Claire Dawson
Cardiac protocols in hospitals are standardized, evidence-based guidelines for treating and managing various heart conditions. These protocols are designed to assist clinicians in making informed decisions about patient care and include cardiac monitoring, cardiac procedures and surgeries, as well as preventative measures such as tobacco cessation programs. They are based on clinical experience, research, and expert opinions, and aim to improve patient outcomes and reduce the risk of long-term health problems related to cardiac issues. Cardiac protocols are an essential component of hospital care, providing a structured approach to dealing with heart-related emergencies and offering guidance on the best path to recovery.
| Characteristics | Values |
|---|---|
| Treatment protocols | Standardized, evidence-based protocols are used to manage and lower cholesterol levels in patients with atherosclerotic cardiovascular disease (ASCVD) and patients at risk for heart attack, stroke, or ASCVD. |
| Clinical guidelines | The American College of Cardiology (ACC) and the American Heart Association (AHA) released guidelines on cholesterol treatment and statin use in 2018. |
| Cardiac monitoring | Continuous cardiac monitoring is recommended for patients resuscitated from cardiac arrest to detect arrhythmias and underlying rhythm. |
| Arrhythmia monitoring | Uninterrupted arrhythmia monitoring is indicated during patient transport, for patients with critical left main coronary artery disease, and for patients with unstable angina until infarction is ruled out. |
| Cardiac arrest management | The American Heart Association provides guidance on recognizing and responding to cardiac arrest, including checking for responsiveness and breathing, calling for emergency services, and using an automated external defibrillator (AED). |
| Cardiac procedures | Various cardiac procedures and surgeries are described, including angioplasty, bypass surgery, heart transplant, and minimally invasive heart surgery. |
| Patient support | The American Heart Association offers resources for patients recovering from cardiac events, such as information on cardiac medications and emotional support for patients with implantable cardioverter defibrillators (ICDs). |
| Tobacco cessation | Evidence-based interventions and treatment protocols are available to help patients quit smoking, which can be integrated into clinical workflows. |
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What You'll Learn
Cardiac monitoring in the emergency department
Cardiac monitoring in an ED setting focuses primarily on arrhythmia, myocardial infarction, and QT interval monitoring. Arrhythmia monitoring is crucial for patients resuscitated from cardiac arrest, as they are at high risk for recurring arrhythmias. A cardiac monitor/defibrillator should be attached to these patients upon arrival in the ED to ascertain the underlying rhythm, and monitoring should continue until the cause is addressed or an implantable defibrillator is in place. Additionally, patients with unstable angina should undergo cardiac monitoring until infarction is ruled out, and signs of transient ECG changes and symptoms are absent.
To assist clinicians in determining which patients require monitoring, experts in electrocardiology and cardiac monitoring have developed practice standards for hospital ECG monitoring. These standards cover all areas of hospital cardiac monitoring, including arrhythmia, myocardial ischemia, and QT interval monitoring. The American College of Cardiology Emergency Cardiac Care Committee has developed a rating system to categorize patients: Class I indicates that cardiac monitoring is recommended for most, if not all, patients in the group, while Class II suggests that monitoring may be beneficial to some but is not essential for all.
Cardiac monitoring is typically performed using electrocardiography, a non-invasive process that records the heart's electrical activity and displays it in an electrocardiogram (ECG). This differs from hemodynamic monitoring, which focuses on blood pressure and flow within the cardiovascular system. Both methods can be performed simultaneously on critical patients. Telemetry, or biotelemetry, refers to the ability to monitor a patient's cardiac activity from a remote location, often a centralized system located at a nursing station.
In the emergency department, digital patient monitors are often used, and some incorporate defibrillator functions. These monitor/defibrillators have capabilities similar to those of an ICU monitor, with additional manual or semi-automatic defibrillation features. They may also include specialized parameters such as waveform capnography, invasive blood pressure monitoring, and pulse oximetry.
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Tests to determine treatment plans
There are several tests that can be carried out in hospitals to determine cardiac treatment plans. These tests can help diagnose heart problems, evaluate the effectiveness of treatment, and determine safe levels of physical activity. Here are some of the tests used to determine treatment plans:
Stress Test
The stress test is used to diagnose and determine the severity of heart disease. It can also help identify the cause of symptoms that appear during exercise, such as shortness of breath, fainting, or irregular heartbeat. This test can be done in a hospital or a doctor's office. It involves physical exercise, such as walking on a treadmill or riding a stationary bicycle. If the patient is unable to exercise, doctors may administer medication to stimulate the heart and increase the heart rate, mimicking the effects of physical activity. This test guides treatment planning by helping doctors decide on the appropriate medication, cardiac catheterization, surgery, or transplantation.
Coronary Angiography
Coronary angiography is often performed in a hospital setting to help doctors plan treatment for patients experiencing a heart attack. During this procedure, the doctor will numb an area on the arm, groin, upper thigh, or neck, and make a small incision in the skin and a blood vessel. A catheter tube is then inserted into the blood vessel, and X-ray pictures are taken to guide the placement of the catheter in the coronary arteries. A contrast dye is injected through the catheter to highlight any blockages, and additional X-ray images are captured.
Carotid Ultrasound
Carotid ultrasounds are typically performed in hospitals or doctors' offices. This test utilizes an ultrasound machine, consisting of a computer, a screen, and a transducer. The technician applies gel to the patient's neck, over the carotid arteries, and then moves the transducer against different areas of the neck to send and receive sound waves. These sound waves create detailed images of the carotid arteries and blood flow, helping doctors plan treatments to remove or stabilize plaque and prevent strokes.
