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The notes are about Emergency care, Study notes of Nursing

Rajiv Gandhi UniversityNursing

The notes includes Cardio Pulmonary Resuscitation, cardio-respiratory failure , Causes of Cardiac Arrest, its Signs and Symptoms, Tracheostomy and its indication.

Typology: Study notes

2012/2013

Available from 07/04/2024

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Emergency Care
CARDIO-PULMONARY RESUSCITATION
Resuscitation includes all measures that are applied to revive patients who hav
stopped breathing suddenly and unexpectedly due to either respiratory and cardiac failure.
Cardiac arrest is one of the most common causes of cardio-pulmonary failure.
Cardiac arrest is synonymous with the term sudden death; it means that the victim's
heart beat, circulation of blood and respiration have suddenly and unexpectedly
stopped. Prompt action is vitally important for the success of cardio-pulmonary
resuscitation. When a person stops breathing spontaneously, his heart also stops
beating. Clinical death has occurred. Within 4 to 6 minutes, the cells of the brain,
which are sensitive to the paucity of oxygen begin to deteriorate. If the oxygen
supply is not restored, the patient suffer irreversible brain damage and biological
death occurs.
Cardio-Respiratory Failure
The respiratory and cardio-vascular systems are interdependent. The heart
consumes more oxygen per minute than any other organ in the body, because it is
constantly beating. Consequently, when the lungs stop working, the heart-fail occurs.
Conversely, the ventilation of the lungs fails soon after the heart stops. This is because the
respiratory centre in the medulla oblongata cannot function without the continuous supply
of oxygen that is normally transported to it by the cardiovascular system.
The cardio-respiratory failure is marked by hypoxia - a sudden fall in the arterial
oxygen tension and a rise in the arterial carbon dioxide content. Angina pectoris is the chest
pain produced by the heart tissues that are hypoxic. Clinical death occurs with the cessation
of blood flow and the respiratory chest. If the cardiac arrest is identified quickly and cardio-
pulmonary resuscitation is started immediately, we will be able to bring back the patient to
life from clinical death.
Causes of Cardiac Arrest
Anoxia caused by airways obstruction
Myocardial Infarction
Anaesthesia depression
Hypotension
Retention of carbon dioxide
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Emergency Care

CARDIO-PULMONARY RESUSCITATION

Resuscitation includes all measures that are applied to revive patients who hav stopped breathing suddenly and unexpectedly due to either respiratory and cardiac failure. Cardiac arrest is one of the most common causes of cardio-pulmonary failure. Cardiac arrest is synonymous with the term sudden death; it means that the victim's heart beat, circulation of blood and respiration have suddenly and unexpectedly stopped. Prompt action is vitally important for the success of cardio-pulmonary resuscitation. When a person stops breathing spontaneously, his heart also stops beating. Clinical death has occurred. Within 4 to 6 minutes, the cells of the brain, which are sensitive to the paucity of oxygen begin to deteriorate. If the oxygen supply is not restored, the patient suffer irreversible brain damage and biological death occurs.

Cardio-Respiratory Failure

The respiratory and cardio-vascular systems are interdependent. The heart consumes more oxygen per minute than any other organ in the body, because it is constantly beating. Consequently, when the lungs stop working, the heart-fail occurs. Conversely, the ventilation of the lungs fails soon after the heart stops. This is because the respiratory centre in the medulla oblongata cannot function without the continuous supply of oxygen that is normally transported to it by the cardiovascular system. The cardio-respiratory failure is marked by hypoxia - a sudden fall in the arterial oxygen tension and a rise in the arterial carbon dioxide content. Angina pectoris is the chest pain produced by the heart tissues that are hypoxic. Clinical death occurs with the cessation of blood flow and the respiratory chest. If the cardiac arrest is identified quickly and cardio- pulmonary resuscitation is started immediately, we will be able to bring back the patient to life from clinical death.

Causes of Cardiac Arrest

 Anoxia caused by airways obstruction  Myocardial Infarction  Anaesthesia depression  Hypotension  Retention of carbon dioxide

 Downing and other forms of asphyxia resulting in an inadequate ventilation of lungs.  Electric shock  Carbon monoxide and other types of poisoning  Drug reactions(anaphylactic shock)  Pulmonary embolism  Extensive haemorrhage  Brain injuries  Hypothermia  Electrolyte disorder and drug therapy

Signs and symptoms of Cardiac Arrest

 Apnoea - Apnoea which indicates respiratory failure diagnosed by the absence of movements of the chest and abdominal muscles.  Absence of Carotid and Femoral Pulse - Pulse in the large arteries close to the heart, are palpable even when the peripheral pulse is absent. Carotid pulse can be checked easily. It is palpable by gentle pressure over the depression between the trachea and the sterno-cleido-mastoid muscle at the level Adam's apple. Absence of carotid pulse indicates cardiac arrest.  Dilated Pupils - Cerebral hypoxia (lack of oxygen to the brain tissues) causes loss of muscle control in the entire body, including eyes. The other signs and symptoms include cyanosis, unconsciousness, fit (grand mal seizure) and complete loss of muscle tone.  Cyanosis - Cyanosis occurs due to the lack of oxygenation of blood resulting fro hypoventilation of the lungs and circulatory failure.  Unconsciousness - Hypoxia of the cerebral cortex causes unconsciousness. Brain cells are very sensitive to the paucity of oxygen than any other tissues of the body. Mild hypoxia leads to confusion and disorientation.  Fit (grand mal seizure) - This is also occurring due to cerebral anoxaemia.

Sequence of Cardio- pulmonary Resuscitation

**1. A -Airway

  1. B - Breathing**

Indications for Tracheostomy

 Obstruction in the air passage in the upper part of the trachea due to tumours, stenosis, oedema of the larynx and trachea and intrusion of foreign bodies.  Unconscious patients with respiratory depression.  Patients who develop intolerance to endotracheal tube.  Patients undergoing major surgeries of the mouth and neck such as hemiglossectomy, mandibulectomy, laryngectomy, radical neck surgeries etc.  Patients with laryngeal and tracheal trauma and paralysis.  Patients receiving irradiation therapy for laryngeal tumours.  Patients with head, neck and chest injuries.  Neurological disorders involving diaphragm and respiratory muscles.  Patients with accumulated secretions in the lower tracheobronchial tree which could cause hypoxia or atelectasis or both.  Patients with severe haemorrhage after thyroidectomy or radical neck resection in which the blood may escape into the soft tissues of the neck and exert pressure on the trachea.  Post operative patients with laryngeal oedema due to prolonged intubation.  Canine biting. When the flesh eating animals attack on man they attack on their throat.

ENDOTRACHEAL INTUBATION

Endotracheal intubation means passing of an endotracheal tube into the trachea through the nose or mouth.

Indications

  1. To administer oxygen.
  2. To remove secretions.
  3. To ventilate the lungs using a resuscitation bag or respiration.
  4. To establish and maintain an airway.
  5. To administer anaesthetics(in the operation theatre).

Endotracheal Tube sizes for different age groups:

 Newborn infants - 2.5 mm to 4 mm  0 to 1 year - 4 mm to 4.5 mm  Children up to 10 years - 5 mm to 7 mm  Children above 10 years - 7 mm to 8 mm  Adults - 8 mm to 9.5 mm