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Recognition and management of cardiopulmonary arrest
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
There is strong evidence correlating higher ratios of registered nurse staffing with lower rates of pneumonia, shock and cardiac arrest (Needleman et al. 2002; Aiken et al. 2014). The preceding chapters in this book have aimed to equip you with the knowledge needed to recognise and identify changes in a patient’s condition that could precede a cardiac arrest. Early recognition and effective management will prevent cardiac arrest from occurring in many instances (Soar et al. 2015), although, even with optimal assessment and monitoring, some patients will suffer cardiopulmonary arrest.
Paediatric Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Signs of cardiopulmonary arrest include: Unresponsiveness to pain (coma).Apnoea or gasping respirations.Absent circulation.Pallor or deep cyanosis.
Ethical decisions and end-of-life care in older patients with cardiovascular disease
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Esther S. Pak, James N. Kirkpatrick, Craig Tanner, Sarah J. Goodlin
In the 1960s, multiple advanced life-support techniques were combined to form a new lifesaving intervention known as CPR. In its infancy CPR was restricted to intraoperative use and cardiac arrest due to ventricular arrhythmias. Before long, however, CPR began to be applied more broadly both in and outside of health care facilities. In 1974, the American Medical Association recommended that “code status” be documented in the medial record. Hospital policies regarding do-not-resuscitate (DNR) orders first appeared in 1976, ushering in an era, extending to the present day, in which CPR became the default medical treatment after cardiopulmonary arrest in the absence of a DNR order (17). Patients undergoing in-hospital CPR have a rate of return of spontaneous circulation of 30%–45% but only between 10% and 18% survive to hospital discharge (18). Though older adults as a group have a lower rate of survival to discharge following CPR, there are conflicting data as to whether age predicts poorer outcome independent of illness burden (19). Cardiopulmonary arrest from cardiac disease may be more responsive to CPR than other disease states, especially in the case of cardioversion for witnessed ventricular fibrillation (20).
The rapid response system: an integrative review
Published in Contemporary Nurse, 2019
John Rihari-Thomas, Michelle DiGiacomo, Phillip Newton, David Sibbritt, Patricia M. Davidson
A further systematic review was undertaken by Chan (Chan, Jain, Nallmothu, Berg, & Sasson, 2010). The review incorporated data on nearly 1.3 million hospital admissions. Implementation of a rapid response team in adults was associated with a 33.8% reduction in rates of cardiopulmonary arrest outside the intensive care unit (relative risk [RR], 0.66; 95% confidence interval [CI], 0.54–0.80) but was not associated with lower hospital mortality rates (RR, 0.96; 95% CI, 0.84–1.09). In a paediatric population, the use of rapid response teams was associated with a 37.7% reduction in rates of cardiopulmonary arrest outside the intensive care unit (ICU) (RR, 0.62; 95% CI, 0.46–0.84) and a 21.4% reduction in hospital mortality rates (RR, 0.79; 95% CI, 0.63–0.98) (Chan et al., 2010). This review also found evidence that deaths were prevented out of proportion to reductions in cases of cardiopulmonary arrest, raising questions about mechanisms of improvement. In spite of this limited evidence for mortality reduction in many settings, rapid response systems became a standard of care throughout Australia. This expansion may have been led by the absence of conclusive evidence for mortality reduction being insufficient to discard the routine application of these systems.
Autologous haematopoietic stem cell transplantation for Japanese patients with systemic sclerosis: Long-term follow-up on a phase II trial and treatment-related fatal cardiomyopathy
Published in Modern Rheumatology, 2018
Hiroyuki Nakamura, Toshio Odani, Shinsuke Yasuda, Atsushi Noguchi, Yuichiro Fujieda, Masaru Kato, Kenji Oku, Toshiyuki Bohgaki, Junichi Sugita, Tomoyuki Endo, Takanori Teshima, Tatsuya Atsumi
Cardiopulmonary arrest occurred in a patient (No. 13) on the day transplantation was performed following the conditioning with intravenous CY. Echocardiography showed diffuse akinesis of myocardia. The patient was supported by intensive care including percutaneous cardiopulmonary support (PCPS) and intra-aortic balloon pumping (IABP). PCPS and IAPB were withdrawn after 15 d and 20 d, respectively, since her myocardial function gradually improved. Myocardial biopsy revealed no apparent abnormalities. She is still alive without any cardiac after effects. Another patient (No. 14) developed cardiopulmonary arrest during the conditioning with intravenous CY. He had a fatal course despite of intensive resuscitation including PCPS. In both cases, cardiac function evaluated by echocardiography as well as electrocardiogram was normal. In patient 14, progression of skin sclerosis was extremely rapid and continuous even after CY administration for the mobilization, which resulted in mRSS as high as 36 when conditioning was started.
Local anesthetics systemic toxicity association with exparel (bupivacaine liposome)- a pharmacovigilance evaluation
Published in Expert Opinion on Drug Safety, 2018
There were 346 LAST cases associated with bupivacaine HCl as the prime suspect drug and 130 LAST case reports associated with Exparel (bupivacaine liposome) as the prime suspect drug. Demographics and a brief summary of some of the Exparel associated critical adverse events related to LAST are presented in Table 2. About 12 cases involved seizures: 3 cases with generalized tonic-clonic seizures and 9 cases with the adverse event specified as ‘seizure’. There was 1 death and 6 of the 12 seizure cases were coded as life-threatening. Bradycardia was reported in 8 cases, 4 of which were coded as life-threatening. Cardiac arrest was reported in 7 cases out of which death was reported for 4 cases and one additional case was coded as life-threatening. Cardiopulmonary arrest was reported in 6 patients. In three of these cases, mortality was the end result and an additional two cases were coded as life threatening.