Description
Resuscitation is a critical medical intervention aimed at restoring spontaneous circulation and breathing in individuals experiencing cardiac arrest or respiratory failure. The science behind resuscitation involves a multifaceted approach, including prompt recognition of the emergency, initiation of cardiopulmonary resuscitation (CPR) to maintain blood circulation and oxygenation, defibrillation to correct life-threatening cardiac arrhythmias, and advanced life support interventions such as airway management and medication administration. Key principles underlying successful resuscitation include early access to care, high-quality CPR, effective teamwork and communication among healthcare providers, and timely integration of advanced interventions based on the latest evidence-based guidelines. The ultimate goal of resuscitation is to improve the chances of survival with good neurological outcomes for patients in cardiac or respiratory arrest.
Summary Listen
- Heat stroke is primarily differentiated from heat exhaustion by the presence of CNS involvement, indicated by altered consciousness (semi-conscious or unconscious). Treatment involves heat dissipation methods like conduction, convection, and radiation, along with fluid administration and air currents. Shivering in the emergency room may indicate a reflex mechanism to raise body temperature, requiring paracetamol and fluids even if the current temperature is normal.
- CPR aims to maintain brain function during cardiac arrest, not to restart the heart. Chest compressions should be at a rate of 100-120 per minute to achieve adequate cerebral blood flow, minimizing interruptions. Adrenaline (1 mg diluted) is the primary drug for ACLS, and it should be administered without delay.
- In drowning cases, patients should not be declared dead until the core body temperature reaches 32°C. Resuscitation should continue for at least 40 minutes, and temperature monitoring with rewarming is crucial. Defibrillation attempts should be limited to a maximum of three if the temperature is below 30°C, and adrenaline frequency should be halved. Atropine is contraindicated in cardiac arrest scenarios and should only be used for bradycardia.
- Tension pneumothorax requires immediate needle thoracostomy in the safety triangle (formed by the fifth intercostal space, lateral edge of pectoralis major, and lateral edge of latissimus dorsi). It is important to release the pressure and avoid a large bore ICD to prevent re-expansion pulmonary edema. Defibrillators are used to stop the heart and allow the SA node to regain control, while synchronized cardioversion is used for live patients with arrhythmias.
- Snake bites in India are treated with polyvalent anti-snake venom (ASV), regardless of snake identification. Tourniquets should only be applied by skilled professionals. Foot elevation above heart level is now recommended. Test doses of ASV are unnecessary, and ASV should be continued even in cases of allergy (with anaphylaxis management). Neostigmine should be avoided in tertiary care, and treatment for Methemoglobinemia is methylene blue.
- Rapid Sequence Intubation (RSI) involves careful planning, pre-oxygenation, premedication (sedation, induction agents, and paralysis), and post-intubation checklist. Intubation decisions should be based on clinical scenarios, not solely on GCS score. In COPD patients with CO2 narcosis, avoid aggressive CO2 washout if the patient is stable. Activated charcoal is primarily for plant poisonings. Coma cocktail is no longer recommended.
- In shock, prioritize wide-bore IV access and oxygen administration. Noradrenaline is the first-line vasopressor, but requires adequate fluid resuscitation (except in septic or anaphylactic shock). Vasopressin is the second-line vasopressor for septic shock. Blood is the primary treatment for hemorrhagic shock. Cannulas are preferred over central lines for fluid resuscitation, while central lines are reserved for noradrenaline infusion.
Sample Certificate
About the Speakers
Dr. Ravi Teja Kethavath
Dr. Ravi Teja Kethavath Assistant Professor, Emergency Medicine, GMC, Srikakulam
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