China
Africa
Explore chapters and articles related to this topic
Assessing and responding to sudden deterioration in the adult
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
The cessation of breathing and heartbeat in a person is a natural process of dying (Resuscitation Council 2021b). For a person who experiences sudden cardiac or respiratory arrest, cardiopulmonary resuscitation (CPR) can be effective in improving the chances of recovery for the person who is deteriorating. In some situations, however, due to gradual deterioration, CPR cannot be effective and may be detrimental to the individual’s wishes or failing health condition. People who, due to their condition, will not benefit from resuscitation attempts may have a ‘Do not attempt resuscitation’ (DNAR) request signed. The British Medical Association, Resuscitation Council and Royal College of Nursing offer practitioner guidelines relating to how these decisions are made and by whom. Decision frameworks and consideration of healthcare team views should be used to assist in planning the best outcome. These decisions, however, are complex and require a great deal of knowledge and skills to ensure the optimum outcome for the person is achieved. Senior clinicians should be involved in these processes and assist and guide junior healthcare practitioners to develop their own decision-making skills. The individual’s best interests should be paramount in any decision-making process regarding CPR and DNAR.
Palliative care
Published in Henry J. Woodford, Essential Geriatrics, 2022
In the event of a cardiac arrest (a sudden and potentially reversible event in someone who was otherwise in reasonable health), cardiopulmonary resuscitation (CPR) can be life-saving. Although CPR doesn't address the reason for the cardiac arrest, it can provide time to address acute reversible causes, such as thrombolysis, rewarming or percutaneous coronary intervention. However, CPR has no benefit when the heart stops beating as the final step of a multi-organ failure process (i.e. normal dying) because it can only restore somebody's physiological status to the point just prior to the heartbeat stopping. In such situations, it is more likely to cause harm than provide any benefit. CPR may simply medicalise, and possibly extend, the dying process. In recognition of this, ‘do not attempt CPR' (DNACPR) decisions are often appropriate for people who are approaching the end of life. They should be considered in three situations:19When a person with mental capacity refuses CPR or a person without capacity has recorded not wanting CPR in advanceWhen CPR is judged very unlikely to be effective because the person is dying from an irreversible conditionWhen the potential burdens of CPR outweigh the potential benefits
Paper 1
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
How long should the rescuer take in looking, listening and feeling for breaths in a victim, before assuming that he/she is not breathing and commencing cardiopulmonary resuscitation? 5 seconds10 seconds15 seconds20 seconds25 seconds
Effect of Wearing N95 Mask on the Quality of Chest Compressions in Prehospital Emergency Personnel: A Cross-over Study
Published in Prehospital Emergency Care, 2023
Liang Chen, Yang Shen, Shuangmei Liu, Yanyan Cao, Zhe Zhu
Out-of-hospital cardiac arrest is a leading cause of global mortality (1). Cardiopulmonary resuscitation (CPR) is an important emergency technique for saving patients from cardiac arrest and is something that prehospital emergency personnel must be proficient in. CPR training is generally based on simulated scenarios, using simulators for practice. Because novel coronaviruses such as COVID-19 can be transmitted via respiratory droplets and aerosols, and because of the general susceptibility of the population, the latest American Heart Association (AHA) guidelines require rescuers to wear personal protective equipment (PPE) when performing CPR (2). Because of the high-risk scenario of respiratory exposure in prehospital emergencies, rescuers need to wear N95 masks. N95 masks may lead to discomfort for medical personnel due to better airtightness, resulting in increased breathing resistance and greater physical exertion for users during strenuous exercise (3–5). Early, high-quality chest compressions are critical to the implementation of CPR and are essential for circulatory recovery and survival after cardiac arrest (6). Previous studies have shown that the quality of chest compressions of medical staff using PPE is significantly decreased (7). This trial was planned to determine whether wearing N95 masks influenced the performance of chest compressions by prehospital emergency personnel and the rescuer's condition when compared to surgical masks.
Extracorporeal membrane oxygenation for large pulmonary emboli
Published in Baylor University Medical Center Proceedings, 2023
Timothy J. George, Jenelle Sheasby, Rahul Sawhney, J. Michael DiMaio, Aasim Afzal, Dennis Gable, Sameh Sayfo
Acute pulmonary embolism (PE) is a common and growing problem.1 Large submassive and massive PE large enough to cause significant obstruction of the pulmonary arteries can cause hypoxia, hypercapnia, right ventricular failure, and hemodynamic instability.1,2 In some cases, patients will suffer cardiovascular collapse requiring cardiopulmonary resuscitation (CPR). In patients requiring CPR, in-hospital mortality is high, ranging from 25% to 80%.2–5 Although the first line of therapy consists of anticoagulation, treatment options include systemic thrombolysis, directed thrombolysis, percutaneous thrombectomy, and open surgical embolectomy. These therapies have been employed with varying degrees of success in different clinical situations.
Prehospital Cardiac Arrest Airway Management: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Jestin N. Carlson, M. Riccardo Colella, Mohamud R. Daya, Valerie J. De Maio, Philip Nawrocki, Dhimitri A. Nikolla, Nichole Bosson
Airway management is a critical component of cardiac arrest resuscitation; however, it has the potential to interfere with other interventions that are essential for good outcomes (18–21). Regardless of the airway management strategy selected, EMS clinicians should focus on prioritizing interventions that are shown to improve patient outcomes during cardiac arrest resuscitation including high-quality chest compressions (optimizing rate and depth, recoil, chest compression fraction), rapid defibrillation for shockable rhythms, and addressing reversible causes of the arrest. High-quality cardiopulmonary resuscitation (CPR) can be maintained during airway management by considering the timing of airway interventions, avoiding pauses in chest compressions for advanced airway placement, and minimizing harms of ventilation after advanced airway insertion.