A Resuscitation Room Guide Banerjee
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Ashis Banerjee Chris Hargreaves. Acknowledgements v Detailed contents ix Preface xvii Symbols and abbreviations xix 1 2 3 4 5 6 7 8 9 10 11 12 Resuscitation room organization Basic principles of resuscitation Team approach to resuscitation Cardiac arrest and peri-arrest management Airway and breathing management Circulation management Trauma Burns Neurological resuscitation and management Renal, endocrine, and metabolic management Toxicology Gastrointestinal and gynaecological resuscitation Sepsis Contact addresses Useful websites Index Detailed contents Acknowledgements v Preface xvii Symbols and abbreviations xix 1 Resuscitation room organization.
The cardiac arrest team 48 Critical care outreach teams 50 Cardiac arrest protocol 52 Trauma team activation criteria 54 4 Cardiac arrest and peri-arrest management. Introduction 58 Causes of cardiac arrest 60 Cardiac arrest management 62 Chest compression 64 Indications for the termination of CPR 66 Drugs used in cardiac arrest 74 Antiarrhythmic drugs in peri-arrest situations 78 Defibrillation 82 Cardiac arrest in pregnancy 88 Anaphylaxis 90 5 Airway and breathing management Introduction 96 Features of increased work of breathing 98 Patterns of altered breathing Features of paediatric upper airway Elective airway evaluation Airway adjuncts Face mask application Bag and mask ventilation Adult and paediatric choking Respiratory system monitoring techniques Pulse oximetry Capnography Oxygen therapy Oxygen delivery devices Arterial blood gases Tracheal intubation Confirmation of tracheal tube placement Laryngeal mask airway Airway trolley contents Aids to intubation Cricothyroidotomy Tracheostomy Rapid sequence intubation Rapid onset sedativehypnotics Neuromuscular relaxants Management after uneventful intubation Failed intubation Anticipated difficult intubation Mechanical ventilation Transport ventilator Ventilatory modes Non-invasive ventilation Setting up non-invasive ventilation Components of an anaesthetic machine Chest X-ray Dyspnoea Asthma Acute exacerbation of COPD Stridor Upper airway infections Community-acquired pneumonia Pleural effusion Pneumothorax Haemoptysis Drowning 6 Circulation management Methods for cardiovascular system monitoring Indications for cardiovascular support Shock Venous access Venipuncture techniques Intraosseous access Central venous access Saphenous vein cut-down Central venous pressure measurement Pulmonary artery catheter Arterial line Intravenous infusions Inotropic agents Blood transfusion Blood products Requesting blood for transfusion Giving blood Coagulation profile Sickle cell crisis Electrocardiography Normal lead ECG ST segment elevation Evaluation of cardiac arrhythmia Narrow complex tachycardia Broad complex tachycardia Atrial fibrillation Atrial flutter Anti-arrhythmic drugs Specific anti-arrhythmic agents Atrioventricular block Indications for pacing External pacing Temporary transvenous pacing Permanent pacemaker problems Acute coronary syndromes Cardiogenic shock Myocarditis Heart failure Aortic dissection Abdominal aortic aneurysm Pulmonary embolism Hypertensive emergencies Cardiac tamponade 7 Trauma Trauma resuscitation Primary survey Cervical spine control Secondary survey Useful details about injury circumstances Indications for tracheal intubation Potential causes of shock after trauma Head injury Spinal injury Spinal cord injury Penetrating neck injury Chest trauma Cardiac trauma Evaluation Evaluation of body surface area involvement Replacement formulae for fluid replacement after burns Burn depth assessment Referral to burns unit 9 Neurological resuscitation and management.
Checklist for acute alteration in mental state Coma Brainstem death and organ donation Convulsive status epilepticus Stroke Subarachnoid haemorrhage Meningitis Acute weakness GuillainBarre syndrome Myasthenia gravis Sedatives Analgesia 10 Renal, endocrine and metabolic management Oliguria Acute renal failure Renal support Water balance Sodium disorders Potassium disorders Hypercalcaemic crisis Hypoglycaemia Diabetic ketoacidosis Addisonian Crisis acute adrenocortical failure Hypothermia Frostbite Heat stroke Rhabdomyolysis 11 Toxicology.
