The Journal of cardiovascular nursing
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Recovery from nontraumatic cardiac arrest depends on the presence of all the elements in the chain of survival. Early defibrillation is critical because ventricular fibrillation is the most common initial dysrhythmia of sudden cardiac arrest, defibrillation is the only treatment, and survival from ventricular fibrillation is determined by time. Out-of-hospital studies have demonstrated that defibrillation provided by first responders improves survival. ⋯ Improvement in in-hospital survival rates from cardiac arrest is not as evident as in the emergency medical services community. Medical centers need to assess response times to cardiac arrest and implement AED programs. All nurses should learn to use an AED as part of basic life support training.
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Pediatric resuscitation is most frequently required for respiratory arrest. Cardiac arrest is a rare and ominous event and usually develops as a complication of shock or respiratory failure. Once asystolic cardiac arrest occurs, the outcome of any resuscitation is dismal; if cardiopulmonary arrest persists longer than 15 minutes in the normothermic child, further efforts are unlikely to result in patient recovery. For this reason, attention must focus on prevention of arrest and prompt restoration of oxygenation and ventilation, heart rate, and systemic perfusion.
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Alterations in right ventricular (RV) performance are critical to the cardiac dysfunction witnessed in adult respiratory distress syndrome (ARDS), septic shock (SS), and as a consequence of positive end-expiratory pressure (PEEP) administration during mechanical ventilation. The authors review evidence for right heart dysfunction in these circumstances. In ARDS, an increase in RV afterload with the onset of pulmonary artery hypertension is the predominant factor promoting RV dysfunction. ⋯ The application of PEEP during mechanical ventilation can potentiate alterations in RV preload, afterload, and/or contractility, all of which promote RV dysfunction and compromise left ventricular filling. As RV dysfunction may seriously affect global myocardial performance in all of these settings, the clinician must identify that RV function is impaired, discern the contributing mechanism, and select an appropriate therapeutic regimen targeted at addressing this predominant mechanism. Assessment and management strategies are described.