Cardiac Computed Tomography (CT) Scan
The cardiac CT scan is a non-invasive imaging test that uses X-rays to capture detailed images of the heart and its blood vessels. Computers combine these images to create a three-dimensional (3D) model of the heart. This test helps doctors identify heart diseases or problems with the heart and its blood vessels. It can also be used to follow up on abnormal findings from chest X-rays or to check the results of coronary artery bypass grafting. The scan itself is quick, usually taking about 15 minutes, but preparation can take longer due to the administration of medications to slow the heart rate and dilate arteries.
Echocardiogram
An echocardiogram is an imaging test that uses ultrasound to visualize the heart muscle and valves. It can be performed while the patient is at rest or during exercise to elevate the heart rate. This test helps identify abnormalities in the heart and can be used to guide treatment decisions.
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Standardized treatment protocols
The use of standardized protocols is associated with improved patient outcomes and reduced costs. They help reduce unnecessary variation in care, eliminate redundant interventions, and improve coordination and workflow. Protocols ensure timely delivery of desired care, as evidenced by their implementation in sepsis treatment, which led to shorter times to first antibiotics and decreased hospital mortality.
In cardiac care, protocolized treatment of patients with ST elevation myocardial infarction has been associated with improved survival compared to standard care. Additionally, continuous cardiac monitoring is recommended for patients resuscitated from cardiac arrest to monitor for recurring arrhythmias.
While standardized protocols offer numerous benefits, it is important to note that they do not create a physician-patient relationship. Robust education and continuous quality improvement programs should be in place when utilizing standardized protocols.
Standardized nursing protocol orders, also known as standardized procedures, order sets, or triage protocols, are endorsed by organizations like the American College of Emergency Physicians (ACEP) for use in emergency departments. These protocols enhance patient care by reducing variation, improving workflow, and ensuring timely initiation of evaluation and treatment.
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Cardiac arrest causes and prevention
Cardiac arrest is a life-threatening condition that occurs when the heart suddenly stops beating. It is often caused by an electrical problem in the heart that disrupts the normal heartbeat. When this happens, blood flow to the brain and other vital organs is cut off, leading to a loss of consciousness, disability, or death if not treated immediately.
There are three main causes of cardiac arrest: arrhythmia, an enlarged heart, and coronary artery disease. Arrhythmia, including ventricular fibrillation, is a common cause, as it leads to an abnormal heartbeat. An enlarged heart can also cause abnormal contractions, leading to cardiac arrest. Coronary artery disease, on the other hand, is characterised by narrowed and thickened coronary arteries due to plaque build-up, restricting blood flow to the heart. Heart attacks, which are caused by blocked arteries, can alter electrical signals in the heart and increase the risk of cardiac arrest.
To prevent cardiac arrest, it is crucial to address these underlying conditions and maintain heart health. This includes managing conditions like arrhythmia and coronary artery disease through medical treatment and lifestyle changes. Maintaining a healthy weight, eating a balanced diet, exercising regularly, and avoiding smoking can all contribute to a healthy heart and reduced risk of cardiac arrest.
In a hospital setting, cardiac arrest protocols are essential for patient care. These protocols include guidelines for cardiac monitoring, such as electrocardiogram (ECG) monitoring, to detect arrhythmias and other cardiac abnormalities. Continuous monitoring is crucial, especially for patients with conditions like ventricular fibrillation or unstable angina, to identify and manage any arrhythmias promptly.
Additionally, hospitals should have emergency protocols in place for responding to cardiac arrests. This includes the immediate administration of cardiopulmonary resuscitation (CPR) to maintain blood flow to vital organs until more advanced treatments, such as defibrillation, can be provided. Automated external defibrillators (AEDs) are often required to be available in public spaces and can be used by bystanders to deliver life-saving support until emergency medical services arrive.
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Cardiac procedures and surgeries
Another example is coronary angioplasty, a minimally invasive procedure where a stent is inserted into a narrowed or blocked coronary artery to open it and improve blood flow. This method does not involve open-heart surgery, although it may require an overnight hospital stay. During this procedure, a catheter (a thin, hollow tube) is threaded to the heart, and surgical instruments, balloons, or stents are inserted through it.
Cardiac surgeons may also perform open-heart surgery, which is a major surgery that requires significant recovery time. This procedure often involves stopping the heart from beating to perform the operation, and a heart-lung bypass machine is used to maintain circulation. After such major surgeries, patients may experience anxiety and depression, and they should refrain from driving or lifting heavy objects for at least the first six weeks.
Cardiac monitoring is crucial in emergency departments to assist clinicians in determining which patients require monitoring. This includes monitoring for arrhythmias, myocardial ischemia, and QT intervals. Patients resuscitated from cardiac arrest should be continuously monitored, and those recovering from cardiac arrest should also be monitored if they leave the emergency department for diagnostic or therapeutic procedures.
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Frequently asked questions
Cardiac arrest is the sudden loss of responsiveness and the absence of normal breathing. It can strike without warning.
Check for responsiveness by tapping them hard on the shoulders or asking loudly if they're OK. If they don't respond, shout for help and ask someone nearby to call an emergency number and bring an AED (automated external defibrillator) if one is available.
An ICD, or implantable cardioverter defibrillator, is a device that can save your life by providing a low-energy shock to your heart to restore a normal heart rhythm in the event of ventricular fibrillation or tachycardia.
Some common cardiac procedures and surgeries include angioplasty, coronary artery bypass surgery, heart transplant, and stent procedure.