Introduction to poisoning Specific antidotes Toxidromes toxicological syndromes Beta blocker Cocaine Digitalis Ecstasy Paracetamol Salicylate Tricyclic antidepressant Carbon monoxide 12 Gastrointestinal and gynaecological resuscitation Caustic burns of the oesophagus Upper gastrointestinal bleeding Acute liver failure Acute pancreatitis Early pregnancy complications Preface The resuscitation room is the hub of intense and focused activity within the emergency department.
In most departments, the demands on resuscitation room usage have been steadily increasing, especially linked with the increasing presentation of acutely unwell medical patients to the emergency department. A wide range of health care professionals contribute to care in this situation. Effective team working hence assumes great importance when working in this environment. The composition and working of teams is thus discussed early in the course of the text.
This book concentrates on important aspects of resuscitation room organization, and emphasizes clinical aspects of management that are of particular importance in this situation. Given the size of the book, it is inevitable that there are alternative views regarding management that may not have been considered or mentioned.
Furthermore, the frontiers of evidence-based medicine are rapidly advancing, leading to the potential non-inclusion of some very recent advances. The authors would welcome any suggestions and comments with regard to improving the content of future editions. They, however, sincerely hope that the large majority of users will find it to be a useful adjunct to their clinical practice. AB CH. Index A Aa gradient , ABCDE approach 6 abciximab abdominal aortic aneurysm abdominal trauma acidaemia acidosis , activated partial thromboplastin time acute chest syndrome acute coronary syndromes Addisonian crisis , adenosine , admission wards 18 adrenal crisis adrenaline epinephrine 73, anaphylaxis 90, 91 cardiac arrest 74 adrenocortical failure adrenocortical insufficiency adrenocorticotrophic hormone ACTH advance directives 24 advanced life support adults 69 paediatrics 71 agitation air leak airway adjuncts assessment and control 96 clearing Cormack and Lehane classification , Difficult Airway Society , elective evaluation , emergency management 96 foreign bodies immediate priority 6 inadequate air exchange B bacterial meningitis bag and mask ventilation , Bair Hugger basal requirements base excess basic life support adults 68 paediatrics 70 Bazetts formula Becks triad benzodiazepines poisoning , beta blockers, toxicity , bicarbonate HCO3 bilevel positive airway pressure BIPAP bladder injury D D-dimer defibrillation dehydration dextrans dextrose diabetic ketoacidosis diamorphine intranasal , diaphragm rupture diastolic heart failure , diazepam , Difficult Airway Society , digitalis digoxin , poisoning disability assessment 6 disseminated intravascular coagulation dobutamine documentation 8 do not attempt resuscitation 24 dopexamine double lumen tube Downs syndrome 36 drowning drug administration routes 74 dying dyspnoea , INDEX etomidate euvolaemic hypernatraemia euvolaemic hyponatraemia , Evans formula examination 6 exhaust fumes expiratory positive airway pressure EPAP exposure 6, 44 extradural haematoma , F face masks facet joints falciparum malaria Fastrach intubating LMA FAST scan femoral pulse femoral vein catheterization , fentanyl , , fever fibrin degradation products fibrinogen assay flail chest flecainide , flumazenil fluoride poisoning Foxs sign fresh frozen plasma , frostbite G gas delivery, colour codes gas exchange gastrointestinal bleeding gelatins gelofusine general wards 18 Glasgow Coma Scale 12, Glasgow meningococcal septicaemia prognostic score glucagon glucocorticoid deficiency glucose, oral glyceryl trinitrate infusion Grey Turners sign Guedel airway , , GuillainBarre syndrome , gum elastic bougie , , H haemaccel haematemesis haemodynamic support Haemophilus influenzae type b haemoptysis haemorrhage 6 class I IV hand hygiene 22 Hartmanns solution head injury burr hole categorization consciousness CT scan intracranial pressure , neurosurgical referral pupils tracheal intubation head tilt 36 heart failure , heart rate 12, heart transplantation, ECG heat stroke Heimlich manoeuvre heliox , helmet removal hepatitis B and C 20 hepatorenal syndrome high dependency 18 high flow masks house fire smoke human albumin hydroxyethyl starches hyperamylasaemia hyperbaric oxygen hypercalcaemic crisis hyperglycaemic non-ketotic coma hyperkalaemia 14, , hypernatraemia hypertensive emergencies , hypertonic hyponatraemia hypervolaemic hypernatraemia I ibuprofen ibutilide indomethacin induction programmes 23 infection control 22 influenza