Prehospital Advanced Cardiac Life Support

by ; ;
Edition: 2nd
Format: Paperback
Pub. Date: 2003-11-14
Publisher(s): Pearson
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Summary

Developed out of the authors' numerous years of successful classroom instruction to hundreds of students in ACLS courses. This volume contains 14 chapters that provide the core information necessary to prepare a candidate for the American Heart Association's ACLS Provider course. Concepts are presented in a logical manner that allows the reader to progress from a foundation of basic core knowledge (first six chapters) to more complex case management material. As the chapters progress, the information, cases and algorithms become more complex, requiring integration of the knowledge gained in previous chapters. Continuous reinforcement is a critical aspect of this book and will give readers the understanding necessary to pass ACLS and the confidence to use it.The volume presents key concepts of advanced cardiac life support, systematic approach to emergency cardiac care, airway management, ventilation, and oxygen therapy, gaining intravenous access, monitoring and dysrhythmia recognition, 12-lead electrocardiographic interpretation, electrical therapy, pharmacological therapy, acute coronary syndromes, algorithms and emergency cardiac care protocols, prehospital cardiac emergency scenarios, acute stroke, special resuscitation situations and special treatment considerations in the prehospital environment.For paramedics and EMTs.

Author Biography

Joseph J. Mistovich, M.Ed, NREMT-P: Chairperson and Professor, Department of Health Professions; Youngstown State University, Ohio Randall W. Benner, M.Ed, NREMT-P: Program Director, Emergency Medical Technology; Instructor, Department of Health Professions; Youngstown State University, Ohio Gregg S. Margolis, MS, NREMT-P: Assistant Professor of Emergency Medicine, The George Washington University, Washington, DC Howard A. Werman, M.D., Professor of Clinical Emergency Medicine, The Ohio State University School of Medicine and Public Health, Columbus

