Complications of Percutaneous Lithotripsy
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
Incremental injections of 5 to 7 cc of air into the renal collecting system via a ureteral catheter can help delineate the posterior calyces for precise nephrostomy access. Although the normal collecting system has a capacity of approximately 10 cc, air embolism secondary to positive pressure air pyelograms have been reported both before and after initial attempts at calyceal access (57,58). Signs suggesting air embolism include oxygen desaturation, decreased end-tidal carbon dioxide, hypotension, and bradycardia. When air embolism is suspected the procedure should be halted and any routes for further air entry should be sealed. The patient should be placed supine in trendelenburg position and if possible with the right side up. Cardiopulmonary resuscitation should be initiated. A right internal jugular central line may confirm diagnosis with aspiration of foamy blood and be used to evacuate air from the right atrium.
The intrauterine device (IUD)
Suzanne Everett in Handbook of Contraception and Sexual Health, 2020
Vasovagal and anaphylaxis attacks are usually rare; however, it is important to have emergency equipment and clear guidelines available for such events. Your client may feel sweaty and complain of feeling faint or sick. She may look pale and her pulse may be slower. If the IUD insertion procedure is still in progress, then it should be stopped and the woman should be laid in supine position with her head lowered and feet raised. If bradycardia persists then slow intravenous atropine 0.5 to 0.6 mg/ml may be required by a suitably trained professional. If the woman has difficulty breathing and there is loss of consciousness and absence of a carotid pulse, her airway should be maintained by using pocket mask and emergency services phoned and help summoned. She should be laid in the left lateral position, and if there is no central pulse then 0.5 mg adrenaline 0.5 ml of 1/1000 ml may be given by deep intramuscular injection. If there is no improvement this may be repeated at 5-minute intervals (Joint Formulary Committee, 2019). If required cardiopulmonary resuscitation should be commenced. The woman should never be left unattended at any time (FSRH, 2016b).
Getting the Best Out of People
Bill Runciman, Alan Merry, Merrilyn Walton in Safety and Ethics in Healthcare, 2007
If a patient’s trachea cannot easily be intubated, ventilation must be maintained using a self-inflating bag and a mask. This may also require considerable skill and close co-ordination, potentially with one person having to hold the mask with both hands to maintain a patent airway, and another person having to squeeze the bag.30 It is not adequate for staff who may have to perform these tasks to be expected to pick up the required skills on the job. Formal training in the basic skills of resuscitation has become relatively common, and certification of staff in cardiopulmonary resuscitation (CPR) is a requirement in many institutions. However, the real need is for the staff who will have to work together as a team to train together in similarly constructed teams. For example, a resuscitation team may include nurses, technicians and doctors from more than one specialty. Simulation provides a way of practising the team interactions inherent in this work (see pages 242–243).
How long should we run the code? Survival analysis based on location and duration of cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Ahmad Raza, Ahmad Arslan, Zain Ali, Rajeshkumar Patel
The field of resuscitation has been evolving for more than two centuries [1]. Cardiopulmonary resuscitation (CPR) is an emergency lifesaving procedure performed when the heart stops beating; immediate CPR can double or triple the chances of survival after cardiac arrest. CPR is a high acuity event, and its adequate performance requires a multidisciplinary approach involving leadership skills and effective communication [2]. Although health care professionals follow the preset Advanced Cardiac Life Support (ACLS) algorithms while doing CPR on hospitalized patients, determining when to stop resuscitation efforts in cardiac arrest patients is difficult. Unfortunately, very little data exist to guide decision-making in this regard. Because of the nature of resuscitation research, few randomized controlled trials have been completed in humans [3,4].
Acquired methemoglobinemia in children presenting to Italian pediatric emergency departments: a multicenter report
Published in Clinical Toxicology, 2022
Umberto Raucci, Michela Stanco, Marco Roversi, Eduardo Ponticiello, Mara Pisani, Margherita Rosa, Raffaele Falsaperla, Piero Pavone, Claudia Bondone, Irene Raffaldi, Lucia Calistri, Stefano Masi, Antonino Reale, Alberto Villani, Marco Marano
As cited above, 76% was the highest methemoglobin value recorded in our sample. This belonged to a 6-month-old infant transferred from another hospital to the pediatric ICU of the Bambino Gesù Children's Hospital with a diagnosis of septic shock. On arrival the patient had a Glasgow Coma Scale of 8, was hemodynamically unstable and required mechanical ventilation. After administration of crystalloids and inotropic support, hemodynamic conditions progressively worsened to an asystolic cardiac arrest. Cardiopulmonary resuscitation was successfully performed. After collection, the blood presented the characteristic dark brown discoloration that suggested the diagnosis of MetHb, as confirmed by the blood gas analysis performed on the same blood sample. The laboratory workup showed 35.0 * 103 leukocytes per μl and negative indices of inflammation. The chest X-ray was also negative. Intravenous methylene blue therapy was then administered slowly at a dose of 1 mg/kg and repeated after 1 h, allowing reduction of methemoglobin from 76% to a value of less than 1%.
Usefulness of thrombolysis in cardiac arrest secondary to suspected or confirmed pulmonary embolism
Published in Baylor University Medical Center Proceedings, 2021
Vivek Kataria, Kelsey Kohman, Ronald Jensen, Adan Mora
Lastly, chest compression duration post–thrombolytic administration should be considered prior to terminating efforts. In 2002, Abu-Laban and colleagues randomized 233 patients to receive alteplase 100 mg or placebo.4 Standard resuscitation was continued for at least 15 minutes following the intervention. Only 1 patient who received alteplase survived. In 2015, Nobre and colleagues reported the results of prolonged chest compressions (>30 minutes) in six patients after tenecteplase administration.10 Four patients survived to hospital discharge. Lastly, the European Society of Cardiology guidelines recommend continuing for at least 60 to 90 minutes before terminating resuscitation.2 In our sample, chest compressions were continued for a median of 13 and 16.5 minutes in patients with and without ROSC, respectively. Based on current evidence, continuation of cardiopulmonary resuscitation for at least 15 minutes and up to 90 minutes may be considered.
Related Knowledge Centers
- Agonal Respiration
- Cardiac Arrest
- Necrosis
- Heart
- Brain
- Artificial Ventilation
- Indication
- Mouth-to-Mouth Resuscitation
- Mechanical Ventilation
- Brain Damage