Ebook Critical care medicine the essentials: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Critical care medicine the essentials: Part 2
Ebook Critical care medicine the essentials: Part 2
Chapter 20 Cardiopulmonary Arrest• Key Points1The success (hospital discharge without neurological impairment) of cardiopulmonary resuscitation is hig Ebook Critical care medicine the essentials: Part 2ghly variable among patient populations. Cardiopulmonary resuscitation is very effective when applied promptly to patients with sudden cardiac death because of electrical instability, but is quite ineffective when applied in chronically debilitated patients and those suffering arrest as part of the Ebook Critical care medicine the essentials: Part 2natural progression of multiple organ failure.2The goal of resuscitation is to preserve neurological function by rapidly restoring oxygenation, ventilEbook Critical care medicine the essentials: Part 2
ation, and circulation to patients with arrested circulation.3The resuscitation status of every patient admitted to the ICU should be considered at adChapter 20 Cardiopulmonary Arrest• Key Points1The success (hospital discharge without neurological impairment) of cardiopulmonary resuscitation is hig Ebook Critical care medicine the essentials: Part 2initiating resuscitation efforts. Obvious exceptions to this recommendation apply when cardiopulmonary resuscitation is prohibited by patient mandate or not indicated because it cannot produce successful results.4Most successful resuscitations require only 2 to 3 minutes. In these, establishing a pa Ebook Critical care medicine the essentials: Part 2tent airway and promptly applying direct current shocks to reestablish a perfusing rhythm are the key actions necessary. It is quite uncommon to succeEbook Critical care medicine the essentials: Part 2
ssfully resuscitate a patient after more than 20 to 30 minutes of effort. A notable exception to this rule occurs in patients with hypothermia who areChapter 20 Cardiopulmonary Arrest• Key Points1The success (hospital discharge without neurological impairment) of cardiopulmonary resuscitation is hig Ebook Critical care medicine the essentials: Part 2n a hospitalized patient often has a specific cause: therefore, resuscitative efforts should be individualized. Common situations are outlined in Table 20-1.6In most cases, reestablishing an effective rhythm involves either the application of direct current shocks to terminate ventricular fibrillati Ebook Critical care medicine the essentials: Part 2on or tachyarrhythmia or the acceleration of bradyarrhythmias.7Although the systemic acidosis seen in patients with circulatory arrest can be bufferedEbook Critical care medicine the essentials: Part 2
with NaHCOs, a better strategy is to optimize ventilation and circulation. NaHCO3 should not be used routinely but retains a role for specific arrestChapter 20 Cardiopulmonary Arrest• Key Points1The success (hospital discharge without neurological impairment) of cardiopulmonary resuscitation is hig Ebook Critical care medicine the essentials: Part 2monary arrest are not derived from highquality randomized human studies but rather from retrospective series, animal experiments, and expert opinion. Treatment recommendations traditionally have been most applicable to patients who sustained sudden cardiac catastrophes, especially those occurring ou Ebook Critical care medicine the essentials: Part 2tside the hospital. Because the focus of this book is on the hospitalized critically ill patient, some of the discussion that follows will naturally dEbook Critical care medicine the essentials: Part 2
iffer from widely disseminated recommendations. Most arrests among patients with ischemic heart disease are due to ventricular tachycardia (VT) and veChapter 20 Cardiopulmonary Arrest• Key Points1The success (hospital discharge without neurological impairment) of cardiopulmonary resuscitation is hig Ebook Critical care medicine the essentials: Part 2 almost always be treated immediately with unsynchronized cardioversion. By contrast, a respiratory event (aspiration, excessive sedation, pulmonary embolism.P.422r.*+z.o airway obstruction) is much mere likely to occur at other sites in the hospital. It follows that arrests on a hospital ward or no Ebook Critical care medicine the essentials: Part 2ncardiac ICU are more likely to respond to a directed intervention beyond a cardiac rhythm change, often one involving the lungs.Table 20-1. Common ClEbook Critical care medicine the essentials: Part 2
inical Scenarios of Cardiopulmonary ArrestSettingLikely EtiologyAppropriate InterventionDuring mechanical ventilationMisplaced ET tube Tension pneumotChapter 20 Cardiopulmonary Arrest• Key Points1The success (hospital discharge without neurological impairment) of cardiopulmonary resuscitation is hig Ebook Critical care medicine the essentials: Part 2t tube placement Fluid bolus Reduce minute ventilation, increase expiratory time, bronchodilator, suction airway Check ET tube placement, oximeter saturation: administer 100% 02 Suction airwayPostcentral line placement/attemptTension pneumothorax Tachyarrhythmia Bradycardia/'heart blockPhysical exam Ebook Critical care medicine the essentials: Part 2ination, chest tube placement Withdraw intracardiac wires or catheters: consider cardioversion/antiarrhythmic Withdraw intracardiac wires or cathetersEbook Critical care medicine the essentials: Part 2
