Epidemiology

VF is the commonest initial rhythm leading to cardiac arrest, particularly in patients with coronary heart disease. VF may be Pulseless ventricular tachycardia is treated in the same way as VF preceded by ventricular tachycardia and is seen in up to 80-90 of those patients dying suddenly outside hospital in whom the cardiac rhythm can be monitored without delay. It is particularly common in the early stages of myocardial infarction. It is therefore important that those general practitioners and...

Tracheal intubation

Risks Tracheal Intubation

This technique entails flexing the patient's neck and extending the head at the atlanto-occipital junction. A laryngoscope is used to expose the epiglottis by lifting the jaw and base of the tongue forward, and the larynx is seen. A curved tube is inserted into the trachea through the vocal cords. Inflation of the tracheal cuff isolates the airway and enables ventilation to be performed safely. The potential risks of the technique include stimulating laryngospasm and vomiting in a semiconscious...

Management of asystole and PEA

Guidelines for the treatment of cardiopulmonary arrest caused by asystole or PEA are contained in the universal advanced life support algorithm. Treatment for all cases of cardiac arrest is determined by the presence or absence of a rhythm likely to respond to a countershock. In the absence of a shockable rhythm non-VF VT is diagnosed. This category includes all patients with asystole or PEA. Both are treated in the same way, by following the right-hand side of the algorithm. When using a...

Conclusion

A commitment to treat cardiac arrest is a commitment to critical care after resuscitation. The patient who survives should generally be managed in an intensive care unit and is likely to need at least a short period of mechanical ventilation. If the conscious level does not return rapidly to normal, induced hypothermia should be considered. Predicting longer term neurological outcome in the immediate post-arrest period is fraught with difficulties. The initial clinical signs are not reliable...

Myasthenia gravis

Acid gastric fluid may cause severe chemical pneumonitis. Failure to maintain a clear airway during spontaneous ventilation may encourage regurgitation. This is because negative intrathoracic pressure developed during obstructed inspiration may encourage aspiration of gastric contents across a weak mucosal flap valve between the stomach and oesophagus. Recent food or fluid ingestion, intestinal obstruction, recent trauma especially spinal cord injury or in...

Defibrillation and drugs

Pregnant Defib

Defibrillation and drug administration is in accordance with advanced life support recommendations. On a practical note, Alternative method for lateral position Alternative method for lateral position it is difficult to apply an apical defibrillator paddle with the patient inclined laterally, and great care must be taken to ensure that the dependant breast does not come into contact with the hand holding the paddle. This problem is avoided if adhesive electrodes are used. Increasingly,...

Complete the following checklist

Ensure that the ET tube is correctly placed in the trachea, using direct laryngoscopy or end-tidal CO2 monitoring Ensure that the patient is being adequately ventilated with 100 oxygen. Listen with a stethoscope and confirm adequate and equal air entry. If pneumothorax is suspected insert a chest drain Measure arterial pH and gases, repeating frequently Measure urea, creatinine and electrolytes, including calcium and magnesium Insert a urinary catheter and measure the urinary output Insert a...

Regular narrow complex tachycardia

Vagotonic manoeuvres, such as the Valsava manoeuvre or carotid sinus massage, should always be considered as first line treatment. Caution is required, however, as profound vagal tone may cause a sudden bradycardia and trigger ventricular fibrillation, particularly in the presence of acute ischaemia or digitalis toxicity. Carotid sinus massage may result in rupture of an atheromatous plaque and the possibility of a stroke. The drug of choice for the initial treatment of regular supraventricular...

Acute MI

Temporary Pacing Wire Xray Placement

Pacing may generate QRS complexes with an effective cardiac output, particularly when myocardial contractility is not critically compromised. Conventional cardiopulmonary resuscitation CPR should be substituted immediately if QRS complexes with a discernible output are not being achieved. Many defibrillators incorporate external pacing units and use the same electrode pads for ECG monitoring and defibrillation. Alternatively, pacing may be the sole function of a dedicated external pacing unit....

Classification of hypovolaemic shock and changes in physiological variables

Class I Class II Class III Class IV Class I Class II Class III Class IV Class III is blood loss of 30-40 1500-2000ml , which is associated with a thready tachycardic pulse, systolic hypotension, pallor, and delayed capillary refill Class IV blood loss is in excess of 45 more than 2000 ml and is associated with barely detectable pulses, extreme hypotension, and a reduced level of consciousness Some texts claim that the radial, femoral, and carotid pulses disappear sequentially as blood pressure...