Lesson 1.5
SUDDEN CARDIAC DEATH

1-41.  CARDIAC ARREST

a. Cardiac arrest, also known as sudden cardiac death, is defined as the sudden, unexpected cessation of the heartbeat and circulation. This occurs when the heart action stops entirely or the heart fibrillates. Causes of sudden cardiac death include the following:

(1) Cardiac arrhythmias.

(2) Myocardial infarction.

(3) Shock.

(4) Drowning.

(5) Electrocution.

(6) Carbon monoxide poisoning.

(7) Anoxia.

b. The absence of peripheral pulses and heart sounds is all that is necessary to make the diagnosis. There is a period of about four minutes between the cessation of circulation and the onset of irreversible brain damage. For this reason, it is imperative that resuscitation begins immediately. Resuscitation requires that two basic life support functions be restored: blood must be pumped through the body and oxygen and carbon dioxide exchange must occur. Restoration of one function without the other is not adequate.

1-42.  THE PARAPROFESSIONAL ROLE

a. The role of the nursing paraprofessional in cardiac arrest is one of extreme importance in saving a life, as the paraprofessional may be the first one to observe the emergency. It is necessary to have a well-planned course of action in mind at all times, in order to be prepared for an emergency. The nursing paraprofessional must:

(1) Be proficient in cardiopulmonary resuscitation (CPR).

(2) Be familiar with local standard operating procedures (SOP) for "CODE" procedures, including whom to call and how to reach them.

(3) Be able to locate and operate emergency equipment.

(4) Be ready to assist in the activities of code management at the direction of the physician or professional nurse.

b. The following items are found in a standard "crash cart."

(1) Emergency drugs.

(2) Intravenous infusion equipment.

(3) Needles and syringes.

(4) Intubation equipment, oral airways.

(5) Ambu bag with assorted masks and connecting tubing.

(6) Oxygen equipment.

(7) Suction equipment.

(8) Assorted dressing materials.

(9) There should be a defibrillator/cardiac monitor available if one is not located on or near the crash cart.

c. It is not necessary for the paraprofessional to be familiar with every single item that is found in a crash cart or emergency kit. It is important, however, to be familiar with the cart and the general layout of its contents. This will save precious time in an emergency. All paraprofessional nursing personnel should be proficient in the use of oxygen and suction equipment.

1-43.  CODE

a. Sudden cardiac death and the ensuing hectic activity involved in code management can be a frightening and anxiety producing experience for nursing personnel who are unaccustomed to this type of event. A basic understanding of what takes place during a code will do much to alleviate that anxiety.

b. When a cardiac arrest has been identified:

(1) The person who witnesses the event or discovers the patient will call for help from his co-workers and immediately initiate CPR. The co-workers will respond by initiating the procedures for "calling" a code. They will then obtain the emergency equipment, take it to the location of the code, and relieve or assist the individual performing CPR. As help arrives, several things begin to happen simultaneously:

(a) An IV "lifeline" will be initiated.

(b) Blood pressure readings will be obtained.

(c) The patient is connected to the cardiac monitor.

(d) Baseline blood work is drawn to assess the patient's status.

(e) An ambu bag and oxygen will replace mouth-to-mouth resuscitation.

(2) The physician in charge will make decisions based on his observations of the patient's condition and the response to CPR. If there is no response to CPR, the code continues, and again, several things happen simultaneously:

(a) The patient will be intubated.

(b) Appropriate emergency drugs will be administered.

(c) Cardiopulmonary resuscitation is continued while the electrical activity of the heart is observed on the cardiac monitor. If appropriate to the patient's condition, the patient will be defibrillated.

(d) Blood samples are drawn repeatedly to monitor the effectiveness of the treatment. Acid-base balance and adequacy of oxygenation are of extreme concern.

(3) These procedures continue until the patient is stabilized or the physician makes the determination to declare the patient dead.

c. The seeming confusion of people is actually a coordinated effort by a group of people, each performing a particular task. The major roles are as follows:

(1) A physician will direct the activities, "managing" the code.

(2) A nurse will administer IV medications at the direction of the physician in charge.

(3) A nurse (or paraprofessional) will monitor blood pressure and obtain blood samples.

(4) One individual will perform chest compressions.

(5) One individual will administer artificial ventilation. This is normally the anesthesia specialist, who has intubated the patient.

(6) One individual will act as a recorder, charting the exact time of each action performed and each medication given.

(7) One or more individuals act as "runners," taking specimens to the lab, obtaining needed supplies, receiving lab reports, and so forth.

d. Remember, the purpose of a "code" is to attempt resuscitation of a patient whose heart has stopped pumping effectively (fibrillation) or stopped pumping altogether. Keep this purpose in mind at all times, and be aware of your role as a paraprofessional.