cardiopulmonary
resuscitation (CPR) : the restoration to life or consciousness of one
apparently dead; the artificial substitution of heart and lung action as
indicated for cardiac arrest or apparent sudden death resulting from electric
shock, drowning, respiratory arrest, and other causes. The 2 major components
of CPR are :
150 J biphasic shocks achieve higher rates
of defibrillation and return of spontaneous circulationref1,
ref2
pediatric :
2-4 J/kg for monophasic shocks
1–2 J/kg for biphasic shocks. Higher biphasic doses
(up to 4 J/kg) are not likely to be harmful and are more efficacious than
equivalent monophasic shocksref.
Biphasic shocks may be delivered in a fixed dose of 50 J by an AED. The
use of AEDs in children < 1 year of age is not recommended, as in this
situation these devices are unable to differentiate between shock-able
and non-shockable rhythms (eg, VF vs. PEA))
=> CPR
=> i.v. access and intubate => set up 1 l NS drip to flush drugs => adrenaline
1 mg (children 0.01 mg/kg) i.v. bolus every 3-5 minutes => defibrillate
360 J within 60 seconds of adrenaline => repeat cycle of adrenaline and
defibrillation 3 times => amiodarone 3-5 mg/kg i.v. over 30 minutes (add
to 250 ml of 5% glucose (incompatible with NS)) => repeat cycles of defibrillation
and adrenaline => consider alternative antiarrhythmic agents (e.g. class
Ic antiarrhytmics
: sotalol 1 mg/kg over 15-30 minutes; lignocaine 1 mg/kg stat dose, then
infusion at 4 mg per minute. May be used prophylactically after successful
cardioversion of VF) => 360 J discharge every 30 secondsref1,
ref2,
ref3,
ref4,
ref5,
ref6,
ref7,
ref8,
ref9,
ref10,
ref11,
ref12,
ref13,
ref14,
ref15,
ref16,
ref17,
ref18,
ref19,
ref20,
ref21,
ref22,
ref23,
ref24,
ref25,
ref26,
ref27
cardiac asystolia : confirm asystole with at least 2 leads- check electrodes,
monitor leads and monitor to ensure correct diagnosis => be suspicious
if there is no electrical artifact with chest compression => if there is
any doubt about whether the rhythm is asystole or fine VF treat as VF :
CPR => IV Access +/- Intubate - set up 1L normal saline drip to flush drugs
=> CPR => i.v. access +/- intubate, set up 1 L NS drip to flush drugs =>
adrenaline 1 mg (children 0.01 mg/kg) i.v. every 3 minutes - repeat until
arrest is over => atropine 1 mg (children 0.02 mg/kg) in every 3-5 minutes
to total of 3 mg
in shocks
in emergency setting the first medical intervention should be positioning
of a vascular access
device
before veins collapse : for long-time positioning in antecubital fold place
a flexible needle-cannula (despite once bent it loses elasticity) or use
the forearm, wrist, or arm portions of cephalic vein The access can
be used for blood sampling first and phleboclysis then (the first examination
in hemorrhage should be blood group typization; the first examinations
ehen acute myocardial infarction is suspected should be myocardial necrosis
enzymes and coagulation profile). The first operation should be thawing
of cryoprecipitates and platelet concentrates as hypothermia worsens acidosis
Rose's position : one intended to
prevent aspiration or swallowing of blood, as from an injured lip: the
patient is supine with head hanging over the end of the table in full extension
so as to enable bleeding to be over the margins of the inverted upper incisors
Heimlich maneuver : a method of
dislodging food or other material from the throat of a choking victim:
after wrapping the arms around the victim at the belt line and allowing
his upper torso to hang forward, make a fist with one hand and grasp it
with the other; with both hands placed against the victim's abdomen slightly
above the navel and below the rib cage, forcefully press into the abdomen
with a quick upward thrust. If the victim is sitting, stand behind him
and perform the same procedure; if he is prone, turn him on his back, kneel
astride the torso, place both hands at the location on the victim's abdomen
as described above and press forcefully with a sharp upward thrust. The
maneuver may be repeated several times if necessary
The rate of survival after out-of-hospital cardiac
arrest
is low. Training and equipping volunteers to attempt early defibrillation
with automated
external defibrillators (AEDs)
within a structured response system before paramedics arrive can increase
the number of survivors to hospital discharge after out-of-hospital cardiac
arrest in public locations from 14% to 23%. Trained laypersons can use
AEDs safely and effectivelyref.
Because paramedics often arrive relatively late, the research found the
people they save are more likely to suffer brain damage: 78% of those saved
by bystanders without paramedics survived with excellent brain function
vs. 68% of those treated by paramedicsref.
The addition of advanced-life-support interventions did not improve the
rate of survival after out-of-hospital cardiac arrest in a previously optimized
emergency-medical-services system of rapid defibrillation. In order to
save lives, health care planners should make cardiopulmonary resuscitation
by citizens and rapid-defibrillation responses a priority for the resources
of emergency-medical-services (EMS) systemsref.
basic life
support with defibrillator (BLSD)
pediatric basic life
support (PBLS)
intermediate
cardiac life support (ICLS)
advanced life support (ALS)
advanced cardiac
life support (ACLS)
advanced trauma life
support (ATLS) : endotracheal intubation if GCS <= 8
prehospital trauma care
(PTC)
prehospital trauma
life support (PHTLS)
emergency medical services
(EMS)
emergency medical dispatch (EMD)
emergency medical physicians
emergency medical technicians (EMTs)
neonatal emergency transport service (NETS)
ambulance : a vehicle for conveying the
sick or injured, and equipped with apparatus for rendering emergency treatment.
central district ambulance (CDA)
triage : 1. the sorting out and classification
of casualties of war or other disaster, to determine priority of need and
proper place of treatment. 2. by extension, the sorting and prioritizing
of patients for treatment in nonemergency health care settings.
field triage
inter hospital triage to specialised care facilities