Reaction and Prevention of Post-ROSC Pulseless Arrests

It is becoming increasingly difficult to ignore the fact that reaction and prevention are essential perspectives of healthcare, nursing, and medicine as a whole. There is a wide range of events that require immediate medical assistance to save the patient’s life. One such event is a return of spontaneous circulation (ROSC) and a related possibility of a new cardiac arrest. The latter is a dangerous situation since it is unexpected; therefore, nurses and physicians have to be ready to react properly. Inappropriate treatment may result in numerous and profound negative consequences the prevention of which is especially important.

Besides the requirement for an immediate reaction and prevention, the sequence and quality of actions performed are not satisfactory. Thus, modern healthcare fails to accumulate and utilize already possessed knowledge concerning ROSC, its probable consequences, and spontaneous cardiac arrest. This gap relates to the knowledge in terms of theory and practice by means of mechanical reaction and prevention.

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It is worth saying that contemporary healthcare obtains a substantial volume of theoretical and empirical knowledge, which needs an evident systematization. This issue has raged unabated for decades and is still one of the central concerns nowadays. Regarding that, the following paper focuses on the literature review devoted to the identification of best practices and standards of reaction and prevention in cases of cardiac arrest after successful ROSC.

To be more specific, the paper contextualizes the impacts of the existing protocols of prevention in terms of healthcare delivery. Then, the study specifies the knowledge concerning the involvement of nurses as direct agents of healthcare delivery. The next section is the literature review based on the discussion and description of best practices and the current state of the prevention standards. The paper obtains a sufficient amount of the related literature, which serves as the primary basis for all findings. The successful outcomes of the experiments have determined the majority of the findings, which is an obvious benefit for the study as it is capable of rendering a maximum of empirical knowledge.

However, the paper makes certain comments itself; therefore, it can be regarded as independent research based on the review of the academic literature. Its primary academic value should be recognized in the variety of systematized knowledge regarding theory and practice. However, the study does not make revolutionary explorations but provides a meaningful basis for the development of specified researches. As long as the thesis, structure, and the key terms of the study have been outlined, it is necessary to proceed to the following sections.

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Impact in Healthcare Delivery

Recent developments in the sphere of healthcare and nursing have indicated that the use of venous prophylactic treatment is a key approach concerning the prevention of such events as sudden evidence of repeated pulseless arrest. The framework of best practice for addressing post-ROSC cardiac attack considers evidence of worsening in terms of hospitalization or post-hospitalization phases of treatment of the cardiac attack.

However, the majority of standards suggested by the framework is usually neglected, thus, response activities usually outcome with serious and tragic consequences. It is worth saying that physicians have already succeeded in the development of a new effective framework (Manno, 2012). It is quite complex and sophisticated and includes specific requirements for the diagnosis, prevention activities, and factual treatment of the patients with these events or their distinct symptoms.

The updated framework is supposed to meet the following requirements. First, it has to be simple and accessible. This aspect is important to not only the nurses and doctors but ROSC patients as well. Most lethal outcomes occurred in terms when the patients were not under the supervision of nurses and healthcare organizations. Therefore, it should be relatively flexible. Every single human being possesses specific peculiarities of health and organism conditions; hence, the framework needs to consider this aspect. Otherwise, the patients are tending to face unnecessary complications.

However, the framework does not have to address the universal context of reaction and prevention of post-ROSC cardiac arrest events since it can be improved in the future. The current state of knowledge rests on the understanding that none of the universally applicable techniques can be designed, as scientific and technical progress will contribute to the further improvement of a certain practice.

Impact on Nursing Care

It is becoming increasingly apparent that nurses contribute much to the factual embodiment of the framework aimed at the effective reaction to post-ROSC cardiac arrests. In fact, the nurses take high responsibility as long as they are expected to recognize the basic symptoms of these events. Furthermore, conducting basic diagnostic tests, complex treatment, and communication with the patients are also the main duties of the nurses in terms of the outlined framework.

Therefore, they have to ensure that they are utilizing the best practice of reaction and prevention of post-ROSC pulseless arrests. Actually, a current understanding of the best practice involves a reasonable balance between pharmaceutical and mechanical treatments based on immediate reaction and response. It is fair to say that the majority of important activities belongs to the set of nurses’ responsibilities. Thus, their education and training are vital.

