Description
Sudden cardiac death (SCD) is unexpected cardiopulmonary collapse. SCD can occur as a primary manifestation of ischemic heart disease.
Many hospitals and ambulances have automated defibrillators that professional staff can use if a patient suffers a heart attack or cardiac arrest.
Risk factors mirror the risk factors for coronary artery disease (CAD); cigarette smoking, hyperlipidemia, hypertension, diabetes, obesity, stress, and a positive family history of cardiovascular disease. Men, especially those older than 50 years, and postmenstrual women are susceptible. Additional risk factors include patients who:
- Has known sudden cardiac death survivors.
- Had an acute MI within the past 12 months.
- Have cardiomyopathies that have demonstrated left ventricular ejection fractions <40%,
- Had prolonged QT intervals.
Signs and Symptoms
- A previously normal-appearing adult will suddenly collapse with cardiopulmonary arrest not associated with accidental or traumatic causes.
- There are commonly no prodromal symptoms, although there may be a brief period of anxiousness or chest discomfort.
Physical Examination
- Full cardiopulmonary arrest
- Pulselessness
- No respirations
Acute Care Patient Management
Nursing Diagnosis: Decreased cardiac output related to electrophysiologic instability after resuscitation.
Outcome Criteria
- Patient alert and oriented
- Skin warm and dry
- HR 60 to 100 beats/min
- Absence of lethal dysrhythmias
- BP 90 to 120 mm Hg
- Mean arterial pressure 70 to 105 mm Hg
- Urine output 30 ml/ hr
Patient Monitoring
- Monitor in the lead appropriate for ischemia or dysrhythmia identification.
- Analyze ECG rhythm strip at least every 4 hours and note rate, rhythm.
- Obtain pulse arterial pressures and central venous pressure hourly or more frequently if titrating pharmacologic agents.
- Monitor arterial oxygen delivery and oxygen consumption as indicators of tissue perfusion.
- Monitor blood pressure hourly.
- Monitor hourly urine output to evaluate effects of decreased cardiac output and pharmacologic intervention.
Diagnostic Assessment
- Review serial 12 lead ECGs and cardiac enzymes to determine whether ischemia, injury, or infarct has occurred.
- Review serial electrolyte levels because disturbance in potassium or magnesium is a risk factor for dysrythmias.
- Review ABGs for hypoxemia and acidosis because these conditions increase the risk for dysrythmias, decreased contractility, and decrease tissue perfusion.
Patient Management
- Provide supplemental oxygen to maintain or improve oxygenation. The patient may be intubated and mechanically ventilated.
- Minimize oxygen demand by maintaining bed rest.
- Be alert for dysrhythmias risk factor for anemia, hypovolemia, hypokalemia, hypomagnesemia and acidosis.
- Because most sudden cardiac death occurances are secondary to a lethal dysrhythmia, 24 hour Holter monitoring and possible electrophysiologic study (EPS) may be done to determine the effectiveness of pharmacologic regimen.
