By Anthony F. T. Brown
The 6th variation of this overseas bestselling emergency medication instruction manual has been thoroughly redesigned, revised and elevated to incorporate the very most modern evidence-based directions for interns, SHOs and junior medical professionals who're new to the emergency care surroundings. The textual content follows a logical, regular, transparent and good set out technique designed to maximise the sensible supply of care on the bedside.
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Additional info for Emergency Medicine: Diagnosis and Management
Repeat the dose after 10–15 min if ineffective. 4% sodium bicarbonate – particular indications are for life-threatening hyperkalaemia or tricyclic antidepressant overdose (see p. 132 and p. , then as guided by arterial blood gases (ABGs). 6 Asystole or pulseless electrical activity These are non-shockable rhythms. 1 for a rapid overview of treatment. (i) Asystole is absence of any cardiac electrical activity (a) make sure the ECG leads are not disconnected or broken by observing the cardiac compressions artefact on the ECG screen during CPR (b) check appropriate ECG lead selection and gain setting, without stopping chest compressions or ventilation (c) do not rely on a gel pad-manual paddle combination to diagnose asystole, but use independent ECG electrodes (d) continue chest compressions and ventilation if there is difficulty in differentiating from fine VF, in an attempt to ‘coarsen’ unsuspected VF.
3 Attach a cardiac monitor and pulse oximeter to the patient. MANAGEMENT This depends on the suspected cause. 1 Sit the patient up and give 100% oxygen via a face mask. Aim for an oxygen saturation above 94%. 2 Inhalation of a foreign body (i) Perform up to five back blows between the shoulder blades, using the heel of your hand with the victim leaning well forwards or lying on the side. Critical Care Emergencies 13 ACUTE UPPER AIRWAY OBSTRUCTION (ii) Perform up to five abdominal thrusts if back blows fail (Heimlich’s manoeuvre) in adults and children over 1 year: (a) stand behind the patient, place your arms around the upper abdomen with your hands clasped between the umbilicus and xiphisternum (b) give thrusts sharply inwards and upwards to expel the obstruction.
3 Continue the drug–shock–CPR–rhythm check sequence. (i) Analyse the rhythm again after another 2 min of CPR: (a) immediately deliver a fourth shock if still in VF/VT. 4 Look for signs of life suggesting ROSC, or palpate for a pulse once a non-shockable rhythm is present with regular or narrow complexes. (i) Resume CPR if the pulse is absent or difficult to feel. (ii) Begin post-resuscitation care when a strong pulse is felt, or the patient shows signs of life suggesting ROSC. See page 11. v. access (c) review all potentially reversible causes.