Chest compression only CPR

Chest compression only CPR should replace the current guidelines on CPR.

Reasons supporting the statement:

Physiological:

a) In cardiac arrest heart dilates acutely. Decompression of the heart occurs with good

compressions

b) Ventilation can lead to decreased venous return

c) Passive ventilation still occurs with compression only CPR

d) Gasping can provide adequate ventilation and in presence of a partial airway

obstruction may lead to increased venous return

Logistic reasons:

a) Reluctance to perform mouth to mouth by rescuers therefore some people do not

attempt CPR.

b) Interruption to compressions therefore limiting their effectiveness

c) Easier to teach compression only CPR.

d) Out of hospital arrests it will minimise time to hospital.

e) Useful particularly in the setting of a single rescuer

Studies:

Mostly observational or animal. Some RCT No difference in outcome using compression only versus standard CPRs in most studies Evidence of value of good compressions

Against:

Most studies are observational.

Reported survival is no better with compression only therefore why change.

Data for most studies are prior to the change in recommendation to 30:2 RATIO

Ventilation is important for many arrests EG drowning/children/in hospital arrests

ARC not recommend as standard practice

Present position:

Not standard currently. Wait further studies. It can be used if rescuer is reluctant to use mouth to mouth

Comments

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...

Falling from Height...The Prognostic factors

Falls from Height is Knwon to cause major morbidities and mortalities. There are several prognostic factors for survival that have been identified: Height Age Type of surface Body part that touches the ground first Two other factors are important, but do not have a significant effect on mortality: Circumstances of the fall (suicide, accident, escape) Initial impact with an object before impacting the ground Height . Overall, about half of victims die at the scene, and a total of 70% die before they reach the hospital . The median height leading to death is about 49 feet, or about 4 to 5 storeys. 100% of victims die after falling 85 feet, or about 8 storeys. Age . Mortality increases with age due to pre-existing medical conditions and decreased physiologic reserve. Type of surface . The type of surface struck (i.e. grass, water, construction debris) can also have an effect on secondary injuries and survival. Mortality after striking a hard surface is nearly doubl...

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...

sedationstation

Search This Blog