By Michael Colquhoun, Anthony J. Handley, T. R. Evans
This consultant has concise and useful info on all features of resuscitation. New instructions are only one of many adjustments to the fifth variation of this e-book as a few of the chapters were thoroughly rewritten.
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The “oxygen cascade” described by J B West 35 years ago explains how oxygen is conducted down a series of tension gradients from the atmosphere to cellular mitochondria. These “supply and demand” gradients increase when disease states or trauma interfere with the normal oxygen flux. Partial or total reduction of ventilation or blood flow are obvious examples and form the fundamental basis for the ABC of resuscitation. Other subtle causes coexist. Within the lung parenchyma at alveolar level, ventilation (V) and pulmonary artery perfusion (Q) are optimally matched to maintain an efficient V/Q ratio such that neither wasted ventilation (dead-space effect) nor wasted perfusion (shunt effect) occurs.
Adenosine attenuates ␤ adrenergic mediated increases in myocardial contractility and may increase coronary blood flow. Although these effects may be cardioprotective, it has been suggested that under some circumstances they may produce or maintain cardiac asystole. Aminophylline and other methylxanthines act as adenosine receptor blocking agents, and anecdotal accounts of successful resuscitation from asystole after their use have led to more detailed investigation. A pilot study reported encouraging results but subsequent small studies have not shown such dramatic results nor any clear benefit from the use of aminophylline.
If needle jet ventilation is unavailable or is ineffective, cricothyrotomy may be life saving and should not be unduly delayed. In the absence of surgical instruments any strong knife, scissors point, large bore cannula, or similar instrument can be used to create an opening through the cricothyroid membrane. An opening of 5-7 mm diameter is made and needs to be maintained with an appropriate hollow tube or airway. Assisted ventilation may be applied directly to the orifice or tube. Tracheostomy is time consuming and difficult to perform well in emergency situations.
ABC of resuscitation by Michael Colquhoun, Anthony J. Handley, T. R. Evans