By Michael Colquhoun, Anthony J. Handley, T. R. Evans
This consultant has concise and sensible details on all elements of resuscitation. New instructions are only one of many alterations to the fifth variation of this booklet as a few of the chapters were thoroughly rewritten.
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Extra resources for ABC of resuscitation
Although this may cause some minor skin burns in the immediate area, this risk has to be balanced against the delay involved in its removal Clothing should be open or cut to allow access to the patient’s bare frontal chest area The patient’s chest should be checked for the presence of self-medication patches on the front of the chest (these may deflect energy away from the heart) Oxygen that is being used—for example, with a pocket mask—should be directed away from the patient or turned off during defibrillation The environment should be checked for pools of water or metal surfaces that connect the patient to the operator.
Patients may be placed into one of three risk groups depending on the ventricular rate and the presence of clinical symptoms and signs. The treatment of each is summarised in the algorithm. Patients with a ventricular rate greater than 150 beats/min, those with ongoing ischaemic cardiac pain, and those who have critically reduced peripheral perfusion are considered at particularly high risk. Immediate anticoagulation with heparin and an attempt at cardioversion is recommended. This should be followed by an infusion of amiodarone to maintain sinus rhythm if it has been restored, or control ventricular rate in situations in which atrial fibrillation persists or recurs.
Recent food or fluid ingestion, intestinal obstruction, recent trauma (especially spinal cord injury or in children), obesity, hiatus hernia, and late pregnancy all make regurgitation more likely to occur. During resuscitation, chest compression over the lower sternum and/or abdominal thrusts (no longer recommended) increase the likelihood of regurgitation as well as risking damage to the abdominal organs. Gaseous distension of the stomach increases the likelihood of regurgitation and restricts chest expansion.