| Heart Treatment Procedures (all species, all ages) |
| Written by Commander Anne E Erickson Approved by: Captain Gavic Casteclear CMO |
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Cardiopulmonary Resuscitation: CPR--Heart-lung resuscitation. A combined effort to restore or maintain respiration and circulation. Cardiac Arrest: When the heart stops beating, and no longer circulates blood. Mediastinum: the central portion of the thoracic cavity, containing the heart, its greater blood vessels, part of the trachea, and part of the greater vessels superior to the heart. Pericarduim: the membranous sac that surrounds the heart, connecting to the base of the greater vessels superior to the heart. Atrium: an upper chamber of the heart. There is a right atrium ( receives blood returning from the body) and a left atrium (receives oxygengentated blood from the lungs). The plural is Atria. Ventricle: a lower camber of the heart. There is a right ventricle (sends blood to the lungs) and a left ventricle (sends oxygenated blood to the body). Pulmonary Artery: the blood vessel that transports blood from the right ventricle to the lungs. Aorta: the artery that transports blood from the left vetricle to begin systemic circulation. Conduction System: modified heart muscle that acts as nervous tissue to cause heart contraction. Pulmonary Circulation: the transport of blood from the right atrium to the lungs where it is oxygentated, and then returned to the left atrium. Pulmonary Viens: the vessels that transport oxygentated blood from the lungs to the left atrium. Systemic Circulation: the portionof the firculatory system that transorts blood from the left ventricle out to the body's tissues and back to the heart. Venae Cavae: the superior vena cava and the inferior vena cava. These two major veins return blood from the body to the right atrium. CPR Compression Site: the sternal point approximately one finger-width superior to the substernal notch to the xiphoid process. Substernal Notch: a general term for the lowest region on the sternum to which ribs attach. Xiphoid Process: a small projection at the inferior end of the sternum. Sternum: the breast bone. Clavicle: The collarbone. There are two one attached to the right sideof the superior sternum, and one attached to the left side. Interposed Ventilation: the artifical ventilation provided during CPR. Brachial Pulse: the pulse measured by palpating the major artery (brachial artery) of the upper arm. This pulse is used to detect heart action and circulation in infants. Ref. Emergency Care; Grant, Murray, and Bergeron. |
| Cardiac Terms |
| CPR is Cardiopulmonary Resuscitation. This basic life support measure is applied when a patient's heart and lung actions have stopped. The ABC's of Emergency Care A = Airway B = Breathing C = Circulation The Techique's of CPR. Assessing your patient first. 1. Establish unreponsiveness- Is your patient responsive? 2. Establish an open airway- This should be done by the head tilt, chin lift. 3. Check for Breathing by using the LOOK, LISTEN, and FEEL method by assessing your patient. If you determine that your patient...not breathing 4. Deliver four quick breaths- using rescue breathing technique's at this time you will be able to determine if your patient has an obstructed airway. First reposition your patients neck and insure you have an open airway and repeat your four quick breaths if still no reponse proceed in attempts to clear the airway. 5. Check for a carotid pulse after you assesment of the patient he has no pulse then Begin CPR and notify your nearest Medical personal aboard ship or Starbase Medical Facility. ONE RESCUE CPR 1. Establish Unresponsiveness 2. Open Airway 3. Look, Listen and Feel 4. Provide 4 rapid breaths 5. Assess Pulse if none 6. Locate Compression Site 7. Correct placement of hands 8. Begin Compressions: Compression Rate delivered at a rate of 100 per minute as per the AHA current standards for CPR. Instead of the old standard count of 1 100...2 1000...3 1000 verbal count. One and Two and Three...after 15.. 