virus types A and B inotropic agents , inspiratory positive airway pressure IPAP insulins intensive care 18 inter-hospital transfer 16, 19, intermittent positive pressure ventilation , internal jugular vein catheterization , international normalized ratio INR inter-vertebral disc spaces intracranial pressure intraosseous access 74, , intravenous infusions intubation, see tracheal intubation ipratropium , iron poisoning isoprenaline isosorbide dinitrate infusion isotonic hyponatraemia L lactate 12 Laerdal bag laparotomy laryngeal foreign body laryngeal mask airway laryngoscopes , laryngotracheobronchitis lead poisoning left heart failure , left ventricular aneurysm Legionnaires disease lidocaine 75, , , , limb fractures liver failure Liverpool Care Pathway 32 local anaesthetics log roll lorazepam , lower motor neuron low flow masks lumbar puncture Lund and Browder chart , M Macklers triad maculo-papular rash Magills forceps magnesium sulphate 75, malaria Mallampati score , MARS BAR score mast cell tryptase 90 McCoys laryngoscope , mean arterial pressure mechanical ventilation N N-acetylcysteine NAC nalbuphine naloxone , naproxen narrow complex tachycardia , nasal cannulae , nasal catheter nasal prongs , nasopharyngeal airway National Poisons Information Service NCEPOD 48, neck penetrating injury stiffness necrotizing fasciitis needle cricothyroidotomy needle disposal 20 needle thoracentesis neonatal life support 72 neostigmine neurological status 6 neuromuscular junction neuromuscular relaxants nitrate infusion nitrous oxide non-invasive ventilation 7, asthma chest injury INDEX non-invasive ventilation Contd COPD 7, indications masks modes pulmonary oedema 7 selection guidelines setting up , when to use non-rebreathing masks , norepinephrine noradrenaline note keeping 8.
O oesophagealtracheal combitube oesophagus barogenic rupture bleeding varices caustic burns foreign body oliguria , ongoing care 10 opioids analgesia overdose , , organ donation organophosphate poisoning oropharyngeal airway , , orthodromic AV re-entrant tachycardia outreach 50 over-the-needle catheters oxygenhaemoglobin dissociation curve oxygen partial pressure , , oxygen saturation , oxygen therapy asthma COPD 7, , , delivery devices hyperbaric P pacing and pacemakers external indications permanent pacemaker problems temporary transvenous Plasmodium falciparum malaria platelet concentrates , platelet count , pleural effusion Pneumocystis carinii pneumonia pneumonia pneumothorax , , poisoning 11 positive end-expiratory pressure PEEP , posterior cord syndrome postural hypotension , potassium disorders Powers ratio pre-cordial thump 64 pregnancy cardiac arrest 88 complications pressure control ventilation pressure support ventilation PSV , prilocaine primary brain injury Prinzmetals angina priorities 4, 67 procainamide Procurator Fiscal 33 propofol , protective lung ventilation prothrombin time pseudo-hyperkalaemia 14 pulmonary arterial pressure pulmonary artery catheter pulmonary contusion pulmonary embolism , , pulmonary laceration pulmonary oedema 7, pulse pulse oximetry pulsus paradoxus pupils coma head injury purpuric rash pyridostigmine T tachyarrhythmia tachycardia 80, , , targeted treatment 10 team approach temperature control 14 tenecteplase tension pneumothorax terbutaline thallium poisoning thiopentone thoracotomy , three-column theory thrombin time thrombolysis , TIMI risk score tissue oxygenation tissue perfusion TOXBASE toxicological syndromes toxicology 11 toxic shock syndrome toxidromes tracheal intubation 96, , , aids , anticipated difficult , blind burns BURP , cant intubate, cant ventilate , chest X-ray confirmation of tube placement INDEX tracheal intubation Contd correct tube length Difficult Airway Society guidelines , dislodgement drug administration 74, 76 endotracheal tubes , , , , failed , fibreoptic gas induction of anaesthesia , gum elastic bougie , , head injury hypotension hypoxia illuminated stylet indications in trauma light wand McCoys laryngoscope , oesophagealtracheal combitube retrograde securing tube stiff lungs surgical tracheostomy tracheal tube introducer or stylet , uneventful, management after tracheal suction tracheostomy , , tramadol transfer 16, 19, translocational hyponatraemia transport documentation 28 key checks U universal precautions 20 unstable acute coronary syndrome unstable angina, TIMI risk score upper airway infection upper gastrointestinal bleeding upper motor neuron urethral injury urinary bladder urine output 12, W Wackenheims clivus baseline Wallaces Rule of Nines warfarin overdose warming methods water balance water requirement weakness Wells score Wenckebach phenomenon WolffParkinsonWhite syndrome , work of breathing Read Free For 30 Days.
