YOUR PATIENT is STILL CODING, NOW WHAT?! - Reversible Causes of Cardiac Arrest - The H's and T's
ฝัง
- เผยแพร่เมื่อ 29 ธ.ค. 2019
- For the last lesson of 2019, we will be taking a look at our reversible causes of cardiac arrest. When our patient codes, we quickly react, calling a code, starting compressions and beginning to work the ACLS algorithm. But what happens when they don’t come back right away? We need to start looking at what may have caused this.
Some causes are reversible and if we fix the problem we can also fix what was causing the arrest. We have grouped these causes in to 2 groups of the same first letter to try and help you remember them. These are what we call the H’s and T’s.
The H’s are hypovolemia, hypoxia, hydrogen ions (acidosis), hypo/hyperkalemia, hypoglycemia, and hypothermia. The T’s consist of toxins, tamponade, tension pneumothorax, thrombus (coronary vs. pulmonary), and trauma. We take a look at each of these, including underlying causes, what to assess for and possible treatments.
Finally we finish up looking another other way to remember these by looking at them in groups of findings based on either the monitor, labs, thinking of the heart and lungs, and then overall the whole body.
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#ICUAdvantage #ACLS #CardiacArrest
![ทททททททท #27 [หลุยส์ เค โตมายังไง ณ สระบุรี]](http://i.ytimg.com/vi/CaKoYw_Xmtg/mqdefault.jpg)
Worked in the Trauma ICU and it always amazes me how well we all work together to keep these patients alive and well. To me, there's no other adrenaline rush that matches a code well done.
💯 agreed
I am an ICU nurse and I really enjoyed watching your videos. You explain your topic clearly. Continue creating more videos.
Thanks so much Missy! Really happy to hear this and I'll definitely be making more!
I would like to ask you a question: One of my relatives has been in a coma for a month due to cardiac arrest. He needs oxygen support now. Could you tell me how do they treat this condition in the United States? Thank you so much.
This channel is The new Netflix… Definitely BINGE WORTHY!
Hahah yeeees!! 😊 starting to get to be a LOT to binge these days 😉
Thanks for all that you do. Keep them coming 😊
@@MichelleTyner Will do!
My 2 longest codes both exceeded 6 hr. and both pts. left the hospital without sequelae. Moral: NEVER give up...keep thinking.
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Arterial Blood Gases: th-cam.com/play/PL2oVjKTYocdMz1qF-3iS6iUZ-R_fKbeJw.html
ECG/EKG Interpretation: th-cam.com/play/PL2oVjKTYocdPMaNwn4xbg6xAIaAnyraMj.html
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This was very helpful, thank you Eddie! I'm med surg & IV team not ICU, but I'm trying to expand my knowledge base. Really enjoy all of your content; you are a fantastic teacher!!
Thank you so much! And yes, this information certainly applies in a lot of areas outside of ICU, for sure! I appreciate the kind words and really glad these videos are helpful for you.
Thanks for a helpful presentation! Don't forget that a pneumothorax may be spontaneous and idiopathic - even in young healthy folks. Sometimes there is a past history of spontaneous pneumothorax. Recent injections in the shoulder or upper spine may be associated with a pneumothorax as well. I have seen all of these. I also saw a 15-year old patient in the ER who presented with severe SOB. A quick assessment showed absent breath sounds on the left. In severe distress. I took his shirt off for a more detailed examination and he had a small - maybe 1-2mm - cut just medial to his left nipple. "What were you doing when you started to feel short of breath" I asked. "Mowing the yard" he said!! The mower had picked up a nail and it perforated his chest wall, missed his heart by a centimeter, collapsed his lung, penetrated his diaphragm, and ended up inside his spleen! The ER presents far more options for etiology of respiratory and cardiac arrest than does the ICU...
Your videos are so helpful and well-done!
Well explained. Thank you
You're a good man, making good things. Thank you!
Thank you. I really appreciate the kind words Eric!
Super useful information! Thank you for explaining this so great and breaking it down!💪🤗
Very glad to hear this Nathalie. Glad you liked it! 😊
Just found you and love the channel, the information delivery, the graphics, etc.!
-Much love from a secondary medical student
Awesome! So happy you found it. Welcome!
amazing teacher, very clear, organised notes, thank you xxx
Wow, thank you so much Emme! Glad you liked it and really appreciate you taking the time to leave a comment! 😊
Really helped my review before my internship as an SRT! Awesome videos.
Yay!! Thank you so much Sarah and really glad to know I was able to help in some way!
