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Additional resources for A Resuscitation Room Guide Banerjee
Repeated counter-shocks with a short interval in between: stacked shocks have, however, been abandoned in the Resuscitation 2005 Guidelines as they interrupt chest compression. 84 Avoid placement of paddles on • ECG electrodes 44 45 • Breast tissue • Medicated (nitrate) patches • Implanted pacemaker module or pulse generator of implantable cardioverter-defibrillator: paddles should be 12-15cm away. Waveforms employed for defibrillation All new defibrillators and AEDs use biphasic defibrillation.
Absent endotracheal CO2 may indicate inadvertent oesophageal intubation, which should be checked by immediate laryngoscopy. • Improving acid-base status, as measured by rising venous or arterial blood pH. Central or mixed venous pH is more meaningful than arterial pH. • Metabolic acidosis is invariably present after all but the briefest cardiac arrest, with raised base deficit and plasma lactate. g. asystole, agonal rhythm • Bedside trans-thoracic echocardiography allows evaluation of cardiac wall motion.
It is important always to have a clear back-up plan of action in the anticipation of failure • Patients arriving in the resuscitation room can present some of the most challenging airway problems requiring urgent skilled anaesthetic and even surgical intervention For patients in respiratory failure, intubation and ventilation is the tried and tested method of respiratory support and still essential in most circumstances • As well as ensuring gas exchange, airway control by intubation is also the definitive way to safeguard the unconscious patient against aspiration pneumonitis when protective reflexes have been lost • In severe head injury and other situations where ICP may be raised, intubation and ventilation assists in ICP control • Monitoring of oxygen saturation by pulse oximetry indicates whether or not oxygenation is being achieved far more reliably than visual appearances of skin colour.
A Resuscitation Room Guide Banerjee by Hargreaves