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28 Monitor patient’s cardiac rhythm and record 12-lead ECG. Normal sinus rhythm is required for optimum cardiac function (Resuscitation Council 2010b, C). An assessment of whether cardiac arrest has been associated with a myocardial infarction should be made, as the patient may be suitable for coronary angioplasty or thrombolytic therapy (Nolan et al. 2005, C).

29 A chest X-ray should be taken. To establish correct position of tracheal tube, gastric tube and central venous catheter. To exclude left ventricular failure, pulmonary aspiration and pneumothorax. To establish size and shape of heart (Nolan et al. 2006, C).

30 Continue respiratory therapy aiming for SaO2 94–98% for adults. Hypoxia and hypercarbia both increase the likelihood of a further cardiac arrest (Resuscitation Council 2010b, C).

31 Assess patient’s level of consciousness. This can be done by use of the Glasgow Coma Scale. Although this is intended primarily for head injury, it is clinically relevant. It contains five levels of consciousness:

(a) Conscious and alert

(b) Drowsy but responsive to verbal commands

(c) Unconscious but responsive to minimal painful stimuli

(d) Unconscious and responsive to deep painful stimuli

(e) Unconscious and unresponsive.

See Chapter 12

. Once a heart has been resuscitated to a stable rhythm and cardiac output, the organ that influences an individual’s survival most significantly is the brain (Resuscitation Council 2010b, C). Initial assessment and regular monitoring will alert the nurse to any changes in function.

32 The patient should be stable prior to any transfer and nursed in the appropriate position, that is semi-Fowler or the recovery position. Avoid nursing supine as this physiologically hinders cardiac output and respiration, unless clinically indicated for patients with acute head or spinal cord injury. Careful explanation and reassurance are vital at all times, particularly if the patient is conscious and aware. Transferring a patient post arrest may pose risks because of changes in their haemodynamic status. This is due to movement of the trolley – inertia, changes in environment and/or changing equipment, which may impact negatively on the patient’s physiological status (Shirley and Bion 2004, E).

Nursing a patient in semi-Fowler’s position ensures good air entry, and reduces risks for aspiration for patients not contraindicated for head of bed to be elevated (Tablan et al. 2004, C).

Problem-solving table 10.3 Prevention and resolution (Procedure guideline 10.5)

Postprocedural considerations

Immediate care

Following stabilization of the patient post cardiac or respiratory arrest, consideration should be given to moving them to an appropriate critical care or high-dependency environment. All established monitoring should continue during transfer and the patient should be transferred by individuals capable of monitoring the patient and responding appropriately to any change in the patient’s condition, including a further cardiac arrest. A critical care outreach service or designated transfer team, if available, may contribute to the care of the patient during stabilization and transfer (Nolan et al. 2006, Resuscitation Council 2010b, Shirley and Bion 2004).

Ongoing care

The patient’s haemodynamic status should be continually monitored post resuscitation, as well as observing the patient’s level of consciousness, respiration rate and if possible urine output. Monitor blood glucose levels in adults with sustained return of spontaneous circulation (ROSC) after cardiac arrest. Maintaining blood glucose values > 10 mmol/L, they should be treated in an HDU/ICU environment, however hypoglycaemia must be avoided (Resuscitation Council 2010b). Documentation of physiological parameters needs to continue and any change in haemodynamic status needs to be reported to the medical team or senior nursing staff attending to the patient prior to transfer to the CCU or HDU.

The Intensive Care Society (UK) has published guidelines for the transport