Toxictherapeutic disturbances

Poisoning is a leading cause of cardiac arrest in younger adults (Resuscitation Council UK 2000a). The drugs may have a negatively inotropic effect on the heart. Alternatively, cardiac arrest may be a secondary endpoint caused by respiratory failure or central nervous system depression (Nelson & Hoffman 1996). There may be a definitive history of accidental or deliberate ingestion of therapeutic or toxic substances such as an overdose of tablets or exposure to carbon monoxide. However, even...

Opening and clearing the airway

This manoeuvre reduces the risk of airway obstruction in the unconscious or unresponsive casualty. The procedure allows lifting of the jaw, moving the tongue away from the throat. Open the casualty's airway with a head tilt chin lift (see Figure 5.1). Place one of your hands on the casualty's forehead. Remove any visible debris from the mouth with your finger, but leave well-fitting dentures in place. With the tips of the index and middle fingers of your other hand on the hard palate (the bony...

Acute Severe Asthma

It is important to differentiate routine asthma care from that in acute severe asthma. This section will focus on acute or near-fatal asthma, a condition that is largely reversible so related deaths should be considered avoidable. Interventions are aimed at preventing respiratory and secondary cardiac arrest (AHA & ILCOR 2000, Scottish Intercollegiate Guidelines Network (SIGN) & British Thoracic Society (BTS) 2003). Most deaths related to acute severe asthma occur outside hospital....

Shockable Rhythms Ventricular tachycardia

Monomorphic Ventricular Tachycardia

Ventricular tachycardia (VT) is confirmed by five or more ventricular ectopics in succession and it is usually accompanied by a sudden onset of signs and symptoms. If this rhythm occurs post myocardial infarction it can degenerate into ventricular fibrillation (VF). Ventricular tachycardia can be triggered by an irritable site within the ventricles conduction takes place across ventricular cells, rather than along the normal specialised conducting pathway, resulting in the broad shape of the...

Causes Of Cardiac Arrest

Cardiorespiratory arrest may occur because of a primary airway, breathing or circulation problem (Resuscitation Council UK 2000a). However, it is important to remember that many life-threatening diseases can cause secondary respiratory or cardiac problems, which may ultimately result in the patient suffering a respiratory and or cardiopulmonary arrest (see Table 11.1). Respiratory inadequacy may be due to disorders of the respiratory system such as asthma or pulmonary oedema. A decrease in the...

References

Baubin, M. (2001) Recombinant tissue plasminogen activator during cardiopulmonary resuscitation in 108 patients with out of hospital cardiac arrest. Resuscitation 50, 71-6. Caffrey, S.L. (2002) Public use of automated external defibrillators. New England Journal of Medicine 347, 1242-7. Cummins, R.O., Eisenberg, M.S. & Hallstrom, A.P. (1985) Survival from out-of-hospital cardiac arrest with early initiation of CPR. Annals of Emergency Medicine 3, 114-18. Cummins, R.O., Ornato, J., Theis, W....

Responding to anaphylaxis

Anaphylaxis Resuscitation Council

A wide range of possible presentations and clinical signs and symptoms may make it difficult to diagnose anaphylaxis. It is important to undertake a full history and examination as soon as possible. A history of previous allergies as well as the recent incident is vital. Special attention should be given to skin condition (colour, presence of rashes), pulse rate, blood pressure, respiratory rate and auscultation of the chest. A peak flow should also be measured and recorded if possible...

Introduction About Cardiac Arrest

Despite its popular portrayal, cardiorespiratory arrest is often neither sudden nor unpredictable (Resuscitation Council UK 2000). Studies over several years have shown that most cardiac arrests are avoidable if signs and symptoms are recognised and responded to (Franklin & Mathew 1994, Hodgetts et al. 2002a, Smith & Wood 1998). Patients with coronary artery disease are more likely to have a sudden cardiac arrest, often precipitated by an unstable area of ischaemic myocardium. Such events...

Primary survey and resuscitation

The primary survey identifies and treats life-threatening injuries in the order in which they are most likely to kill the patient. The priorities for recognising and responding are A Airway with cervical spine control C Circulation and haemorrhage control D Dysfunction, refers to neurological status E Exposure and environment. It is important that the casualty has a clear airway and adequate oxygenation. The airway is assessed and managed as described in Chapter 7, with the proviso that the...

Thromboembolic or mechanical obstruction

The most common cause of thromboembolic or mechanical obstruction causing the patient to lose their cardiac output is a massive pulmonary embolus. It has been suggested that an emergency pulmonary embolectomy removal of the clot can be life saving Resuscitation Council UK 2000a . In practice, this is not a procedure commonly carried out. There does appear to be a growing body of evidence that thrombolysis giving clot-busting drugs during the resuscitation may be helpful Caldicott et al. 2002 ....

Transfer and definitive care

Definitive care of the seriously injured casualty requires transfer to an operating theatre or intensive care unit ICU , often via the radiology department for scans. This may require transfer to another hospital. Safe transfer requires Fig. 14.2 The trauma team log rolling a casualty. Fig. 14.2 The trauma team log rolling a casualty. a stable patient - this is not always possible. If a patient is hypovolaemic from a ruptured spleen rapid transfer to an operating theatre and immediate surgery...

Resuscitation equipment

The Resuscitation Council UK 2001a provides a list of recommended equipment for the management of adult cardiopulmonary arrest, as follows. Airway and breathing equipment see Figures 3.1 and 3.2 Pocket masks with oxygen port Self-inflating bag-valve with oxygen reservoir and tubing Clear facemasks sizes 4, 5 and 6 Oropharyngeal airways sizes 2, 3 and 4 Endotracheal suction catheters x 10 Laryngeal mask airway size 4 or Combitube small Endotracheal tubes - oral, cuffed, sizes 6, 7 and 8...

Periarrest Arrhythmias

Peri-arrest rhythms are those that may present as emergency situations. Many of these adverse arrhythmias occur following a myocardial infarction, resuscitation or other factors. In such instances, if standard measures to manage or prevent arrhythmias are ineffective, expert help should be sought promptly ERC 2001 . Adverse arrhythmias can manifest with the following signs and symptoms. Evidence of a low cardiac output - for example, hypotension, cool peripheries, clamminess, pallor, confusion....