I love your videos; easy to understand and concise. I'll be working in cardiac- step down as a new nurse, and will be required to have ACLS cert. Your voice is sooo smooth, I love listening to your lectures. Thank you for making it easier for us 🙂
Thanks so much for this awesome comment! 😊 Always puts a smile on my face to know the videos are appreciated. Congrats btw on the new position in cardiac-step down. You'll be very busy with some complex patients there. Wishing you the best and happy to be able to help in some way. 😉
@@ICUAdvantage I heard that it's busy lol 😅. Thank you 😊!
Cardiac step down is a good unit! That's my specialty.
I am glad that I have found your channel, really appreciate your hard work, please make videos on IABP, fluid management, Central line, basic things to look on chest x-ray etc, eagerly waiting, love from India 🇮🇳
Yes, these are all actually things on my todo list!
I really like your presentations .It is amazing.A great tool for knowledge enrichment.joy
This was exactly the breakdown I needed! Thank you!
Awesome!!!
Thank you for explaining this. Its is so much helpful and informative.
Awesome! So glad you liked the video Suzi! Thanks for stopping by and leaving a comment.
Thank you for making me a better educator!!
So glad to hear this! You are very welcome!
It really helps many to jog their memory on critical care. U r doing a great job. Keep up the good work.✌🏻👍🏻😊
Thank you so much! I'm really happy to hear you liked it and I'll definitely keep it up!
I love your videos, so easily understandable the way you explain it. I was looking in your channel but did not find. Do you have a video explaining code cool, post cardiac arrest?? It would really be helpful, thank you!
Thanks Stefany and glad you liked the video! I do not have a video on TTM yet, but it is on the todo list!
You’re amazing at what you do. You are very thorough in your lessons. Good job! You will be a fabulous CRNA if you choose to do that. You are more knowledgeable than some of the ICU resident doctors I work with. :)
You're making me the smartest ER nurse everrrr
Very helpful! I'm reviewing for CRNA interviews. Thank you!
Always love your videos !
Glad to hear this Mari. Thank you!
Well explained..very informative...good job pal.
Awesome! Thanks Frank!
Great all your lessions are learnable some thing new ...thanks alot
Great to hear! We are always learning!
Thank you from a Med-Surg nurse terrified of the 2 Day ACLS class I’m taking tomorrow.
I have a whole series covering ACLS if you want a quick review beforehand. Check out my videos on here.
And do t be terrified! You’ll do great!
Short and comprehensive as always. Thank you so much for your super helpful lessons. 🙏👍🏆🥇
My pleasure and thank you for the great comment Parisa! 😊
Love the informative videos... keep up the awesome job!!!!
Thank you so much Erica! Always great hearing good feedback on the videos and thanks so much for your support!
Thank you! This was very helpful.
Happy to hear this! You're welcome
Excellent channel, many thanks.
Awesome! Glad to hear you like it Roland!
Thank you sir
Thanks very useful and easy to understand
Awesome! Glad to hear it!
Thank you very much, very useful, interesting presentation
Thank you!
Great video. Thank you!
Glad you liked it!
Thank you
Thank you for your work :)
You are very welcome Allen! Thanks for taking the time to leave a comment! 🙂
Been nursing great review for Acls mega code. Very simple and like your approach not intimidating Thanks. I’m medsurg and look forward to seeing your other videos
Thank you so much for this comment. Really glad the info was well received and appreciate the feedback. Wishing you the best for ACLS!
Thank you great sharing
Glad you enjoyed it
Amazing work thx ❤️❤️🌹
Thank you so much!
Thank you so much for your videos!! They are super helpful. I was given a tip by an instructor to remember the T’s, OPRAH. tOxins, Pneumothorax, tRauma, tAmponade, tHrombus. Hope this helps 😁 and thank you again! Keep up the good work please!
Awesome! Thanks for the comment and appreciate you sharing that info!
Very useful
Awesome!👍
Greetings from Lithuania 🇱🇹thank you for lessons 😄
Very cool! Greetings! Glad you liked it.
we love you!! thanks!
Thank you!!!
Thank you Eddie!!! May you have a blessed New Year!!!🌅🌇
Thanks so much Joe! And wishing you a wonderful 2020 as well!
Thanks, man 👍, pretty helpful ✊
Great to hear!
Thank you so much❤❤❤❤
You're very welcome! ❤️
Thankyou so much Sir.
Most welcome
Very helpful..you have earned a subscriber
Awesome to hear Petty! Welcome aboard!