Overall, nurses are expected to conduct a valid diagnosis and make the best judgment of the situation. It is especially crucial in cases of sudden circulation after successful outcomes of cardiac arrest. People, who had ROSC, can experience such adverse consequences as the thrombosis event, weak pulse, coughing, problematic breathing, and another cardiac arrest. As it has become abundantly apparent, repeated pulseless arrest means an immediate death in the 99,9% of post-ROSC heart attacks. Thus, nurses have to predict such a scenario as fast as possible and conduct pharmaceutical and mechanical prevention.

The sequence of actions depends heavily upon the peculiarities of the patient’s condition and accompanying events. Hence, the assessment of the state requires a rational action vital in these terms. The responsibilities of nurses also include care on a regular basis, training, and consulting the patients. Many of lethal outcomes occur in a post-hospitalization period when a nurse does not assist a patient; hence, patients need to know the basics of individual reaction and prevention.

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Literature Review

To start with, it is appropriate to be explicit about the term of post-ROSC cardiac arrest. In fact, it is commonly recognized as evidence of a spontaneous second heart attack that occurs after a successful overcoming of the first one. Unfortunately, it is the most widespread cause of death in terms of hospitalization as well as non-hospital treatment. According to Field (2009), the cardiac arrest usually occurs in cases of unstable breath, coughing, and in conditions of polluted air. The most dangerous aspect of this event is an unexpected sudden stop in the blood circulation because the heart cannot contract it, which is referred to as sudden cardiac arrest (SCA).

Stopped blood circulation fails to deliver oxygen and glucose to the brain, which may result in the loss of consciousness, which often causes abnormal breathing. Finally, the injury of the brain can occur if the physicians do not treat the arrest within five minutes. Nowadays, SCA ends with positive outcomes in more than 6% cases while nearly 94% of the cases end lethally within 10 years after the first pulseless arrest.

Then, it is necessary to pay attention to the literature, which describes the main factors accompanying the complication of ROSC-related events. As Paradis, Halperin, Kern, Wenzel, and Chamberlain (2007), suggest, SCA is usually containing such signs as loss of consciousness, dizziness, poor appetite, difficulties with breath, vomiting, chest pain, and high blood pressure. However, it is worth saying that post-ROSC cardiac arrest occurs without any specific signs; therefore, it is extremely dangerous. It is evidently pivotal for nurses and doctors to be able to spot the cardiac arrest in time.

It is also important to instruct potential patients and their relatives or caretakers about basic principles of reaction in terms of non-hospital care. Vincent (2010) explains that the post-ROSC heart attack event may produce its effect within a month after the end of the patient’s main treatment of cardiac arrest. Thus, the evaluation of this perspective at the termination state is also recommended.

Besides that, as Ashton (2011) suggests, patients, who need immediate hospitalization, face post-ROSC cardiac arrest after a few days since the first heart attack. The related observations have proved that a certain degree of risk can be expected within seven days after the patient’s termination from the hospital. There is a wide range of risk causes, which include coronary artery disease, traumas, bleeding, drowning, non-ischemic heart disease, poisoning, obesity, and diabetes.

Furthermore, negative habits, especially smoking, alcohol, or substance abuse, are the major contributors to provoking a post-ROSC cardiac arrest. In addition, as O’Kane (2015) reports, certain races have a major vulnerability to post-ROSC cardiac attacks. It is mainly Whites and Blacks while Asians and Hispanics are reported to have better resistance to these events so that post-ROSC pulseless arrest occurs to them less frequently. The environmental, as well as social conditions, can explain this fact.

It is becoming increasingly apparent that one of the most evident difficulties for a successful implementation of the anti-ROSC-consequences framework rests on the variety of risks, which follow the reaction to the events’ symptoms. This problem should be directly referred to the absence of preliminary diagnosis and prophylaxis. Only one exclusion can be made by cases of surgical intervention as these patients undergo a profound preliminary diagnosis. Again, the absence of a distinct framework and strict requirements regarding best practice and appropriate reaction to ROSC-related cases also contribute to the problem.

It is also pivotal to mention that human error plays a harmful role. One should note that excessive or insufficient dosage or treatment approach becomes a reason for serious and even lethal outcomes, especially in cases of spontaneous circulation after the pulseless arrest. Thus, it is crucial to discuss two major approaches to the prevention of post-ROSC cardiac attack: pharmaceutical and mechanical.