Table of Contents

Prefacep. xiii
Acknowledgmentsp. xv
About the Authorsp. xvii
Key Concepts of Advanced Cardiac Life Support for Prehospital Care Providersp. 1
Introductionp. 2
Key Elements of Prehospital Cardiac Resuscitationp. 3
Cardiac Arrest in the Prehospital Environmentp. 4
The Stress of Prehospital Resuscitationp. 4
Cerebral Resuscitation: The Fundamental Goalp. 5
Treat the Patient--Not the Rhythmp. 5
Basic-to-Advanced Life Support: A Continuump. 6
Time: A Critical Factorp. 6
Manage Conditions That May Lead to a Cardiac Arrestp. 7
Care Does Not Stop After Successful Resuscitationp. 7
The Phased-Response Approach: A Standardized Structurep. 7
Use Judgement about Futile Resuscitation Attemptsp. 9
Apply the Chain of Survival to All Situationsp. 9
Legal and Ethical Considerations in Prehospital Cardiac Resuscitationp. 10
Living Wills and Advance Directivesp. 10
Do-Not-Attempt-Resuscitation Ordersp. 11
When Not to Start Resuscitationp. 12
Systematic Approach to Emergency Cardiac Care: The Primary and Secondary Surveysp. 15
Introductionp. 16
Preliminary, Presurvey Actionsp. 16
Assess the Scene for Safety Hazardsp. 16
Assess for Unresponsivenessp. 18
Call for Advanced Life Support and Backupp. 18
Position the Patientp. 20
Position the Members of the Resuscitation Teamp. 21
Primary Surveyp. 21
A = Airway: Open the Airwayp. 21
B = Breathing: Assess for Breathlessness and Provide Ventilationp. 22
C = Circulation: Assess for Pulselessness and Provide Chest Compressionsp. 24
D = Defibrillation: Defibrillate Ventricular Fibrillation and Pulseless Ventricular Tachycardiap. 24
Secondary Surveyp. 26
A = Airway: Perform Invasive Airway Control by Inserting an Advanced Airwayp. 27
B = Breathing: Assess Tracheal Tube Placement and Effectiveness of Ventilationp. 28
C = Circulation: Attach the ECG, Establish an IV Line, and Administer Cardiac Medicationsp. 29
D = Differential Diagnosis: Consider the Etiology of the Cardiac Arrest or Rhythmp. 30
Airway Management, Ventilation, and Oxygen Therapyp. 35
Introductionp. 36
Airway Assessmentp. 36
Basic Airway Management Techniquesp. 39
Manual Airway Maneuversp. 39
Basic Mechanical Airway Adjunctsp. 40
Advanced Airway Management Techniquesp. 46
Tracheal Intubationp. 47
Alternative Orotracheal Intubation Techniquesp. 64
Digital Intubationp. 64
Transillumination (Lighted Stylet) Intubationp. 66
Alternative Airway Adjunctsp. 68
Esophageal-Tracheal Combitube (ETC)p. 68
Pharyngeo-tracheal Lumen Airway (PtL)p. 71
Laryngeal Mask Airway (LMA)p. 73
Cuffed Oropharyngeal Airway (COPA)p. 76
Esophageal Obturator Airway (EOA) and Esophageal Gastric Tube Airway (EGTA)p. 77
Translaryngeal and Transtracheal Airwaysp. 78
Transtracheal Catheter Ventilationp. 78
Cricothyrotomyp. 80
Tracheostomyp. 81
Ventilation Techniquesp. 81
Mouth-to-Mouth and Mouth-to-Nose Ventilationp. 81
Mouth-to-Mask Ventilationp. 82
Bag-Valve Devicesp. 83
Flow-Restricted, Oxygen-Powered, Manually Triggered Ventilation Device (FROPVD)p. 87
Automatic Transport Ventilator (ATV)p. 89
Noninvasive Ventilatory Supportp. 91
Suctionp. 92
Oropharyngeal Suctioningp. 92
Tracheobronchial Suctioningp. 92
Oxygen Therapyp. 94
Equipmentp. 94
Gaining Intravenous Accessp. 101
Introductionp. 102
IV Cannulasp. 103
Peripheral IV Linesp. 104
Techniques for Cannulating Peripheral Veinsp. 106
Cannulating an Arm or Leg Veinp. 106
Cannulating an External Jugular Veinp. 107
Complicationsp. 107
ECG Monitoring and Dysrhythmia Recognitionp. 111
Introductionp. 112
Basic Electrophysiologyp. 112
Working Cellsp. 113
Pacemaker Cellsp. 113
Conduction Cellsp. 113
The Electrocardiogramp. 114
Monitoring Systemsp. 115
Analyzing the ECGp. 115
Ratep. 116
Regularityp. 117
The QRS Complexp. 118
The P Wavesp. 119
The P-R Intervalp. 119
The Normal ECG and Sinus Rhythmsp. 119
Normal Sinus Rhythmp. 120
Sinus Tachycardiap. 121
Sinus Bradycardiap. 122
Sinus Dysrhythmiap. 123
Abnormal ECGsp. 124
Fibrillatory Dysrhythmiasp. 124
Reentry and Atrial Dysrhythmiasp. 127
The Absence of Rhythm: Asystolep. 134
The Blocksp. 135
Ectopic Beatsp. 140
Junctional and Ventricular Escape Rhythmsp. 144
12-Lead Electrocardiographic Interpretationp. 153
Introductionp. 154
Coronary Artery Anatomyp. 154
ECG Leadsp. 155
Basics of 12-Lead ECG Interpretationp. 158
Axisp. 158
The ST Segmentp. 160
Ischemia, Injury, and Infarctionp. 160
Findings in Inferior Wall MIp. 163
Findings in Anterior Wall MIp. 166
ECG Findings in Other Medical Conditionsp. 168
Bundle Branch Blocksp. 168
Pericarditisp. 170
Pulmonary Embolismp. 171
Hyperkalemiap. 172
Hypokalemiap. 173
Hypocalcemiap. 174
Hypothermiap. 175
Electrical Therapy: Defibrillation, Cardioversion, and Cardiac Pacingp. 179
Introductionp. 180
Defibrillationp. 180
Importance of Defibrillationp. 182
Components of a Defibrillatorp. 182
Transthoracic Resistance to Energy Flowp. 183
Procedure for Defibrillationp. 186
Defibrillation and Asystolic Heartsp. 188
Current-Based Defibrillation: "Smart Defibrillators"p. 188
Automated External Defibrillationp. 189
Components of an Automated External Defibrillatorp. 189
Semi-automated AEDsp. 189
AED Use in Children Less than 8 Years of Agep. 189
Procedure for Defibrillation with an AEDp. 190
Coordination of ACLS with AEDsp. 193
Emergency Synchronized Cardioversionp. 194
Indications for Synchronized Cardioversionp. 194
Procedure for Synchronized Cardioversionp. 194
Special Situations Involving Electrical Therapyp. 195
Defibrillation of Hypothermic Patientsp. 195
Defibrillation of Patients with Automatic Implantable Cardioverter/Defibrillator (AICD)p. 197
Interruption of CPRp. 197
Monitor/Defibrillator and AED Maintenancep. 197
Emergency Cardiac Pacingp. 198
Components of a Cardiac Pacemakerp. 198
