In: Nursing
Chest pain , unresponsive and pulseless:
These symptoms may occur either in Heart attack or Cardiac arrest.
Heart attack: An acute Myocardial infraction , some times fatal, caused by the sudden occurance of Coronary Thrombosis , which obstructs the blood supply to the heart and leads to necrosis of the heart muscle tissue .
Cardiac arrest: Sudden and complete cessation of the heart beat resuling in the loss of effective circulation of the blood.
In the case of Cardiac arrest , The person may complain about chest pain, then they become unconscious or not responding to any environmental stimuli (unresponsive) , not movement and pulseless and a gradual breathlessness also may develop.
In heart attack patient may remain conscious. But often heart attack may lead to Cardiac arrest.
Immediate treatment for Cardiac arrest:
* Chest compression with a Defibrillator
or
* Cardio pulmonary resuscitation : 100 to 120 compressions a minute
- Before iinitiating Chest compression, check for any Do Not Resuscitation order ( DNR)
- Provide supine position to the patient
- Push hard and fast with an outstretched arm, keep perpendicular and , at the center of the chest .
* Unresponsive patients with normal breathing should place in a recovery position
Other Interventions:
* Targeted Temperature management ( TTM) to maintain a cooling temperature constantly , usually at 36 degree Celsius. It helps to prevent fever also in patient with Cardiac arrest.
* Oxygenation : Avoid excessive ventilation but maintain SpO2 94%
* Treat hypotension by administering
- IV Bolus, Normal saline or Ringer Lactate
- I.V infusion of Epinephrine for vasoconstriction and heart contactility
- Dopamine infusion : to strengthen heart muscles and its pumping.
- Infusion of Nor epinephrine: To increase blood pressure by vasoconstriction.
Electrocardiogram, Capnography, Endo tracheal intubation are some of the procedures to detect abnormalities and to support the patient.
( * Antiarrhyyhmic drugs : Amiodarone or lidocaine can be used during Ventricular fibrillation).