Drowning
Mike Tipton, Adam Wooler in The Science of Beach Lifeguarding, 2018
Basic and advanced life support enables victims to achieve the best outcome possible. After successful CPR, it is crucial to stratify neurological severity; this will allow comparison of different therapeutic approaches. Various prognostic scoring systems have been developed to predict which patients will do well with standard therapy and which are likely to have a significant cerebral anoxic encephalopathy and will require aggressive measures to protect the brain. One of the most powerful scoring systems is the evaluation of the consciousness level related to the Glasgow coma scale at the period immediately after resuscitation (first hour) (Conn & Modell Neurological Classification) [78]. Data suggest that patients who remain profoundly comatose (i.e. decorticate, decerebrate or flaccid) 2–6 hours after the drowning incident are brain-dead or have moderate to severe neurological impairment. Patients who are improving but remain unresponsive have a 50% likelihood of a good outcome. Most patients who are definitely improving and are alert or are stuporous or obtunded but respond to stimuli 2–6 hours after the incident have normal or nearnormal neurological outcomes.
Anaesthesia and resuscitation
Jan de Boer, Marcel Dubouloz in Handbook of Disaster Medicine, 2020
Two levels of resuscitation are distinguished. Basic Life Support (BLS) and Advanced Life Support (ALS). BLS is given by lay people following an internationally accepted and uniform protocol. First, a diagnosis of unconsciousness, respiratory failure and circulatory failure is made. When these vital functions are absent, an ambulance is called. Realisation of free airway and, if necessary, artificial respiration is started immediately after, as are external thoracic compressions. Using this cardiopulmonary resuscitation technique, a minimal circulation and marginal oxygen supply to tissue can be realised. BLS has to be continued without interruption and has to be taken over within 15 min by the aid workers who are capable of giving ALS. When ALS is not started within this period, the chance of survival in case of ventricular fibrillation decreases dramatically. ALS is given by trained nurses or doctors, and can consist of defibrillation, administration of oxygen, intubation and administration of drugs to stabilise or improve the cardiovascular condition. BLS is continued during ALS. ALS usually involves at least 2, but more often 3 or 4 aid workers. If after 40 min of ALS, spontaneous circulation is not restored, further attempts are usually fruitless.
Pregnancy and Childbirth
Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson in Health Care Needs Assessment, 2018
In common with other specialities where emergency situations are encountered, the need for special training in obstetrics has been highlighted. The importance of ‘fire drills’, simulating real emergencies, to deal with rare but life-threatening obstetric emergencies has been stressed by the RCOG, RCM, CESDI and CEMD. The successful implementation of such training programmes should reduce perinatal and maternal mortality and morbidity and also reduce litigation to the NHS (Grade III). The Advanced Life Support in Obstetrics (ALSO) course is one such training programme for doctors and midwives. However, staff must also be recognised as having a role to play in reducing morbidity associated with obstetric emergency. With more obstetric care being provided in the community, GPs and paramedics also need to be trained in the basics of obstetric emergency care.104 There have, however, been no trials to support this (Grade III). In the past, obstetric and neonatal flying squads were considered useful but they are not now recommended.
ALS and BLS, an Historical Perspective: Time for a New Paradigm!
Published in Prehospital Emergency Care, 2022
Kristi L. Koenig, David C. Cone
While “advanced” life support generally denotes the performance of more “invasive” procedures, such as the establishment of advanced airways or intravenous lines, from a patient-centered, outcomes-based viewpoint, there are relatively few out-of-hospital interventions that are critical and time-sensitive. Treatments that can be immediately life, limb, or brain saving include:DefibrillationEpinephrine for anaphylaxisNaloxone for reversal of opioid overdoseDirect pressure/tourniquet for external hemorrhage controlAirway obstruction reversalGlucose for hypoglycemiaOxygen for hypoxemia
Advanced Life Support for Out-of-Hospital Chest Pain: The OPALS Study†
Published in Prehospital Emergency Care, 2022
Ian G. Stiell, Justin Maloney, Jon Dreyer, Doug Munkley, Daniel W. Spaite, Marion B. Lyver, Julie E. Sinclair, George A. Wells
Prephospital advanced life support is routinely provided by paramedics to treat patients with chest pain in the United States and in some regions of Canada. Advanced life support includes the ability to provide advanced airway management and intravenous drug therapy. Basic life support includes oxygen administration, electrocardiogram monitoring and the ability to defibrillate and in some cases sublingual nitroglycerin (NTG) and acetylsalicylic acid (ASA). The effectiveness of advanced life support interventions for patients with chest pain has not been clearly demonstrated in the literature. Studies have revealed that paramedics are capable of effectively treating chest pain with the administration of nitroglycerin, ASA, intravenous medications, cardiac monitoring, and more recently 12 lead electrocardiogram performance and interpretation (5–10). Nevertheless, no high-quality controlled trials have revealed that prehospital advanced life support interventions affect important outcomes such as mortality.11
Analysis of Prehospital Scene Times and Interventions on Mortality Outcomes in a National Cohort of Penetrating and Blunt Trauma Patients
Published in Prehospital Emergency Care, 2018
Octavia S. Ruelas, Craig F. Tschautscher, Christine M. Lohse, Matthew D. Sztajnkrycer
The performance of any procedure is associated with a time cost, and as such should offer a clear benefit in patient care. In the Ontario Prehospital Life Support Major Trauma Study, the addition of advanced life support procedures did not improve patient outcomes, and worsened outcomes in the sickest patients (8). In the current study, intravenous access was obtained in 19.8% of penetrating and 14.7% of blunt trauma patients. An increasing body of literature has noted adverse effects of crystalloid volume resuscitation in trauma patients, emphasizing hypotensive resuscitation and early administration of blood products in critically ill patients (23–26). Spinal immobilization was performed in 5.1% of penetrating trauma patients and 5.7% of severely injured penetrating trauma patients. Studies suggest that spinal immobilization for penetrating trauma in the absence of neurological deficits is not indicated, and may be harmful (27, 28). Based upon the results of the current study, prehospital procedures should be performed after careful risk-benefit consideration, and optimally in a manner that does not delay transport to definitive care.
Related Knowledge Centers
- Basic Life Support
- Cardioversion
- Defibrillation
- Rapid Sequence Induction
- Tracheal Intubation
- Transcutaneous Pacing
- Ultrasound
- Electrocardiography
- Cardiac Conduction System
- Intravenous Therapy