Indications for Emergency Cardiac Pacingp. 198
Transcutaneous Pacing Equipmentp. 199
Procedure for Transcutaneous Pacingp. 200
Standby Pacingp. 201
Complications of Transcutaneous Pacingp. 201
Contraindications to Transcutaneous Pacingp. 202
Other Pacing Techniquesp. 202
Pharmacological Therapyp. 207
Introduction: Cardiovascular Pharmacologyp. 208
Organization of This Chapterp. 209
Oxygenp. 209
Oxygenp. 209
Sympathomimeticsp. 211
Epinephrinep. 213
Vasopressinp. 215
Norepinephrinep. 216
Isoproterenolp. 217
Dopaminep. 219
Dobutaminep. 221
Sympatholyticsp. 222
Beta Blockersp. 222
Antidysrhythmicsp. 224
Rhythm Controlp. 224
Amiodaronep. 224
Lidocainep. 226
Procainamidep. 230
Magnesium Sulfatep. 231
Rate Controlp. 232
Atropine Sulfatep. 232
Adenosinep. 236
Calcium Channel Blockers: Verapamil and Diltiazemp. 237
Digitalis Glycosidesp. 240
Analgesics and Antianginal Agentsp. 242
Morphine Sulfatep. 242
Nitroglycerinp. 244
Diureticsp. 245
Furosemidep. 245
Antihypertensivesp. 246
Sodium Nitroprussidep. 246
Fibrinolytics (Thrombolytics) and other ACS Agentsp. 247
Aspirinp. 248
Glycoprotein (GP) IIB/IIIA Antagonistsp. 249
Angiotensin Converting Enzyme (ACE) Inhibitorsp. 249
Heparinp. 250
Fibrinolytic (Thrombolytic) Therapyp. 252
Other Cardiovascular Drugsp. 253
Sodium Bicarbonatep. 253
Calcium Chloridep. 255
Acute Coronary Syndromesp. 265
Introductionp. 266
The Heart as a Pumpp. 266
The Right-Side Pumpp. 267
The Left-Side Pumpp. 267
The Cardiac Outputp. 268
Pathophysiology of an AMIp. 269
Who Is at Risk?p. 272
General Presentation of an Acute Myocardial Infarctionp. 273
Assessment of the Ischemic Chest Pain/AMI Patientp. 274
General Presentationp. 274
The ABCsp. 274
Vital Signsp. 275
ECG Tracingsp. 276
Historyp. 276
Conclusionsp. 279
Management of Ischemic Chest Pain/AMI: Prehospital, ED, and Hospital Considerationsp. 279
Alleviation of Pain and Apprehensionp. 279
Prevention and Management of Dysrhythmiasp. 280
Limitation of the Infarct Sizep. 280
Initiation of Fibrinolytic Therapy or Percutaneous Coronary Intervention (PCI)p. 280
Management of Specific AMI Presentationsp. 280
Management of the Uncomplicated AMIp. 281
Management of AMI Complicated by Dysrhythmiap. 291
Management of AMI with Hemodynamic Alterationp. 294
Prehospital Algorithms and Emergency Cardiac Care Protocolsp. 301
Introductionp. 302
Key Considerations in the Algorithm Approach to Emergency Cardiac Carep. 302
Prehospital Algorithms and Emergency Cardiac Care Protocols for Patients in Cardiac Arrestp. 303
General Approach to the Cardiac Patientp. 303
Ventricular Fibrillation/Pulseless Ventricular Tachycardia (VF/Pulseless VT) Algorithmp. 306
Pulseless Electrical Activity (PEA) Algorithmp. 311
Asystole Algorithmp. 314
Postresuscitation Patient Management in the Prehospital Settingp. 316
Postresuscitation Interventionsp. 317
Special Considerations in Postresuscitation Carep. 318
Prehospital Algorithms for Patients Not in Cardiac Arrestp. 319
Bradycardia Algorithmp. 320
Tachycardia Algorithmp. 323
Prehospital Cardiac Emergency Scenarios: Application Exercisesp. 337
Introductionp. 338
Responsibilities at the Cardiac Arrest Scenep. 338
Core Emergency Cardiac Scenariosp. 339
Respiratory Arrestp. 339
Ventricular Fibrillation With AED Interventionp. 342
Adult Ventricular Fibrillation/Pulseless Ventricular Tachycardiap. 344
Pulseless Electrical Activityp. 349
Asystolep. 352
Acute Coronary Syndromep. 354
Bradycardiap. 358
Unstable Wide Complex Tachycardiap. 360
Stable Narrow Complex Tachycardiap. 362
Stable Wide Complex Tachycardiap. 365
Acute Strokep. 371
Introductionp. 372
Acute Stroke and Transient Ischemic Attack (TIA)p. 372
Etiology of an Acute Strokep. 372
Etiology of a Transient Ischemic Attack (TIA)p. 373
Clinical Presentation of an Acute Stroke or TIAp. 373
Initial Assessment of the Patient with an Acute Stroke or TIAp. 375
Airwayp. 375
Vital Signsp. 375
Respiratory Effortp. 376
Circulatory Statusp. 376
Neurological Assessmentp. 376
Differential Diagnosis for the Acute Stroke/TIAp. 380
Treatment Strategies for the Acute Stroke Patientp. 382
General Considerations in Initial Care of Acute Strokep. 383
Special Considerations in the Management of the Acute Stroke Patientp. 385
Overall Goals of Acute Stroke/TIA Managementp. 390
Special Resuscitation Situationsp. 395
Introductionp. 396
Traumatic Cardiac Arrestsp. 396
Approach to the Traumatic Cardiac Arrest Patientp. 397
Treatment of the Traumatic Cardiac Arrest Patientp. 398
Cardiac Arrest and Pregnancyp. 399
Treatment of the Pregnant Cardiac Arrest Patientp. 399
Lightning Strikesp. 400
Treatment of the Patient in Cardiac Arrest from a Lightning Strikep. 401
Hypothermia Induced Arrestp. 401
Basic-Life-Support Treatmentp. 402
Advanced-Life-Support Treatmentp. 403
Water Submersion Emergenciesp. 403
Basic-Life-Support Treatmentp. 404
Advanced-Life-Support Treatmentp. 404
Toxicologic Cardiac Emergencies and Arrestp. 405
Special Treatment Considerations in the Prehospital Environmentp. 411
Introductionp. 412
Cerebral Resuscitationp. 412
Cerebral Perfusion Pressuresp. 413
Oxygenationp. 413
Hyperventilationp. 414
Metabolic Acidosis Correctionp. 415
Temperature Regulationp. 415
Glucose Requirementsp. 415
Sedation and Anticonvulsant Therapyp. 415
Brain Resuscitation after Cardiopulmonary Arrestp. 416
Advanced Monitoring Interventions for Cardiac Arrest Patientsp. 416
Arterial Cannulationp. 416
Cannulation of the Pulmonary Arteryp. 416
Arterial Puncturep. 417
Adjuncts for Artificial Circulationp. 417
Alternative Techniques to Compressionsp. 417
Mechanical Devices for CPRp. 418
CPR Assessmentp. 419
Review Questions: Answers and Rationalesp. 423
Indexp. 451
Table of Contents provided by Rittenhouse. All Rights Reserved.

