The Cardiac Care Unit Survival Guide by Herzog Eyal

Author:Herzog, Eyal [Herzog, Eyal]
Language: eng
Format: azw3
Tags: Medical
Publisher: Lippincot (Wolters Kluwer Health)
Published: 2012-07-08T16:00:00+00:00

STEP I

Initial evaluation and treatment of a survivor of out of hospital cardiac arrest. The initial evaluation of a survivor of OHCA upon arrival to the ED includes vital signs, physical examination, and a standard assessment of brain function called the Glasgow coma score. An EKG is obtained immediately and laboratory testing is performed. Initial laboratory testing includes basic tests of kidney, liver, and thyroid function as well as blood count and chemical markers of heart muscle damage called cardiac biomarkers. If there is a suspicion of a stroke or bleeding in the brain a special type of X-ray of the head called a CT scan may be performed.

Although the initial evaluation is ongoing, steps are taken to stabilize the patient’s condition. Virtually all patients who suffer a cardiac arrest are temporarily unable to breathe on their own and require support with a mechanical ventilator. Many will require medications to maintain a normal blood pressure and to prevent any further abnormal heart rhythms.

Once the patient’s condition is stable, a decision is made regarding therapeutic hypothermia. If the patient meets criteria for entry in our hypothermia protocol, then therapeutic hypothermia is initiated in the ED by infusion of cold saline through an IV catheter. The criteria for entry into the hypothermia protocol will be discussed in detail in the next section. These criteria are designed to ensure that only patients in whom the benefits of the therapy outweigh the risks are included in the protocol. The decision whether to initiate therapeutic hypothermia is made jointly by the ED physician and the cardiology or critical care physician.

Cardiac arrest may occur as a primary abnormality of the heart’s electrical system but more often occurs in the setting of a heart attack. A heart attack is caused by a severe narrowing or complete blockage of one or more of the major coronary arteries—the blood vessels that deliver blood to the heart. In the case of a cardiac arrest that is caused by a heart attack, the patient must undergo an emergent procedure called a cardiac catheterization and possible angioplasty to open the blocked vessel.

Therefore, if the initial cardiac arrest was caused by VF or VT, or the EKG is suggestive of a heart attack, the patient is transferred immediately to the cardiac catheterization laboratory, where a cardiac catheterization is performed. Explanations of the catheterization procedure, angioplasty, and the management of a heart attack are provided in detail in Chapters 1 to 4. After completion of the cardiac catheterization the patient is transferred to the cardiac care unit (CCU).

If neither of above criteria is met, the patient is transferred directly to the CCU where an emergency echocardiogram is performed. An echocardiogram is an ultrasound of the heart that provides the physician with essential information regarding the structure and function of the heart muscle and heart valves. This is described in more detail in Chapter 5.

If the cardiac arrest is deemed not to be a primary malfunction of the heart but a consequence of serious medical illness, the patient is transferred to the medical intensive care unit for further care.

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