 

The suggested framework is supposed to address not only the effects of ROSC-related events but the causes of preventing failure as well. As it has been already mentioned, preliminary diagnosis and prophylaxis are obligatory. However, the addressing of the causes starts with pharmaceutical intervention. Then, mechanical procedures can be applied. There is a wide variety of methods aimed at addressing ROSC at its early stages so that there has been a little agreement on what exact approach is the most effective. For the same reason, it has to imply a minimum of risk. Pharmaceutical, as well as mechanical applications, are the most widespread ones so that the literature review particularly focuses on these methods of addressing ROSC-related causes.

The main disadvantage of the pharmaceutical approach is based on relatively high risks of internal bleeding in case the medication was chosen inappropriately. Thus, nurses, as well as doctors, have to make the best judgment of the patient’s condition. In other words, the correlation between risks and positive outcomes should be in favor of positive results. To be more specific, epinephrine is commonly regarded as the most efficient medication, which is also approved by governmental agencies.

The main purpose of efficient prophylaxis has to rely on simplified planning, easy accessibility, financially flexible, and include a minimum of drugs. These requirements are expected to be met by the healthcare organizations while the patients themselves have to exclude any junk food, promote a healthy diet, exercise, and get rid of bad habits. The day regime is also essential as biorhythms influence different extents of blood pressure. In consequence, lack or excess of sleep can lead to SCA as well.

Concerning the mechanic approach, it is to be said that it includes ambulation equipment, Intermittent Pneumatic Compression Devices, and a complex of physical exercises, which are the key alternative to the pharmaceutical approach, especially in cases when the risk of SCA is not well justified. It is pivotal to mention that some devices are not comfortable or simply do not fit a certain patient. Deakin (2014) suggests that the length of these devices has to be approximate of a thigh length. It will make the patient feel more comfortable while the nurses are capable of more active motion as well as space.

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In spite of the advantages from the perspective of mobility and feasibility, they are expected to render a high level of effectiveness so that a patient will be able to have the devices attached in a minimal span of two weeks. Hence, safety still has to prevail regarding the improvement of equipment for the mechanical approach.

The recent researches have witnessed that the majority of patients, who were given low molecular Heparin, received various complications from skin damage to light forms of stroke. Again, the choice of approach has to rely heavily on the exact methods of treatment. In other words, risk assessment is required without any respect for the choice of the prevention approach. Nobody would deny the fact that risk assessment has to comply with the same framework.

High standards and universal applicability are the key requirements for the risk assessment. It is also suggested to make this assessment as plain as possible so that the decision-making will be straightforward and distinct. Therefore, data can be collected based on evidence-based nursing practice (Ashton, 2011). Risks should be assessed in comparison to a certain break-even margin, which can be presented statistically or via matching certain signs with a required condition.

Besides innovations in the pharmaceutical approach, some other improvements can be made in terms of mechanical prevention. The drastic breath problems accompany the majority of ROSC-related cases. Contemporary air-breathing devices are insufficiently effective because chest compression creates a natural obstacle to the patient’s breath. Thus, recent research has distinguished that tracheal intubation can become an efficient alternative as it provides a regular stream of air.

The principle of this device is simple. The stream of oxygen is passed under a pressure sufficient for overweighting carbon dioxide. As a result, the patient exhales excessive carbon dioxide. The pressure can be regulated depending on the amounts of carbon dioxide or the presence of other external gasses in the patient’s lungs. The device is incorporated with a special sensor, which will make a signal when the amount of carbon dioxide is normal. Otherwise, excessive exhaling of this gas can be also harmful.

On the contrary, the researchers do not recommend tracheal intubation for ROSC-related cases, which last for a short time. In other words, this device does not have to be utilized immediately (Frontera, 2009). The modern healthcare obtains a wide variety of medications that prevent cardiac arrest, but the reaction has to be maximally immediate. Thus, the application of mechanical prevention is not advised at the first moments of a strong ROSC event.

To return to the subject of the nurses’ contribution to the prevention activities, it is to be said that they are the party, who ensures that the treatment was accurately scoped. Thus, the nurses are required to work with patients from the perspective of potential conditions worsening. It can be also certain training of the patients regarding proper medication during the treatment. Furthermore, all important and suspicious evidence should be reported to the physician.

