PCT - Cardiovascular

Purpose: Used to decrease heart rate.
Observation: Can monitor heart rate changes on a cardiac monitor during this maneuver.
Effect: The heart rate may fluctuate before stabilizing after performing the maneuver.

Ventricular Fibrillation (V fib) and Pulseless Ventricular Tachycardia (V tach): Two rhythms important for defibrillation.
Mechanism: Defibrillation delivers energy, stopping the heart and allowing the SA node to reset and potentially restore sinus rhythm.
Lightning Survival: Some individuals survive lightning strikes because the electrical energy can reset heart rhythms, allowing the heart to restart.
Death Mechanism: Lightning that impacts the brain along with the heart can lead to respiratory arrest and suffocation.

Key point: Early defibrillation is crucial; the first shock has the highest chance of success due to less cumulative cardiac damage.
Blood Volume: Effective CPR is necessary to ensure the heart is filled with blood before shocks are administered.
Survival Rate: The longer a patient is in cardiac arrest, the lower their chances of survival.
Asystole: Not responsive to defibrillation—requires immediate CPR.

Initial Steps in Cardiac Arrest:
- Ensure patient is on a firm surface for effective CPR.
- Use suction equipment if necessary due to possible vomiting.
- Consider reversible causes of arrest (e.g., hypothermia, trauma).
- Use authorized techniques for airway management (OPA, NPA, supraglottic).
- Maintain minimal disruptions during CPR, even while charging the defibrillator.

Hypothermia: Only one shock advised initially; focus on keeping heart naturally beating.
Trauma Patients: Similar protocols; one shock then assess bleeding before further interventions.
Hanging Cases: Administer four shocks initially due to medical nature of the scenario.
Pregnant Patients: Considerations for both mother and baby after 20 weeks of gestation involving careful adjustments during CPR.

Protocol: Continue CPR until hospital admission if recurrent VF occurs post-shock.
Termination of Resuscitation: Conditions under which resuscitation may be terminated after 20 minutes if no signs of life and unresponsive to CPR.

Defibrillation Instructions:
- Attach pads, remove nitro patches to prevent hypotensive episodes due to vasodilation.
- Perform rhythm analysis to identify shockable rhythms from AEDs.
- Maintain safety protocols; ensure no one else is touching the patient before shocking.

Indication: Used for patients with a pulse experiencing tachyarrhythmias.
Synchronized Current: Modern devices are programmed to avoid shocking during vulnerable cardiac phases (R-on-T phenomenon).
Sedation Requirement: Notable for unstable patients with significant symptoms (requires ACP oversight).
Transcutaneous Pacing: Indicated for unstable bradycardia unresponsive to medications, requires ACP involvement.

LVADs & ECMO: Devices supporting cardiac function and circulation in severe heart failure or cardiogenic shock patients.
IABP: Intra-aortic balloon pumps used for patients needing additional cardiac support during transport.
Patient Mobility: LVADs allow patients awaiting heart transplants to maintain a degree of normalcy in their lives.

Digoxin:
- Commonly used for Chronic Heart Failure (CHF); increases cardiac efficiency by slowing heart rate.
- Overdose symptoms may include bradycardia and yellow vision.
Nitrates: (e.g., Nitro) use:
- Acts as vasodilators reducing afterload, commonly given in cases of chest pain.
Beta Blockers:
- End in "-olol"; reduce heart rate and are effective to combat hypertension.
Calcium Channel Blockers:
- Help to decrease force of contraction, reduce vasoconstriction, and slow heart rate through various mechanisms.