Issues around resuscitation
Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley in Symptom Relief in Palliative Care, 2018
In Canada the Canadian Medical Association and the Canadian Medical Protective Association have given advice on resuscitation decisions. Several papers have commented on the application of resuscitation guidelines in clinical practice. The comfort and treatment measures are instituted after assessment, consultation with patient and family, and on the basis of clinical need. The cardiopulmonary resuscitation (CPR) treatment measures will be instituted by local staff, but would precipitate calling emergency services and admission to an acute hospital. At best, 60% of all resuscitations are successful, and up to half of the patients become well enough to return home, but the discharge rate is lower in other series, and reduces to 1% in non-witnessed arrests. If the clinical team is 'as certain as it can be' that resuscitation would fail, CPR treatment should then not be offered as a realistic option when discussed with the patient and/or health care proxy/proxy decision maker/family.
Resuscitation
Karim Ratib, Gurbir Bhatia, Neal Uren, James Nolan in Emergency Cardiology, 2010
The major role of cardiopulmonary resuscitation is to provide some blood flow to both the myocardium and central nervous system to allow for successful defibrillation and resuscitation, and to preserve long-term organ function. The ABC of resuscitation begins with basic life support and the establishment of an adequate airway (A), breathing (B) and circulation (C). Pacing can often be life saving, especially in situations where bradycardia preceded the cardiac arrest or where bradycardia is associated with haemodynamic intolerance following successful resuscitation. The resuscitation trolley should always be present and venous access available. Temporary venous pacemakers should be checked at least once daily for pacing threshold, evidence of infections around venous access sites, integrity of connections, and battery status of the external generator. Transcutaneous pacing can be easily applied, requires minimum training and avoids the risks of central venous cannulation.
Discussing the Prospects of Cardiopulmonary Resuscitation
Robert Wheeler in Clinical Law for Clinical Practice, 2020
On 5 February 2011, Mrs Tracey was diagnosed with lung cancer with an estimated life expectancy of 9 months. On 19 February, she sustained a serious cervical fracture after a major road accident. She was admitted to the hospital and transferred to the Neuro-Critical Care Unit under the care of a consultant neurosurgeon. The intensivist and oncologist decided that Mrs Tracey should be taken off the ventilator. On 27 February, a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notice was completed. The court therefore found that the Trust had violated Mrs Tracey's right to respect for her private life in failing to involve her in the process which led to the DNACPR notice. The Resuscitation Council made the further point that in recent years there has been a reduction of inappropriate and unsuccessful attempts at CPR and that a judgement requiring consultation with a patient save in exceptional circumstances would be likely to reverse that process.
Hemodynamic recovery after hypovolemic shock with lactated Ringer's and keratin resuscitation fluid (KRF), a novel colloid
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2013
Fiesky A. Nunez, Michael F. Callahan, Simon Trach, Luke R. Burnett, Victor Kislukhin, Thomas L. Smith, Mark Van Dyke
Death after severe hemorrhage remains an important cause of mortality in people under 50 years of age. Keratin resuscitation fluid (KRF) is a novel resuscitation solution made from keratin protein that may restore cardiovascular stability. This postulate was tested in rats that were exsanguinated to 40% of their blood volume. Test groups received either low or high volume resuscitation with either KRF or lactated Ringer's solution. KRF low volume was more effective than LR in recovering cardiac function, blood pressure and blood chemistry. Furthermore, in contrast to LR-treated rats, KRF-treated rats exhibited vital signs that resembled normal controls at 1-week.
A multi-parameter system for use in neonatal resuscitation research and training
Published in Journal of Medical Engineering & Technology, 2013
Charlotte R. Platten, Fiona E. Wood, Iain R. Chambers
Training staff in the resuscitation of neonates is an essential skill; resuscitation efficacy is difficult to quantify but critical to infant survival. Objective assessments of the efficacy of training methods, resuscitation techniques and devices have used concurrent measurements of air flow and air pressure in commercially available manikins. This system also simultaneously measures the force transmitted through the manikin head during simulated resuscitation, as applying excessive force may be deleterious to newborn infants. The overall accuracy of the force plate over the range 0–5 kg was 0.5%; the output was linear; the frequency response sufficiently high and there was no evidence of hysteresis. This system enables comparison of staff groups, resuscitation techniques and devices in an accurate and reproducible manner. Its use could improve training by offering a means of objective performance feedback through a range of parameters. Evaluation of clinical practice may also result in direct patient benefit.
Social workers’ experiences as the family support person during cardiopulmonary resuscitation attempts
Published in Social Work in Health Care, 2017
Janice Firn, Keli DeVries, Dawnielle Morano, Toni Spano-English
During inhospital cardiopulmonary resuscitation attempts, a designated family support person (FSP) may provide guidance and support to family members. Research on nurses and chaplains in this role has been published. Social workers also regularly fulfill this service, however, little is known about how they perceive and enact this role. To explore their experiences, qualitative interviews (n = 10) were conducted with FSP social workers. Critical realist thematic analysis identified five themes: walking in cold, promoting family presence, responding to the whole spectrum of grief, going beyond the family support role, and repercussions of bearing witness. Social workers perform a variety of tasks to promote family presence during resuscitation attempts and provide psychosocial support over the continuum of care. The FSP role impacts social workers emotionally and professionally. Implications for hospital policy, staffing, and clinical practice are discussed.
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