The training must include such aspects as distinct symptoms of ROSC, proper dining, clothing, risks, and proper motion. Nurses may also create a custom program of physical and breathing exercises for the patients and record the changes in their condition on a regular basis. The recent healthcare practice suggests a regular record and reporting on the patients’ conditions and close communication with them can help in avoiding the acts of negligence.

However, it is not a single aspect that has to be addressed in terms of the new framework. The contemporary medical practice faces a wide range of cases when complications occur after successful prevention. This evidence should be particularly referred to as cases of repeated pulseless cardiac arrest. It can be explained by the fact that the flows of blood pumps are still not stable so that the myocardium is potentially vulnerable at this period (Venkant, 2011).

Therefore, therapy has to be prolonged on a home basis from 10 to 30 days. This recommendation should be mainly based on the pharmaceutical approach rather than on mechanical, but this phase may include both of them as long as the venous system needs to adjust to sustained blood flow. Furthermore, diastolic, as well as systolic functions, will be kept in a proper balance, which is important to ROSC-related events and the possibility of their secondary events.

To get back to the subject of the pharmaceutical approach, it should be noted that the post-hospital period could be supported with a double dosage of epinephrine, which is equal to 2 x 0. 1g. The same dosage is strongly recommended for the patients, who faced substance abuse or event according to the type of addiction. Alcohol and the majority of drugs include ethanol so that epinephrine neutralizes its effects. The recent research has proved that patients with such post-hospital medication had a minimal frequency of deviations concerning their conditions (Leper, 2014).

Conversely, the majority of patients complied with parameters of a normal state or had minor signs of the ROSC-related event, which actually can be justified by the age of the patients. Younger generations, however, demonstrate more vulnerability to post-hospitalization risks. This phenomenon rests on the fact that the blood system of the senior people is more flexible even though it is weaker than the younger ones. Therefore, fast improvement of the pulse, systolic and diastolic functions, and pressure imply a sudden getting back since the young blood system is not flexible enough to change its forms with a high frequency. These are the main findings of the literature review, so that is it necessary to sum them up and draw a relevant conclusion.

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Conclusions and Reflections

In conclusion, it is appropriate to make a general comment on ROSC-related events. The paper has conducted a meaningful literature review related to a discussion and description of two main approaches to ROSC consequences treatment: pharmaceutical and mechanical ones. Concerning the pharmaceutical approach, it is worth saying that it should be applied to the patients, who did not undergo surgery. The study has placed the emphasis on the use of heparin and epinephrine in a post-hospital phase of treatment. Significant attention should be paid to the patients, who had substance abuse or suffer from such addiction for a long time.

The recent researchers explain that the epinephrine’s characteristic feature is to neutralize ethanol, known to be a comprising element of alcohol and drugs. Still, the paper has identified that a contemporary medical practice evidently lacks a framework regarding general preventions in terms of hospitalization. The rest of the non-hospital cases end lethally or lead to complicated consequences. The core of the problem is based on late or missing detection of ROSC risks, which result in the SCA and other complications.

As for the mechanical approach, it is commonly recommended to be utilized in a complex with physical and breathing exercises. However, a central concern regarding mechanical equipment for ROSC therapy, diagnosis, and prophylaxis is the feasibility and comfort of the devices. The literature review has revealed that the majority of such medical equipment is not effective to its maximal extent because of uncomfortable configuration. Hence, the paper has suggested adjustable contacts so that they are capable of fitting any patient.

The length and placement are also important; therefore, it has been recommended to make them at least thigh-long so that nurses can give assistance from any direction. These are all minor aspects, but they are pivotal for the best practice of SCA prevention, especially in cases of spontaneous circulation after the pulseless arrest. What is more, traditional equipment for artificial breaths is not effective any longer. Instead, the recent development suggests that tracheal intubation should be commonly used in contemporary practice.

The devices presuppose the streaming of oxygen under relevant pressure so that the patient naturally exhales carbon dioxide. The device has a special detector that acknowledges about normal pressure rate and amount of carbon dioxide inside the patient’s organism. As a result, the following research is suggested to be focused on the detailed framework for both approaches to SCA prevention.

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