THANK YOU!!!! you are awesome
Thank you so much for that Aden! Appreciate you stopping by the leave a comment and glad you enjoyed the video.
loved everything, but especially loved the last bit! your videos are amazing!
Awesome Jayne! Glad you liked it and especially the end with the different way to look at things that might make a little more sense :)
well done!
Thanks!
Great stuff
Awesome! Glad you liked it Justin!
Thanks!
Thank you so much for this Belinda!
Thanks
Thank you so much Sally!
Ty so useful this information ty
Youre very welcome. My pleasure!
Great video but i wanted to ask since im still newer to icu, 5 yr nurse but only last 6 mos has been in icu, and thinking in this way does not yet come automatic for me yet,... I feel like a new grad at times, should i be concerned about that or is it normal? I am watching as much as i can trying to refresh on things in order to think more like gow an icu nurse should think 🤔
My family member had cardiac arrest on Friday night at the hospital when the staff is cut to 1/3(with no supervisor around), and the displacement of his airway was not caught on time to avoid the cardiac arrest. He was revived thru CPR but lost consciousness. Should hospital be responsible for that negligence?
Would you give the calcium infusion or the insulin D50 first in hyperkalemia?
Especially in a code, they both are going to happen quick, but unless you have insulin in your code cart, its going to have to be pulled. (Although Dextrouse is probably in there). Calcium chloride syringes are usually in there as well, so typically given first, as well as you get the cardioprotective effects on board. Obviously it all depends on your cart and whats readily available. If you have both in front of you, Id give the Calcium first due to the protective effects awaiting lowering of the potassium levels.
Hi, my doubt is regarding tamponade. I wanted to ask, how do you propose doing a bedside echo during an ongoing code?
Thanks for making these videos, they are amazing!
We do them all the time. Either less formal with an ultrasound and a cardiac probe, but also a formal echo at bedside too.
Glad you like the videos!
Sp02 can show hypoxemia, not hypoxia
Reversible* but great work
Ahhh no, did I spell it wrong somewhere!?!? 🤦🏻♂️
how does calcium gluconate protect the cardiomyocytes?
Is it to protect the sodium channels.
You might get hypothermia in the inpatient setting with burn patients
I thought Trauma and Hypoglycemia were dropped years ago
Yeah I'm not sure why they were officially removed, but I think, as well as others, that they still have a valid place. Maybe Trauma less so from an inpatient setting, but I've yet to hear a good reason not to take them in to consideration when evaluating any potential causes.
I am a wife, my husband had congestive heart failure. And I came across this lessons, about coding , my husband was being treated in the ICU from day 1 until 10th days is his final days. My main question is why he developed fever even he is been given antibiotics while he is sedated and incubated. All i know he is going to be better because day 1 .to day 5 he is progressing, and all his medications was taking off I the drips nurses given his medication thru injection to his IV. What i cant understand doctors why doctors order 2.5ml of morphine on day 10, and after 2.5 hours he was in code blue, to my understanding they suppressed his death. All I thought he is going to be treated not be murdered under ICU's Hospital doctor's. Please help me, to understand why this happen quickly. To end his life.
My husband died in cardiac arrest while he is sedated and incubated, for 10 days first to 5th days his doing progress then on the 8 days he developed fever for 2 days on the 10 days he was coded. Please explain why this happen to Him his only 42 years old. I have knowledge about medical thermonology. And I believed they mis treated him they don't give the treatment that he needs.
I mean Intubation
Ll
1. Never check an ABG during arrest. It takes 20 minutes for equilibration to take place before the ABG will show true values.
2. NEVER give calcium Bicarbonate in ACLS. This is NOT part of ACLS stop teaching people this! Numerous studies have shown that giving bicarbonate during these situations makes the acidosis worse and the patients actually have a higher mortality rate. Secondly, if you understand biochemistry bicarbonate is converted through carbonic anhydrase which produces CO2 thereby worsening your acidosis. Lastly, giving bicarbonate creates an alkalotic extracellular environment while shifting an acidosis into the cell worsening cardiac myocyte contractility and function.
If you want to save your patient perform high quality CPR and follow the ACLS algorithm. If you feel your method is more superior then conduct studies on your method, present this to the medical community and prove the AHA wrong after all their decades of research.
Hi! if you read the title and description it says "YOUR PATIENT is STILL CODING, NOW WHAT", which probably means that he is past doing CPR. In the ACLS Algorithm it says :"treat reversible causes", this is after CPR and cardioversion.