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By Macintosh, Michael; Moore, Tracey

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This makes it inappropriate for an acutely hypovolaemic situation where the goal is to increase the intravascular volume. Colloids are fluids that contain particles that exert an oncotic pressure and are mainly confined to the intravascular space when given because the capillary membrane is not permeable to the large molecules. Colloids can be classified as those that have an oncotic pressure that is the same as plasma, such as blood and blood products and those with a higher osmotic pressure. While all colloids will pull fluid into the intravascular space, if the oncotic pressure of the colloid is higher than the natural oncotic pressure of plasma, then more fluid is pulled into the intravascular space.

Ensure conducting pads are in place. Select the energy level. This will be determined by the rhythm and by the type of equipment being used. Place paddles firmly on the chest using 25 lb pressure. One paddle should be to the right of the sternum below the clavicle. The other is placed to the left of the nipple in the anterior axillary line. Press the charge button on the paddles. Check rhythm and ensure that everyone is clear of contact with the bed, equipment and patient. Press the ‘shock’ button and wait until the charge has been delivered.

The American College of Cardiology have expressed this as presenting a ‘warm and caring approach combined with professionalism and confidence’ (ACC/AHA 1999). There can be long-term psychological problems caused by profound disturbing emotions experienced in the immediate aftermath of the MI (Whitehead 2005). Continuous ECG monitoring is essential during the early stages to allow for the early detection of arrhythmia, as is careful observation for the signs of possible cardiac failure: rising heart rate, falling Sao2, restlessness, dyspnoea, falling pulse pressure.

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