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One case of elderly patients with cardiac arrest the 62 min heart of recovery after a successful nursing experience

Author: XuZuo GuoZuoZuo RenJunJie From: www.yourpaper.net Posted: 2010-06-24 09:23:22 Read:
[Keywords] advanced age patients with cardiac arrest cardiac resuscitation care
Cardiac arrest is the ejection function of the heart suddenly stops, aortic pulse and heart sounds disappear, vital organs severe ischemia, hypoxia, resulting in the termination of life. This unexpected sudden death, medicine, also known as sudden death. Cause cardiac arrest one of the most common causes of ventricular fibrillation. Our department in 2008, successfully rescued an elderly cardiac arrest 62 min in patients, are as follows.
1 clinical data
Patients, male, 82 years old. The main cause of paroxysmal chest tightness, shortness of breath for 10 years, increased 8 h hospitalized, into families and only 3 min in patients with sudden convulsions, loss of consciousness, call not, ventricular fibrillation, weak breathing, blood pressure of 8.4/4.7 kPa immediately for emergency treatment, 360 J defibrillation, given continuing external cardiac massage continuous infusion of vasopressors, epinephrine 1 mg bolus, 5% glucose 20 mL amiodarone 150 mg bolus, endotracheal intubation, mechanical ventilation. Continued 62 min after the patient's heart rate recovery, ECG showed: sinus rhythm, blood pressure 14.1/8.1 kPa, a heart rate of 52 beats / min, oxygen saturation 86%. Rescue during the patient has recurrent ventricular fibrillation, ventricular tachycardia, third degree atrioventricular block, ventricular spontaneous cardiac rhythm, has given electrical defibrillation 11 times, intermittent application of boost, strong heart, adjust the rhythm drugs. Improved and was discharged 18 days after.
care
2.1 cardiopulmonary resuscitation in the process of care with
2.1.1 quickly determine the condition
Nurse cardiac arrest in a short period of time to make an accurate judgment, the sudden loss of consciousness, aortic pulse suddenly disappeared can be diagnosed as cardiac arrest, cardiopulmonary resuscitation immediately and notify the other medical staff for emergency treatment [1].
2.1.2 keep the airway Typically, row external cardiac massage
Other medical personnel arrived at the scene, the nurse should immediately line of external cardiac massage, medical attention should immediately intubated, given the breathing bag the artificial ventilation successor ventilator-assisted breathing.
2.1.3 establishment of intravenous access
Choose a suitable vein, the establishment of intravenous access, external cardiac massage. Intravenous administration than other vein center above the diaphragm, but central venous puncture is too much trouble, at the same time to intubation, rescue more choice of peripheral venous catheter open venous access, easy to operate, fast, fewer complications, and as a preferred way of cardiopulmonary resuscitation, speed, administration after administration of normal saline infusion line.
2.1.4 ECG
To grasp the disease and guide treatment based on ECG monitoring, in order to do a good job in the application of cardiac drugs should be observed in patients with ECG changes at any time. 2.1.5 Observation of the effects
Rescue process should be closely observe the patient's heart rate, blood pressure, dilated pupils, pale with aortic pulse recovery, skin color turn red, one of the pupillary light reflex recovery, can the effective cardiopulmonary resuscitation, or the opposite.
2.2 cardiopulmonary resuscitation postoperative care
2.2.1 monitoring of vital signs
Given intensive care, continuous ECG, blood pressure, and oxygen saturation monitoring, facilitate the timely detection and treatment of cardiac arrhythmias and to improve hypoxia, timely reporting of abnormal doctor. And ready to rescue medicines and rescue equipment in order to urgently.
2.2.2 observation and care of brain damage
The patients he was successful cardiopulmonary resuscitation, during the recovery process, we also attach great importance to the recovery of the brain, but serious brain damage, and ultimately did not restore. First cooling, hypothermia can reduce intracranial pressure and cerebral metabolism, general rectal temperature can not be less than 31 กใ C to 32 กใ C is appropriate. Followed by dehydration, prescribed application of 20% mannitol, joint use of furosemide injection. The course of treatment should be closely observed urine output, blood pressure changes, to prevent dehydration too fast cause hypovolemia appropriate sedation, convulsions and restlessness, antispasmodic, to prevent the development of cerebral edema.
2.2.3 close observation of changes in urine
After cardiopulmonary resuscitation in patients whose kidneys are bound to damage by hypoxia, it is necessary to observe the changes in urine. Indwelling catheter, record 24-h urine output, to detect the presence or absence of renal dysfunction.
2.2.4 continuous oxygen to maintain airway patency
When breathing deep, superficial, double suction, nodding like breathing and tidal breathing the central hypoxic damage, poor respiratory, pulmonary infection, metabolic disorders, cerebral edema affect the medullary respiratory center results. Difficulty breathing, facial cyanosis, lung infection caused by respiratory obstructive symptoms. Maintain airway patency is repeated suctioning to clear respiratory secretions [2].
2.2.5 Infection Prevention
Recovery throughout the course of the disease is often complicated by infection, the most common lung infection, urinary tract infection, stomatitis, tracheotomy opening infection. Inability to cough and coma should be given to the suction; stand up on time, 1.5 to 2 h stand 1 and massage pressure parts of the skin; 6 h 1 times adhere to the oral care; 0.1% benzalkonium bromide solution disinfection urethra and gentamicin sulfate solution, rinse the bladder; timely replacement of the tracheotomy at the dressing, keep the trachea incision clean and dry. Each operation should adhere to the principles of aseptic technique.
2.2.6 diet care
Given a high-calorie, high in vitamins, digestible diet, maintaining smooth stool.
discussion

The patients with cardiac arrest 62 min after successful treatment by cardiopulmonary resuscitation, mechanical ventilation 18 d condition improved and discharged, which is very rare in clinical. Now rescue success factors are summarized as follows: CPR in a timely manner during the rescue center; timely adjustment amiodarone arrhythmia; timely and to endotracheal intubation open airway; defibrillation as soon as possible; closely with health care. The above factors are key to successful treatment.
[References]
[1] Wupei Zhen, Zhang Meiqing care with cardiopulmonary resuscitation [J] Chinese Journal of Modern Nursing, 008,5 (9): 864.

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