<br />

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