9. Ventilate: Provide Two Interposed Ventilations every 15 Compressions. 10. Periodical Assess your patient for spontatous return of pulse and breathing. CPR TECHNIQUES FOR INFANTS AND CHILDREN: The techinque's of CPR for infants and small children are essentially the same for those used for the adult. Positioning the Patient for CPR is best performed when adults, children,and infrants are placed on their back on a hard surface. Note: Opening the airway for the Infant: Use the head-tilt, neck lift technique applying only a slight tilt. Too great a tilt will close off the airway of your infant patient. Always be sure to support the infant's head. Child: The same caution applies to small children as to infants. Larger children can have their airways opened by standard head-tilt. Establishing a pulse on Infant's DO NOT use the cartoid or radial pulse. For infants, you should use the brachial pulse. This is the pulse that can be felt when compressing the major artery of the upper arm, the brachial artery. You can locate the brachial pulse by 1. Locating the point halfway between the infant's elbow and shoulder. 2. Placing your thumb on the lateral side of the upper arm at this midway point. 3. Placing the tips of your index and middle fingers at the midway point on the medial surface of the infant's upper arm. You will feel a groove in the muscle at this location. 4. Pressing you index and middle fingers in toward the bone, taking care not to exert too much pressure. To do so will collapse the artery and stop circulation to the lower arm, and perhaps cause you to miss feeling the pulse. CHILD: Determine circulation by assessing the carotid pulse. EXTERNAL CHEST COMPRESSIONS INFANT: apply compressions to the midline of the sternum, directly between the nipples, Use the tips of two or three fingers to deliver the compressions. The infant's breastbone should be depressed 1/2 to 1 inch (1.5 to 2.5 cm.) CHILD: compressions are applied using the heel of one hand. THe compression site is the midsternum, directly between the nipples. The child's breastbone should be depressed 1 to 1 1/2 inches(2.5 to 4 cm.) INTERPOSED VENTILATIONS INFANT: the rescuer should provide a gentle breath of air using the mouth- to- mouth and nose techinque. This may be no more than a puff of air. It is essentail to watch the rise oand fall of the infant's chest. The rescuer should deliver just enough air to cause the infan'ts chest to rise. CHILD: a gentle breath is provided to the child patient. Again, only enough air is delivered to cause the patient's chest to rise. Mouth-to-mouth or Mouth-to-nose techniques are usually employed depending upon the size of your patient. COMPRESSIONS RATIO'S INFANT: deliver compressions at the rate of 100 per mintue. Interpose a gentle breath every 5 compressions to give a ratio of 5:1 CHILD: deliver compressions at the rate of 100. Interpose a gentle breath every 5 compressions to give a ratio of 5:1. Note: To establish the correct count rate for INFANTS count to yourself: "One, two, three, four, five, Breathe. CHILD: count- "One and two and three and four and five and breathe" Provide the interposed ventilation immediately after "five". TWO RESCUER CPR ADVANTAGES CPR efforts are more effective are more effective when two resucers work together. The patient recieves more oxygen, chest compressions are not interrupted, and he problem of rescuer fatigque is lessened. Compressions and Ventilations: For the two-rescuer method, the rate of compressions is five compressions every five seconds. This means that the EMT delivering the compressions (Compressor) has to provide a full compression and release every second, thus providing 60 compressions per minute. The EMT delivering interposed ventilations (the Ventilator) provides one full breath on the upstroke of every fifth compression, to provide a rate of 12 breaths per minute. When in performing two rescuer CPR the Compression calls for