Question

While caring for a patient who is experiencing a postoperative hemorrhage,you note the rhythm observed on the electrocardiogram(EKG) does not produce a pulse. Which actions should you initiate to resolve this patient's problem?

Answer 1

If the ECG is showing ventricular Tachycarida (VT) without pulse is a life-thretening situation and requires emergency management.Because sustained VT causes a severe decrease in cardiac output because of decreased sustained ventricular diastolic filling times and loss of atrial contraction. This results in hypotension, pulmonary edema, decreased cerebral blood flow and cardiopulmonary arrest. Hence,this dysrhythmia should be treated immediately

Cardiopulmonary resuscitation(CPR) and rapid defibrllation are the first line of treatment followed by administration of vaspressors (eg; epinephrine) and antidyrhythmics (eg: amiodarone) if defibrillation is unsuccessful

After stabilizing the rhythm

• Assess ABCs
• Stabilize cervical spine as appropriate
• Administer high flow oxygen(100%) by non-breather mask or bag-valve mask
• Anticipate need for intubation and mechanical ventillation
• Establish IV access with two large bore catheters (14-16 gauge) or assist with insertion of central line and begin fluid resuscitation with crystalloids (eg: 30 mL/kg repeated under hemodynamic improvement is noted
• Draw blood for laboratory studies (eg: blood culture, lactate, WBCs)
• Control any external bleeding with direct pressure or pressure dressing
• Assess for life-threatening injuries such as liver laceration,cardiac tamponade and tension pneumothorax)
• Consider for vasopressor therapy if hypotension persists after fluid resuscitation

Ongoing monitoring

• Level of consciousness, vital signs including pulse oximetry, peripheral pulse, capillary refil, skin color and temperature
• Respiratory status, heart rate and rhytm, urine output