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2 Minute EBP Challenge

Monday, March 08, 2010
Restoring Hemoglobin
One of the goals for a patient who has a large blood loss is the restoration of normal hemoglobin levels.  This is partially done by blood transfusions, usually to a hemoglobin level of about 10g/dL.  A hemoglobin level that low will leave the patient feeling fatigued, but should be high enough to protect the heart from anemic ischemia.

Sunday, February 28, 2010
Renal Dysfunction
Mrs. Mersa is admitted with sepsis and hypotension.  Her labs indicate:
BUN 58 mg/dl
Serum creatinine 2.1 mg/dl
Urine sodium 70 mEq/L
Urine specific gravity 1.010, with cellular casts and RBCs in the urine.
Based on these findings you would consider:

Friday, February 12, 2010
Which action first?
Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid intervention by the nurse?

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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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