the change on the first stroke of the compression. <Compressor> Change 1000...2000...3000...4000...5000 At the start of the compressors command the Ventilator moves into postion to take over the compressor. During this change between the Compressor and Ventilator make an patient assessment to determine Pulse and respirations. If you determine that there is no pulse at this time Continue CPR providing Ventilation first then continue with the CPR sequence. Note: These procedures are designed for the trained Emergency Technicians and this information is provide for the Role player experience. These techniques slightly differ from the lay person technique. Contact the American Heart Assoc. for more details in your area for training. 1-877-AHA-4CPR Ref: Emergency Care. Grant, Murray, and Bergeron |
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| Crewman Cardiopulmonary Resuscitation |
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Epinephrine - Sympathominmetic Dosage: 1mg/cc/1:10,000 in 10 ml. 0.5-1mg IV, Intratracheally or Intracardiac. Repeat q 5 min. as needed during arrest. Action: Stimulates cardiac beat receptor increases C.O ( Cardiac Output) by stimulating contractility, Increases Heart Rate, Improves stroke Volume Indications: Cardiac resuscitation. Anaphylactic shock, Ventricular Fibrillation. CHB (Complete Heart Block). Aminophylline - Brochodilator Dosage: 500mg/500cc in D5W and Titrate according to Theophylline Levels .5mg/kg/hr. Action: Relaxation bronchial muscle spasms, mild cardiac stimulant, may increase C.O. and decrease pulmonary reserve in patients with left ventricular failure or P.E. (Pulmonary Emboli). Indications: Asthma, Bronchial Spasms (May Cause reflux Tachycardia). Apresoline- Anti-hypertensive Dosage/infusion Rate: 20mg/cc/1cc amp; 10-20mg IV. Action: Relaxation of the arteries by direct action on smooth muscle walls, Vasodilation and decreased Peripheral Vascular Resistance. Indications: Hypertension Replace with oral administration ASAP. Atropine - Anti-cholinergic Dosage: 0.1mg/cc/10cc syringe; 0.5-1.0 as needed. Action: Blocks cholinergic nerve impulse transmission to smooth muscle and cardiac muscle, stimulates vagal nerve. Indications: Bradycardia, Incomplete Heart Block. Bretylium - Adrenergic blocker Dosage: 50mg/cc/10cc amp, 350-500mg (5mg/kg) as initial dose, 2gm/500 D5W at 1-4mg/min. Action: not fully understood, Suppress V-Tach and fibrillation by direct effect on myocardium as Adrenergic blocker. Indications: Recurrent V-Tach and V-Fib. Calan/Verapamil/Isoptin - Calcium Channel Blocker Dosage: 2.5mg/cc/2cc amp; 5-10mg IV over 2 min. may repeat dose in 30 min. Action: Blocks influx of calcium ions decreasing smooth muscle contraction, Increases C.O. by decreasing heart rate and increasing ventricular filling time. Indications: Treatment of Supraventricular Tachy Dysrhythmias. Dobutrex/Dobutamine - Synthetic Catecholamine Dosage: 250 mg Vial; 250mg/250cc D5W at 2.5-10 mcg/kg/min Action: Stimulates Beta receptors in heart, increases C.O. by stimulating contractility and improving Stroke Volume without increase in heart rate. Indications: Patients with depressed myocardial function--EX: Organic Heart Disease Cardiac Surgery. Dopamine HCL/Intropin - Sympathominmetic Beta Adrenergic Dosage: 200mg/5cc;400mg/250cc D5W. Initial: 2-5mcg/Kg/min.; 5-10mcg/Kg/min may be required in critically ill and then up to 50mcg/Kg/min. has been required in some instances. Actions: Inotropic effect increases C.O., increases systolic and pulse pressure, little or no effect on diastolic pressure, renal and mesenteric vasculature dilatation with resultant increase in renal perfusion (at dosage of 2-5mcg/Kg/min.). Indications: To correct hemodynamic imbalances in shocky states due to MI, trauma, open heart surgery, CHF (Congestive Heart Failure), to improve renal perfusion, restoration of normovolemia with volume expanders should be initiated prior to use of dopamine. Inderal - Non-specific Beta Blocker Dosage: 1mg/cc/1ml