Flag for inappropriate content. Original Title: Related titles. Carousel Previous Carousel Next. Thus, the 6-month survival rate was 5. The period of the day during which CA occurred was not associated with any of the following variables: age, gender, sedation condition, GCS score, defibrillation, intubation, CA time, time between procedures, the duration of CA, the return of spontaneous circulation, the use of medications and progression to death at the ward.
Moreover the cause of CA, the initial rhythm of CA, the return of spontaneous circulation, CA recurrence and progression to death at the ward also did not correlate with any of the aforementioned variables, except for the return of spontaneous circulation and duration of CPR.
The duration of CPR was The setting of CA may affect patient survival because CPR should start earlier and patients are expected to show a return of spontaneous circulation if CA occurs in a hospital setting. Studies have reported better results for in-hospital CA in ICUs than for ward outcomes because the patient is being monitored, the events are promptly witnessed, and advanced life support is immediately available. Although immediate survival was This finding may be due to the severity of disease among these patients and the initial asystole rhythm and pulseless electrical activity, a predictor of lower survival.
Some characteristics of the patients in this study were similar to those reported in the literature. Nevertheless, the mean age of the cohort in this study was similar to that of previous Brazilian studies and lower than that of the remaining studies, which included patients from different hospital settings. The time of day when CA occurs is a key factor. The initial rhythm at CA guides its management and affects patient survival.
The populations in other studies derived from various in-hospital settings, including emergency rooms and wards in addition to coronary units and ICUs, and the monitoring of patients with CA may be delayed outside intensive care settings.
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In addition to high-quality chest compressions, some pharmaceutical drugs, including epinephrine and amiodarone, are indicated for cases of non-shockable rhythm and refractory ventricular arrhythmia, respectively. Early defibrillation is a key factor for the survival of patients with CA due to ventricular fibrillation or pulseless ventricular tachycardia.
Despite the intensive care setting of the present study, defibrillation was delayed. The remaining Utstein-style time periods were not assessed for all patients, and this lack of data may also be observed in other published studies. In turn, the duration of CPR, a datum assessed in the entire population, was similar to the duration reported in other studies. A significant inverse association was detected between the duration of CPR and the return of spontaneous circulation. In a multicenter study of 64, patients, the duration of CPR also showed this association as well as an association with increased survival when compared with patients who underwent shorter median of 16 minutes and longer 25 minutes CPR.
Gender reportedly affects CA, and survival rates are higher in men than in women according to a multivariate analysis. Moreover, a recent study of 14, patients However, this study included patients with out-of-hospital CA. Furthermore, recording all data recommended by the Utstein style is difficult because CPR requires focus and agility from the healthcare professionals involved in the maneuvers and that they are trained in recording such data. Accurately and completely filling out the record also implies that 1 fewer professional is available for CPR maneuvers.
However, this standardized and comprehensive method contributes to the implementation of guidelines that improve the quality of care 10 and consequently impact patient survival. To correctly fill out reports and subsequently analyze adherence to CPR guidelines, real-time documentation by an attending professional using a tablet may improve data quality and accuracy without compromising team performance. This method was not applied in the settings in which the present study was conducted.
Therefore, only some Utstein-style variables were recorded in the medical charts, resulting in a non-standard report. The adoption of this method, combined with training the entire team, would enable implementing a high-quality care approach for CA and reach the time goals. The comparison between this group of study patients and a similar group after adopting the Utstein style will enable the assessment of care and ensure quality of care. The present study has limitations, including the failure to complete the resuscitation report and the population size.
Moreover, the study was conducted at a single center and in a public tertiary hospital and consequently fails to express differences that may exist between hospitals and regions.
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A Resuscitation Room Guide
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