, consider chronotropic drugs, temporary pacingDuring dialysis or plasmapheresisHypovolemia Transfusion reaction IgA deficiency: allergic reaction HypChapter 20 Cardiopulmonary Arrest• Key Points1The success (hospital discharge without neurological impairment) of cardiopulmonary resuscitation is hig Ebook Critical care medicine the essentials: Part 2aDuring transportDisplaced ET tube Interruption of vasoactive drugsEarly identification using end-tidal CO2 Restart IV accessAcute head injuryIncreased intracranial pressure (especially with bradycardia) Diabetes insipidus: hypovolemia (especially with tachycardia)Lower intracranial pressure (ICP): Ebook Critical care medicine the essentials: Part 2hyperventilation, mannitol. 3% NaCI Administer fluidAfter starting a new medicineAnaphylaxis (antibiotics) Angioedema (ACE inhibitors) Hypotension/volEbook Critical care medicine the essentials: Part 2
ume depletion (ACE inhibitors) MethemoglobinemiaStop drug; administer fluid, epinephrine, corticosteroids Volume expansion Methylene blueToxin/drug ovChapter 20 Cardiopulmonary Arrest• Key Points1The success (hospital discharge without neurological impairment) of cardiopulmonary resuscitation is hig Ebook Critical care medicine the essentials: Part 2ker Orga nophosphates CarbamatesSevere bradycardia+ glucose Decontamination, atropine, pralidoximeAfter myocardial infarctionT achyarrhythmia/VF Torsades de pointes Tamponade, cardiac rupture Bradycardia. AV blockDC countershock, lidocaine Cardioversion, Mg, pacing, isoproterenol, stop potential dru Ebook Critical care medicine the essentials: Part 2g causes Pericardiocentesis, fluid, surgical repair Chronotropic drugs, temporary pacingAfter traumaExsanguination Tension pneumothorax T amponade AbdEbook Critical care medicine the essentials: Part 2
ominal compartment syndromeFluid/blood administration, consider la parotomy-thoracotomy Physical examination, chest tube placement Pericardiocentesis/Chapter 20 Cardiopulmonary Arrest• Key Points1The success (hospital discharge without neurological impairment) of cardiopulmonary resuscitation is hig Ebook Critical care medicine the essentials: Part 22 HydroxocobalaminABG, arterial blood gases; ACE, angiotensin-converting enzyme; AV, atrioventricular; DC, direct current; ECG, electrocardiogram; ET, endotracheal; PEEP, positive end-expiratory pressure; VF, ventricular fibrillation.PRIMARY PULMONARY EVENTS (RESPIRATORY ARREST AND SECONDARY CARDIAC Ebook Critical care medicine the essentials: Part 2 ARREST)Patients found unresponsive without respirations but with an effective pulse have suffered a respiratory arrest. Failure to rapidly restore veEbook Critical care medicine the essentials: Part 2
ntilation results in hypoxemia and progressive acidosis that culminates in reduced contractility, hypotension, and eventual circulatory collapse. AlthChapter 20 Cardiopulmonary Arrest• Key Points1The success (hospital discharge without neurological impairment) of cardiopulmonary resuscitation is hig Ebook Critical care medicine the essentials: Part 2 depression (e.g., sedation, coma, stroke, high intracranial pressure) or to failure of the respiratory muscle pump (e.g„ excessive workload, impaired mechanical efficiency, small or large airway obstruction, or muscle weakness). Tachypnea usually is the first response to stress, but as the burden b Ebook Critical care medicine the essentials: Part 2ecomes overwhelming, therespiratory rhythm disorganizes, slows, and eventually ceases. Initially, mild hypoxt.. ■ Ul II IUI IWJ u IV* IfSI IVIUI chemiEbook Critical care medicine the essentials: Part 2
cal drive to breathe and stimulates heart rate. Profound hypoxemia, however, depresses neural function and produces bradycardia refractory to autonomiChapter 20 Cardiopulmonary Arrest• Key Points1The success (hospital discharge without neurological impairment) of cardiopulmonary resuscitation is hig Ebook Critical care medicine the essentials: Part 2der conditions of hypoxia and acidosis and because cardiac output falls as heart rate declines. The observation that nearly one half of hospitalized cardiopulmonary arrest victims exhibit an initial bradycardic rhythm underscores the role of respiratory causes of circulatory arrest.Time after respir Ebook Critical care medicine the essentials: Part 2atory arrest (minutes)FIGURE 20-1. Change in arterial partial pressure of oxygen and carbon dioxide after respiratory arrest (normal lungs). Oxygen coEbook Critical care medicine the essentials: Part 2
ncentration falls precipitously to dangerously low levels within minutes. By contrast, the rise in carbon dioxide tension is much slower, requiring 15Chapter 20 Cardiopulmonary Arrest• Key Points1The success (hospital discharge without neurological impairment) of cardiopulmonary resuscitation is hig Ebook Critical care medicine the essentials: Part 2n (PaƠ2) plummets shortly after ventilation ceases because limited 02 stores are rapidly consumed. Reserves are diminished by diseases that reduce baseline saturation (e.g., chronic obstructive pulmonary disease [COPD], pulmonary embolism), lower functional residual capacity (e.g., morbid obesity, p Ebook Critical care medicine the essentials: Part 2regnancy), or both (e.g., pneumonia, pulmonary fibrosis, congestive heart failure). Ambulatory patients who suffer sudden cardiac arrest usually drawEbook Critical care medicine the essentials: Part 2
upon substantially greater 02 reserves because they typically do not have diseases causing significant desaturation or thoracic restriction at baselinGọi ngay
Chat zalo
Facebook