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Cardiac Arrest: Difference between revisions
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''Sébastien Krul, MD, Jonas de Jong, MD'' | ''Sébastien Krul, MD, Jonas de Jong, MD'' | ||
=Introduction= | =Introduction= | ||
Survival of cardiac arrest continues to be very poor. In-hospital cardiac arrest has a survival to hospital discharge of 17,6% all rhythms<cite>Meaney</cite>. Out-of-hospital cardiac arrest has a worse survival with 10,7% survival to hospital discharge for all rhythms.<cite>Atwood</cite> Survival is dependent on the characteristics of the cardiac arrest (rhythm), on the patient’s medical history, and the time between the cardiac arrest en start of resuscitation.<cite>Waalewijn, Holmberg1, Holmberg2</cite> The introduction of the automated external defibrillator (AED) has dramatically increased survival of out-of-hospital cardiac arrest victims.<cite>ESC, Nolan1</cite> In this chapter we give an overview of basic life support (BLS) and advanced life support (ALS) based on the recommendation of the European Resuscitation Council Guidelines for Resuscitation 2010. | Survival of cardiac arrest continues to be very poor. In-hospital cardiac arrest has a survival to hospital discharge of 17,6% all rhythms<cite>Meaney</cite>. Out-of-hospital cardiac arrest has a worse survival with 10,7% survival to hospital discharge for all rhythms.<cite>Atwood</cite> Survival is dependent on the characteristics of the cardiac arrest (rhythm), on the patient’s medical history, and the time between the cardiac arrest en start of resuscitation.<cite>Waalewijn, Holmberg1, Holmberg2</cite> The introduction of the automated external defibrillator (AED) has dramatically increased survival of out-of-hospital cardiac arrest victims.<cite>ESC, Nolan1</cite> In this chapter we give an overview of basic life support (BLS) and advanced life support (ALS) based on the recommendation of the European Resuscitation Council Guidelines for Resuscitation 2010. | ||
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====Foreign body airway obstruction==== | ====Foreign body airway obstruction==== | ||
An obstruction of the airway is uncommon, but reversible and adequate recognition can prevent cardiac arrest.<cite>Fingerhut</cite> Airway obstruction is usually related | An obstruction of the airway is uncommon, but reversible and adequate recognition can prevent cardiac arrest.<cite>Fingerhut</cite> Airway obstruction is usually related to eating. In a mild obstruction patients can cough and speak and only frequent reassessment is advised. Patients that have a severe obstruction are unable to speak and have problems breathing and coughing. If a patient is still conscious five back blows can be applied between the shoulder blades whilst the patient leans forward. Otherwise five abdominal thrusts can be applied by clenching a fist and grasping it with the other hand. Place the hands it between the rib-cage and the umbilicus and pull sharply inward and upward whilst standing behind the patients.<cite>Guildner, Ruben</cite> If the patient loses consciousness start BLS.<cite>Koster2</cite> | ||
====Basic life support in children==== | ====Basic life support in children==== | ||
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==Preventing in Hosptial Cardiac Arrest== | ==Preventing in Hosptial Cardiac Arrest== | ||
[[File:MEWS.svg|thumb|500px|right|'''Figure 2.''' An example of a MEWS<cite>IHI</cite>.]] | [[File:MEWS.svg|thumb|500px|right|'''Figure 2.''' An example of a MEWS. Adapted from: <cite>IHI</cite>.]] | ||
