How about other types of cardiac disease
and cardiac arrest? We've talked about
hyperkalemic cardiac arrest. But most commonly,
cardiac arrest in the operating room is due to ischemic
heart disease, so lack of adequate
oxygen to the heart muscle itself.
It often is associated with patients
and heart failure. Or patients with severe
vascular disease, particularly Severe
Aortic Stenosis. Treatment of cardiac
arrest in the operating room, under normal
circumstances, should follow ACLS guidelines.
With the surgeon providing the CPR
and the anesthesiologist largely
controlling the direction of the arrest protocol
by determining what drugs will be given,
when the defibrillator will be used,
and by monitoring saturation and end-tidal
carbon dioxide. Most important thing to do
in a cardiac arrest situation is to press
the arrest button and get help. They
can occur secondary to pulmonary
emboli, tension pneumothorax, or
cardiac tamponade, or in hypovolemic
shock, patients who have bled out. And these
conditions have to be treated in addition to using
the ACLS protocols, before
recovery can occur.
Arrhythmias are generally treated according to ACLS
protocols. With ventricular fibrillation and pulseless
ventricular tachycardia, treated with defibrillation.
Normally, atrial arrhythmias
are fairly common during anesthesia.
And normally they are of no consequence
and most of the time you don't need to call
a cardiac arrest if you've just got
an atrial arrhythmia. So we're now
going to talk about Drug Errors.