Clinical Simulation Prep work

Clinical Simulation Prep work

Myocardial Infarction

1. What is a coronary artery?

As the heart muscle also requires its own oxygen-rich blood supply to operate, the coronary arteries are designed for this task. Near the point where the left ventricle and the aorta intersect, the two critical coronary arteries separate from the aorta. After the arteries branch off, the right coronary artery provides blood supply to the right side of the heart, which is smaller as it supplies only the lungs with blood. While the left coronary artery supplies the left side of the heart with blood, which is more muscular and more massive as it provides the whole body with blood.

2. Describe coronary artery disease in your own words.

Also referred to as atherosclerotic heart infection or coronary, coronary artery disease is a severe illness induced by plaque buildup in one’s arteries, which are responsible for supplying the heart muscles with oxygen-rich blood. The arteries are supposed to be elastic and smooth, but they become narrow and stiff when the inner walls start to build up a plaque, and this results in the slow flow of the blood to the heart muscles causing it to be deprived of oxygen. In the United States, millions of individuals are suffering from this condition, and when the buildup plaque bursts, it results in sudden cardiac death or heart attack.

3. Label the coronary arteries on the following diagram. Indicate the location of the heart to which they deliver blood in parentheses (Example provided for Aorta).

4. What is a myocardial infarction (MI)? How does this result in damage to the heart?

Heart attack or otherwise known as myocardial infarction (MI) in medical terms,  is a condition that happens when the circulation of blood reduces or is blocked to one section of the heart. This condition results in substantial damage to the heart muscle.

5. What are some common signs and symptoms of an MI?

before highlight some of the most common signs and symptoms of the condition, it is essential to comprehend that these signs vary from one individual to another but here are the common symptoms of MI:

• Breathlessness
• Jaw pain
• Shoulder discomfort
• Chest pains
• Anxiety
• Dizziness
• Increased heartbeat

6. What is common treatment (medications, procedures, etc.) for an MI? Be prepared to describe each.

Most patients start receiving their treatment in the emergency room because MI requires immediate attention. To unblock the arteries tasked to provide the heart with blood, a minimally invasive process known as angioplasty is applied. CABG (coronary artery bypass graft) is another form of treatment for MI as the doctor reroutes the patient’s arteries and veins to enable the flow of blood past the blockage. In order to dissolve clots, thrombolytics are usually employed.

Cardiac Arrest

7. What is cardiac arrest?

Cardiac arrest is termed as the sudden halt of heart operation in an individual who might have been diagnosed or not with heart conditions. This condition may occur after several signs and symptoms, or it might as well be abrupt, and if correct measures are not deliberated at once, it is usually fatal.

8. What four cardiac rhythms may be present in cardiac arrest? Describe each.
   1. Ventricular fibrillation (VF) – Is a disorganized electrical activity
   2. Ventricular tachycardia (VT) – when there is a delay of defibrillation in VF and increase in pulseless VT, the chances of survival for a patient reduces.
   3. Asystole – Is the lack of ventricular electrical activity either with atrial electrical activity or without.
   4. Pulseless electrical activity (PEA) – Is an organized electric rhythm characterized by the insufficient mechanical ventricular process to generate a pulse that can be detected.

9. If a patient’s monitor displays one of the rhythms mentioned above, in which site(s) is it acceptable to check a pulse? (Select all that apply.)
10. Brachial
11. Femoral
12. Carotid
13. Posterior Tibial

10. What other assessments should the nurse perform if one of the rhythms mentioned above (#8) is noted?

One of the most recommended assessments to be conducted after noting any rhythms of cardiac attack is the electrocardiogram (ECG). This assessment is essential as it detects the electrical activity of the heart, which is connected with other organs such as the chest and limbs.

11. What are the common causes of cardiac arrest?

A heart attack resulting from coronary heart illness is the significant cause of cardiac arrest as well as heart valve disease. Other leading causes of the disease include inflammation of the heart muscle (acute myocarditis), congenital heart disease, cardiomyopathy and some hereditary heart disease.

12. What do you do if…
13. Your patient’s rhythm shows ventricular tachycardia (VT). They are awake and talking to you.

V-tach treatment is a crucial treatment for VT, regardless of the patient’s status. Medications are prescribed for patients with VT but can still talk because the antiarrhythmics prevent rapid heartbeat if regularly taken.

1. The patient’s rhythm shows VT, but the patient is unresponsive to any stimuli and has no pulse.

It is essential to deliver an urgent V-tach treatment which comprises the immediate restoration of the heart to its regular rate by offering a jolt of electricity to the heart through defibrillation.

1. Your unresponsive patient’s rhythm shows normal sinus rhythm, but you cannot find a pulse.

I will continue checking for a pulse every two minutes, and if there is no sign of a single pulse, I will begin delivering CRP.

13. When performing CPR, what is the ratio of compressions: breaths?
    1. 30:2

14. Refer to the pulseless American Heart Association’s Adult Cardiac Arrest algorithm (2010).
15. What is the first step to take when a patient is in pulseless VT, VF, PEA, or asystole?

To ensure that the electrical activity of the heart is stabilized and that is attained through electrical cardioversion. The nurse places an intravenous line in the arm of the patient to administer sedative medicine then deliver electrical shocks using two paddles while confirming the heartbeat condition.

1. What cardiac rhythms indicate that a shock from the defibrillator is advised?

VT and VF

1. Refer to the dosages of epinephrine and amiodarone in the “Drug Therapy” section and fill out the following table:

1. For what length of time can CPR be performed total in a cardiac arrest?

two minutes                                                                                                                                       

1. Compressions should aim to be completed at what depth?

the push should be hard, approximately five centimetres

1. How fast should the rate of compressions be when performing CPR?

A hundred pushes per minute and allows the chest to recoil fully.

15. What is “ROSC”? If ROSC is achieved, what assessments should the nurse perform?

Return of Spontaneous Circulation (ROSC) is blood pressure and pulse as well as a sudden sustained rise in PETCO, roughly more than 40mm Hg. ROSC is also a spontaneous arterial pressure wave with intra-arterial monitoring. The nurse should treat reversible causes such as hypoxia, hypovolemia, hypothermia, and so on.

16. If the patient is responsive after ROSC, what medical interventions may be performed on this patient?

If a ROSC is achieved, the nurse should perform post-cardiac arrest care.

17. If the patient remains unresponsive after ROSC, what medical intervention(s) may be performed to preserve brain function? How does this work? (HINT: search “targeted temperature management”)

induced hypothermia is required for the protection of the brain and other body parts. For patients who remain comatose, often termed as deficiency of necessary response to verbal commands after ROSC, the therapeutic approach is vital for them.