Cardiac arrest in ambulatory surgery. The management perspective

Preventing cardiac arrests requires constant vigilance on the part of the entire perioperative team. In the preoperative phase, physicians must make careful patient selections based on the patients' risk factors, and cancel the cases or admit the patients if problems are found. In the intraoperative phase, the anesthesia personnel must carefully monitor vital signs, observe tissue perfusion, replace fluids, position the patient to maximize vital functions, and carefully select the anesthetic agents. In the postoperative phase, nurses must carefully observe and monitor the patient, especially high-risk patients, and take any necessary precautions. They must also explain instructions to the patient regarding complications after discharge. Although a manager may establish careful patient selection criteria, the day may come when the staff members must respond to a cardiac arrest in the ambulatory surgery unit. When it does, management of the patient must be the first priority. The staff members must correctly diagnose the problem, send for assistance, perform CPR, mobilize equipment, oxygen, and medications, control traffic, document interventions, and record patient responses. In an ambulatory setting, there is a high probability that family members or friends will be with the patient. A nurse should be delegated to take them to a quiet area away from the immediate crisis, and provide information and emotional support. Frequent reports will help them cope with the crisis. Public awareness and knowledge about CPR has greatly increased since it was first used in 1960. By 1977, some 12 million Americans had been CPR-trained and some 53 million more were awaiting training.(ABSTRACT TRUNCATED AT 250 WORDS)