The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [382]
The treatment for hypovolaemia is identifying and stopping the source of fluid or blood loss, and replacing the circulating volume with the appropriate fluid. Fluid resuscitation is normally started with a crystalloid, for example 0.9% sodium chloride, and/or colloid, for example Gelofusin (depending on local protocols); there is no evidence that colloids are more effective than crystalloids. Blood is likely to be required rapidly if the blood loss exceeds 1500–2000 mL in an adult (Perel et al. 2007, Resuscitation Council 2010b).
Hypothermia
Hypothermia should be suspected in any submersion or immersion injury. During a prolonged resuscitation attempt, a patient who was normothermic at the onset of cardiac arrest may become hypothermic (Resuscitation Council 2010b). A low-reading thermometer should be used if available. Resuscitation in the presence of hypothermia may be prolonged.
Hypo/hyperkalaemia and other metabolic disorders
Because potassium is so closely linked with muscle and nerve excitation, any imbalance will affect both the nervous conduction and the muscular working of the heart. Therefore a severe rise or fall in potassium can cause arrest arrhythmias. The causes of hypokalaemia are:
gastrointestinal fluid losses
urinary fluid loss
drugs that affect cellular potassium, for example antifungal agents such as amphotericin.
The immediate treatment for hypokalaemia that has resulted in an arrest is to give concentrated infusions of potassium while carefully monitoring the serial potassium measurements. Most intensive care unit (ICU)/Accident and Emergency (A&E) departments and coronary care units (CCUs) will have an arterial blood gas analyser that enables the potassium to be measured in 1 minute.
The patients who are most at risk of hyperkalaemia are those with renal failure or Addison’s disease. The immediate treatment for hyperkalaemia is to give intravenous calcium. This has the effect of protecting the myocardium during the cardiac arrest. If the patient is successfully resuscitated it will be essential to monitor their serum potassium and if it remains high, to commence therapy to lower or remove the potassium (Resuscitation Council 2006).
Thromboembolism
The most common cause of thromboembolic or mechanical circulatory obstruction is a massive pulmonary embolus. Options for definitive treatment include thrombolysis or, if available, cardiopulmonary bypass and operative removal of the clot (Resuscitation Council 2010b).
Tension pneumothorax
A tension pneumothorax is the sudden collapse of a lung, usually under pressure, which results in a severe change in intrathoracic pressure and cessation of the heart as a pump (Bersten et al. 2009). The most common causes are:
trauma
acute lung injury
mechanical ventilation of the newborn.
The immediate treatment is the insertion of a large-bore cannula into the second intercostal space at the midclavicular line of the affected side (Resuscitation Council 2010b). Arrangements should be made for the insertion of a formal chest tube and underwater seal drain.
Tamponade
This is where there is an acute effusion of fluid in the pericardial space and as it enlarges, the heart is splinted and finally cannot beat. The fluid is usually blood but can be malignant or infected fluid (Dolan and Preston 2006). The most common cause for a sudden tamponade is trauma. The immediate treatment is the insertion of a catheter or surgical drainage of the fluid. After drainage, the cause of the tamponade should be sought and corrected where possible, for example with appropriate antibiotic therapy for a bacterial aetiology or surgical repair of a myocardial laceration (Shoemaker 2000).
Toxicity: poisoning and drug intoxication
Poisoning rarely leads to cardiac arrest but it is a leading cause of death in patients less than 40 years old. Self-poisoning with therapeutic or recreational drugs is the main reason for hospital admission (Resuscitation