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2 Minute EBP Challenge

Monday, July 26, 2010
Ms. Shepard and DIC
This morning rapid response is called for Ms. Shepard who was admitted with a urinary tract infection and sepsis. Her blood pressure dropped during the evening hours and she is now hypotensive and is having difficulty breathing. Her IV sites are oozing and there is blood in the urinary catheter. Her physician suspects disseminated intravascular coagulation (DIC). The primary mechanism in the development of DIC is:

Monday, July 19, 2010
Thyrotoxicosis

Which of the following laboratory findings is indicative of thyrotoxicosis?

Monday, July 12, 2010
Urban CPR Patterns
In a recent study of inner-city neighborhoods, the authors found that out of hospital cardiac arrest was 2-3 times higher in some neighborhoods compared to others. In these high incidence neighborhoods what was the rate of bystander CPR?

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Home > 2 Minute EBP Challenge > Better outcomes in VT/VF

Better outcomes in VT/VF

Monday, December 28, 2009

Stay up-to-date the easy way!

How would you answer this question?

Recent studies have demonstrated that passive ventilation with a non-rebreather mask results in better outcomes than active ventilation with a bag-valve mask in which type of cardiac arrest?

a. In-hospital asystole
b. Post-surgical pulseless electrical activity (PEA)
c. Traumatic ventricular tachycardia
d. Out-of-hospital ventricular fibrillation

The correct answer is "d" out-of-hospital ventricular fibrillation

Traditionally, cardiopulmonary resuscitation (CPR) has involved the use of chest compressions and positive-pressure assisted ventilation by bag-valve mask or mouth-to-mouth breathing.  The focus of CPR has been on improving oxygenation by increasing the rate or depth of ventilations.  The problem with this approach is that increasing ventilation increases intrathoracic pressure.

Chest compressions squeeze the heart between the sternum and spine and force blood out of the ventricle causing cardiac output.  Releasing the chest causes elastic recoil of the chest and heart allowing the heart to fill again.  The "vacuum" caused by the release of the chest encourages venous return to the heart and increases cardiac output.

Recent research demonstrates that ventilation increases intrathoracic pressure and decreases venous return to the heart which decreases cardiac output.  So, the more that nurses ventilate during CPR, the lower the cardiac output and worse the outcomes. 

In a study reported by Bobrow, et al. the authors found that passive ventilation administered with a non-rebreather oxygen mask and no forced ventilation led to better neurological outcomes than oxygenation with a bag-valve mask.

The take home point is that the more you ventilate the patient in cardiac arrest, the lower the cardiac ouptput will be and the worse the outcomes will become -- ventilate less, and focus on chest compressions!

From: Bobrow, B.J., et al. (2009).  Passive oxygen insufflation is superior to bag-valve-mask ventilation for witnessed out-of-hospital cardiac arrest.  Ann Emerg. Med. 54:656.

Congratulations to Jackie Barrett who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly.  Congratulations Jackie!   

Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.

PS. Achieve more in 2010 than ever before!  Find out how a professional coach can help.

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