Category: Critical Care Nursing Pseudo-electromechanical dissociation (EMD) caused by myocardial dysfunction is a transient state in the progression to EMD and has the same cause. An additional cardiac cause of pseudo-EMD is papillary muscle and myocardial wall rupture.
Category: Critical Care Nursing True electromechanical dissociation is the result of a primary disorder of electromechanical coupling in myocardial cells. It often is associated with abnormal automaticity and conduction, resulting in bradycardia and a wide QRS complex.
Category: Critical Care Nursing Electromechanical dissociation (EMD) happens when no myocardial contractions occur and pseudo-EMD happens when myocardial contractions occur but are inadequate, and no pulse can be palpated.
Category: Critical Care Nursing Pulseless electrical activity is defined as coordinated electrical activity of the heart (other than VT or VF) without a palpable pulse. This group of dysrhythmias includes electromechanical dissociation (EMD) and pseudo-EMD.
Category: Critical Care Nursing Therapy for refractory ventricular fibrillation and pulseless ventricular tachycardia includes high-quality CPR, administration of vasopressors and antidysrhythmic agents, and repeated defibrillation.
Category: Critical Care Nursing A patient who develops ventricular fibrillation or pulseless ventricular tachycardia while on a cardiac monitor may remain conscious for 15 to 30 seconds. The patient should be encouraged to cough vigorously until a defibrillator is available.
Category: Critical Care Nursing Traditional monophasic defibrillators have been replaced by defibrillators using biphasic waveforms. With biphasic defibrillation, the energy required for successful defibrillation is lower than with monophasic defibrillation.
Category: Critical Care Nursing Ventricular fibrillation and pulseless ventricular tachycardia are treated identically because they are generally caused by the same mechanisms and respond to the same interventions.
Category: Critical Care Nursing Restoration of adequate cardiac function is the defining factor of return of spontaneous circulation, but restoration of good neurologic function is the defining factor of successful resuscitation.
Category: Critical Care Nursing The main usefulness of echocardiography is diagnostic, especially in patients with PEA. Echocardiography distinguishes organized pulseless cardiac activity that does or does not result in mechanical heart contraction.
Category: Critical Care Nursing For ongoing resuscitation of arrest rhythms that fail to respond to CPR and defibrillation, intravenous or intraosseous access should be obtained so that vasopressor therapy can be administered and repeated every 3 to 5 minutes.
Category: Critical Care Nursing ScvO2 also helps to detect return of spontaneous circulation (ROSC) rapidly without interruption of chest compressions, because ROSC will result in a rapid increase in ScvO2 as oxygen delivery to tissues dramatically increases.
Category: Critical Care Nursing ScvO2 values normally range from 60% to 80%. During cardiac arrest and CPR, these values range from 25% to 35%, indicating greatly enhanced oxygen extraction of tissues owing to the inadequacy of oxygen delivery during CPR.
Category: Critical Care Nursing Central venous oxygen saturation, ScvO2, can be used to monitor resuscitative measures. The mixed venous blood oxygen saturation in the pulmonary artery (SvO2) represents the oxygen remaining in the blood after systemic extraction.
Category: Critical Care Nursing PETCO2 monitoring is valuable in patients after return of spontaneous circulation to monitor endotracheal tube placement, titrate minute ventilation to avoid hyperventilation and detect sudden hemodynamic deterioration.
