Cardiac monitoring

Treatment for acute exposure to benzene vapor involves removing the subject from the affected area, followed by artificial respiration with oxygen intubation and cardiac monitors may be necessary for severe acute exposures (125,127). Because of its low surface tension, benzene poses a significant aspiration hazard if the liquid enters the lungs. Emesis is indicated in alert patients if more than 1 mL of benzene per kg of body weight has been ingested and less than two hours have passed between ingestion and treatment (127). 

Promoting an Optimal Response to Therapy Depending on die patient s condition, die nurse may use cardiac monitoring, artificial ventilation (respirator), and odier drag s during and after the administration of naloxone It is important to keep suction equipment readily available because abrupt reversal of narcotic depression may cause vomiting. The nurse must maintain a patent airway and should suction die patient as needed. 

When propranolol is administered orally for a less serious cardiac arrhythmia, cardiac monitoring is usually not necessary. The nurse should monitor the patient s blood pressure and pulse rate and rhythm at varying intervals, depending on the length of treatment and the patient s response to the drug. 

THE PATIENT WITH HEART BLOCK. The patient receiving atropine for third-degree heart block is placed on a cardiac monitor during and after administration of the drug. The nurse watches the monitor for a change in pulse rate or rhythm. Tachycardia, other cardiac arrhythmias, or failure of the drug to increase the heart rate must be reported to the primary health care provider immediately because other dm or medical management may be necessary. 

The primary health care provider may also order laboratory and diagnostic tests, renal and hepatic function tests, complete blood count, serum enzymes, and serum electrolytes. The nurse reviews these test results before the first dose is given and reports any abnormalities to the primary health care provider. The patient is usually placed on a cardiac monitor before aiitiarrhytiuiric drug therapy is initiated. The primary health care provider may order an ECG to provide baseline data for comparison during therapy. 

ADMINISTERING PROPRANOLOL. Cardiac monitoring is recommended when the drug is given IV because severe bradycardia and hypotension may be seen. The nurse obtains written instructions from the primary health care provider for propranolol administration. For example, tire primary health care provider may want the drug to be withheld for a systolic blood pressure less than 90 mm Hg or a pulse rate less than 50 bpm. 

A transient increase in arrhythmias and hypertension may occur within 1 hour after initial therapy with bretylium is begun. The nurse should take the blood pressure and respiratory rate every 5 to 15 minutes and obtain the pulse rate from the cardiac monitor. These activities are continued until the arrhythmia is corrected. 

The nurse monitors the blood pressure and respiratory rate every 2 to 5 minutes when die drug is given IV and every 5 to 10 minutes when die drug is given IM. The pulse rate and rhythm are monitored continually by means of the cardiac monitor. The primary health care provider is contacted immediately if tiiere are any changes in the vital signs or die ECG pattern or if respiratory problems or convulsions occur. 

ADMINISTERING PROPRANOLOL. The nurse monitors die ECG frequendy for cardiac arrhythmias. Fhtients receiving IV propranolol must have continuous cardiac monitoring. The nurse must monitor the blood pressure and pulse frequendy during die dosage adjustment period and periodically throughout dierapy. 

Mr. Summers has a ventricular arrhythmia and is placed on a cardiac monitor. The primary health care provider prescribes IV lidocaine. Discuss preadministration assessments you would perform on Mr. Summers. Analyze which adverse reactions would be most important to monitor for during the ongoing assessment. Determine what reactions should be reported immediately. 

The patient is monitored carefully vital signs are taken frequentiy, and die patient is placed on a cardiac monitor while the drug is being titrated to a therapeutic dose The dosage may be increased more rapidly in hospitalized patients under close supervision. 

ADMINISTERING CALCIUM. When calcium is administered IV, the solution is warmed to body temperature immediately before administration, and the drug is administered slowly. In some clinical situations, die primary health care provider may order the patient to have a cardiac monitor because additional drug administration may be determined by electrocardiographic changes. 

Intravenous potassium infusions running at rates of greater than 10 mEq/hour require cardiac monitoring. 

Quickly ensure ABC (airway/breathing/circulation). See that the victim has a clear airway. If trauma is suspected, maintain cervical immobilization manually and apply a cervical collar and a backboard if feasible. Check for adequate respiration, and administer supplemental oxygen if cardiopulmonary compromise is suspected. Maintain adequate circulation. Establish intravenous access when necessary and warranted. Use a cardiac monitor as necessary. Stop any bleeding when necessary. When ingestion is evident, do not induce emesis (vomiting). For victims who are alert and able to swallow, give four to eight ounces of milk to drink. Administration of activated charcoal is not viewed as beneficial. 

Doxorubicin is a chemotherapeutic onthrocycline antibiotic, which may cause cordiotoxicity through the free-radical mechanism. Cardiotoxicity limits the clinical usefulness as a result of which doxorubicin has a total cumulative dose of about 450 mg/m body surface area. Patients with pre-existing cardiac disease, elderly patients and patients who have received myocardial irradiation must be treated cautiously and cardiac monitoring may be required. 

Functional cardiac changes including irreversible CHF and decreases in LVEF can occur. Cardiac toxicity may be more common in patients with prior treatment with anthracyclines, prior mediastinal radiotherapy, or with preexisting cardiovascular disease. Such patients should have regular cardiac monitoring of LVEF from the initiation of therapy. 

Blocker/Pa ra lytic ] WARNING Use restricted to experienced personnel Uses Induce paralysis to facilitate ET intubation (RSI) Action Competitive antagonist of acetylcholine Dose Adults Peds. 0.04-0.1 mg/kg IV Maint 0.01 mg/kg q45-60min (onset w/in 1 min duration 30-60 min) Caution [C/-] Cardiac monitor, BP monitor, intubation supplies and ventilator required Contra Use w/ caution in... 

Prodrug, fosphenytoin rapidly converted to phenytoin in vivo minimal activity before conversion water soluble, thus more suitable for parenteral applications does not require cardiac monitoring can be administered at faster rate no IV filter required compatible with both saline and dextrose mixtures requires refrigeration... 

A detailed discussion of the treatment of TCA overdose is beyond the scope of this chapter. Important principles of TCA overdose include removal of drug if possible, intensive cardiac monitoring, and support of respiratory, cardiac, and CNS functions. For a detailed discussion of the treatment of overdose, readers are referred to Rogers and Nichols Textbook of Pediatric Intensive Care (1996). 

Little is known about mirtazapine overdose. To date, patients who have overdosed have fully recovered. Warning signs include drowsiness, impaired memory, and tachycardia. Recommended treatment includes gastric lavage, cardiac monitoring, and supportive mea-... 

The management of toxicity requires monitoring of electrolytes, regular CNS observations, use of anticonvulsants should seizures occur, increased fluid intake to promote excretion (unless renal function is impaired) and cardiac monitoring. Haemodialysis should be considered if conservative measures are ineffective or serum lithium is above 3.0 mmol L-l. However, it may be of limited additional value as the volume of distribution of lithium is high. 

An overdose with an MAOI can produce a variety of effects including autonomic instability, hyperadrenergic symptoms, psychotic symptoms, confusion, delirium, fever, and seizures. Management of MAOI overdoses usually involves cardiac monitoring, vital support, and lavage. 

IV fluid, cardiac monitoring, anticonvulsants (for Szs) Sodium bicarbonate ... 

Any history of recent myocardial infarction or arrhythmias should exclude a patient from treatment. An ECG should be examined before treatment is initiated. Continuous cardiac monitoring is essential during the cooling, maintenance, and rewarming periods. 

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