amp.; 1-3mg IV at a rate of 1mg/min. Action: Reduces the responsiveness of the heart to sympathetic stimulation. Indications: Cardiac arrhythmia's, PAT, Sinus Tach, Atrial flutter and Fib, PVC's; APB's and Hypertension. Inocor - Cardiac Inotropic agent Dosage: 5mg/cc/2cc Vials, 0.75/Kg IV bolus over 2-3 min. May repeat in 30 min.; Maintenance is 5-10mcg/Kg/Min I amp/500CC NS. Action: Increases force and velocity of myocardial systolic contraction (Positive Inotropic action) Causes an increase in CO by increasing the force of contraction of the heart, probally by inhibiting cyclic AMP phosphodiesterase. Indications: Poor cardiac performance, low myocyte receptor, low contractility of GMP Pathways. Isuprel/Isopreterenol - Synthetic Catecholamine Dosage: 1mg/5cc amp; 1 mg in 250cc of D5W at 2-20mcg/min. Action: Cardiac stimulant, Increases SV (Stroke Volume) C.O. Cardiac work, coronary flow and venous return. improves AV conduction, Peripheral Vasolidatation, Bronchial muscle relaxant. Indications: AV block, Shock. Levophed/norephinephrine - Vasopressor Dosage: 1mg/cc/4cc amp, 4mg/500 D5W to infuse at 2-3ml/min. ( may add 1amp of Regitine for every 2 amp Levophed for tissuse sloughing) Action: Constricts arterioles and venules, Dilates coronary arteries, Powerful Vasoconstrictor. Indications: All hypotensive states, Ventricular Asystole (Severe tissue sloughing if infiltrated) Lidocaine - Anti-arrhythmic Dosage: IV bolus;50-100 mg IV push (1mg/kg IV push) Actions: Suppresses automaticity in the His-Purkinje System, Suppresses spontaneous depolarization of the ventricles during diastole. Indications: Ventricular arrhythmia's Narcan/ Naloxone HCL - Narcotic Antagonist Dosage: 0.4mg/cc/1cc amp; 0.4-2mg IV Push Repeat at 3 min. intervals or for a drip 2mg/500cc D5W-Titrate to response. Actions: Overcomes narcotic induced respiratory depression by its potent narcotic antagonist properties. Indications: Reversal of narcotic depression, Antidote for natural and synthetic narcotics. Nipride /Nitroprusside - Anti-hypertensive Dosage: 50 mg Vials to be diluted 50-100mg in 250cc D5W and infused at 0.5-10mch/kg/min (Must be protected from light during infusion.) Action: Peripheral vasodilatation via direct action on smooth muscle of blood vessels, Increases cardiac output. Indications: Hypertensive crisis, Cardiogenic Shock (Monitor Cyanide Levels to determine Cyanide intoxication.) Nitroglycerin /Tridil - Vasodilator Dosage: Titrate drip to effect, Drip can range from 50mcg/ml to 200mcg/ml. Action: Relaxes smooth muscle of coronary arteries, increases myocardial blood supply, May improve cardiac output. Indications: Angina (Sublingual) Hypertension (IV). Pavulon - Muscle Relaxant Dosage: 1mg/cc/10cc Vial, Loading Dose is 06-0.1mg/kg. Maintenance: .01/kg every 25-60 min. Action: Skeletal muscle relaxant, Causes paralysis by interfering with neutral transmission at the myoneural junction. Indications: Management of patients on Mechanical ventilation, adjust to anesthesia. Pronestyl\ Procainamide - Anti-arrhythmic Dosage: IV bolus: 100mg/cc in 10cc amp. ; Infusion 500mg/cc in 2cc amp.; 1g in 250cc D5W Infuse at 1-4mg/min. Actions: Decreases membrane permeability of cell and prevents loss of Na+ and K+. Depresses anti-arrhythmic action on heart--> Slows heart rate, slows conduction, reduces myocardial irritability and prolongs refractory period. Indications: Ventricular Arrhythmia's and Supraventricular Arrhythmia's. Sodium Bicarbonate Dosage: 1meq/ml/50cc Bristoject Initial dose 1 meq/kg or 75 cc's to repeat according to ABG's--If not available, use 1/2 initial dose q 10 min. Actions: Alkalizing Agent, Helps to maintain osmotic pressure and ion balance and Elevates blood pH promptly. Indications: Metabolic acidosis in cardiac arrest, Salicylate intoxication or ketoacidosis, Hyperkalemia, Hyponatremia. Ref.: Fingertip File for Critical Care Nurses, Donna Farrell Tennant R.N. |
| Emergency Cardiac Drugs All Species |
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