The best way to prevent sudden death is to early detect deterioration of a patient and to act on early warning signs.<cite>Smith</cite> Cardiac arrest is rarely unpredictable and is precipitated by a slow deterioration. An early warning score (Figure 2) helps to create consensus among care providers about the sickness of a patient.<cite>Hodgetts, Hillman</cite> If the summed score reached a certain threshold, a doctor should be notified. The notified doctor should assess the patient within 30 minutes and discuss a treatment plan. If the patient does not improve within 60 minutes a reassessment should follow with possible inclusion of a medical emergency team (MET) or intensive care specialist.<cite>Bellomo</cite> | The best way to prevent sudden death is to early detect deterioration of a patient and to act on early warning signs.<cite>Smith</cite> Cardiac arrest is rarely unpredictable and is precipitated by a slow deterioration. An early warning score (Figure 2) helps to create consensus among care providers about the sickness of a patient.<cite>Hodgetts, Hillman</cite> If the summed score reached a certain threshold, a doctor should be notified. The notified doctor should assess the patient within 30 minutes and discuss a treatment plan. If the patient does not improve within 60 minutes a reassessment should follow with possible inclusion of a medical emergency team (MET) or intensive care specialist.<cite>Bellomo</cite> | ||
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=References= | =References= | ||
<biblio> | <biblio> | ||
# ESC isbn=9780199566990 | #ESC isbn=9780199566990 | ||
# Nolan1 pmid=20956052 | #Nolan1 pmid=20956052 | ||
# Koster2 pmid=20956051 | #Koster2 pmid=20956051 | ||
# Deakin3 pmid=20956050 | #Deakin3 pmid=20956050 | ||
# Deakin4 pmid=20956049 | #Deakin4 pmid=20956049 | ||
# Soar8 pmid=20956045 | #Soar8 pmid=20956045 | ||
# Atwood pmid=16199289 | #Atwood pmid=16199289 | ||
# Meaney pmid=19770741 | #Meaney pmid=19770741 | ||
# Waalewijn pmid=11719156 | # Waalewijn pmid=11719156 | ||
# Holmberg1 pmid=11320981 | # Holmberg1 pmid=11320981 | ||
# Holmberg2 pmid=9547841 | # Holmberg2 pmid=9547841 | ||
# SOSKANTO pmid=17368153 | # SOSKANTO pmid=17368153 | ||
# White pmid=20026780 | # White pmid=20026780 | ||
# Peberdy pmid=16784998 | # Peberdy pmid=16784998 | ||
# Mejicano pmid=9841588 | # Mejicano pmid=9841588 | ||
# Fingerhut pmid=10662354 | # Fingerhut pmid=10662354 | ||
# Guildner pmid=1018395 | # Guildner pmid=1018395 | ||
# Ruben pmid=740619 | # Ruben pmid=740619 | ||
# Niemann pmid=10381988 | # Niemann pmid=10381988 | ||
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# Mattu pmid=12098179 | # Mattu pmid=12098179 | ||
# Kornberger pmid=10488932 | # Kornberger pmid=10488932 | ||
# Reuler pmid=358883 | # Reuler pmid=358883 | ||
# Zell pmid=3985447 | # Zell pmid=3985447 | ||
# Pease pmid=12075060 | # Pease pmid=12075060 | ||
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# Choo pmid=22513951 | # Choo pmid=22513951 | ||
# Sheikh pmid=17620060 | # Sheikh pmid=17620060 | ||
# Anthi pmid=9440561 | # Anthi pmid=9440561 | ||
# Pottle pmid=11886732 | # Pottle pmid=11886732 | ||
# elBanayosy pmid=9713724 | # elBanayosy pmid=9713724 | ||
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# Padkin pmid=19460604 | # Padkin pmid=19460604 | ||
# Froehler pmid=17559883 | # Froehler pmid=17559883 | ||
# Polderman pmid=19237924 | # Polderman pmid=19237924 | ||
# Arrich pmid=17334257 | # Arrich pmid=17334257 | ||
# Laver pmid=15365608 | # Laver pmid=15365608 | ||
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# Wijdicks pmid=16864809 | # Wijdicks pmid=16864809 | ||
# Edelson pmid=16982127 | # Edelson pmid=16982127 | ||
# Eftestol pmid=12010909 | # Eftestol pmid=12010909 | ||
# Dorian pmid=11907287 | # Dorian pmid=11907287 | ||
# IHI http://www.ihi.org/knowledge/Pages/ImprovementStories/HospitalatNightProgram.aspx | # IHI http://www.ihi.org/knowledge/Pages/ImprovementStories/HospitalatNightProgram.aspx | ||
</biblio> | |||