Excerpts

Management of acute cardiovascular emergencies requires rapid and decisive actions by advanced level prehospital care personnel. Standardized procedures must be established so that an effective continuum of cardiac care can be provided from the prehospital environment to the emergency department and through the more definitive care that is provided in the cardiac care unit. The approach to emergency cardiac care in the prehospital environment is quite different from that which is provided in the medical facility setting. The uncontrolled environment and limited resources make the provision of emergency cardiac care a challenge to the prehospital care provider. To accommodate the needs of this specialized group of providers,Prehospital Advanced Cardiac Life Supportpresents comprehensive information regarding emergency cardiac care procedures in a condensed format.Prehospital Advanced Cardiac Life Supportcontains fourteen chapters that provide the core information necessary to prepare a candidate for the American Heart Association's ACLS Provider course or an equivalent adult advanced cardiac life support course. The information is presented in a logical manner that allows the reader to progresses from a foundation of basic core knowledge to more complex case management material. The first ten chapters are the core knowledge-building chapters. These chapters help the reader comprehend and master the algorithms, emergency cardiac care protocols, and scenarios presented in the later chapters. As the reader progress from one chapter to the next, the information, scenarios, and algorithms become more complex, requiring integration of the knowledge gained from the previous chapters. Review questions at the end of each chapter allow the reader to use the text as an ACLS review manual as well as for the purpose of self-assessment. Key Features of the TextPresentation.The material is presented in a logical order that is relevant to the prehospital care provider and that lends itself to continuous reinforcement of previously learned information. The reader is provided a suitable knowledge base before being asked to analyze and apply the knowledge to the understanding of algorithms or scenarios.In this text, the algorithms are separated and introduced in different chapters. When an algorithm is presented, it is in the chapter in which the background information has prepared the reader to understand the algorithm. Each algorithm and emergency cardiac care protocol is designed to specifically meet the needs of the prehospital care provider.Case Studies.A brief case study is presented at the beginning of each chapter (with a Case Study Follow-up at the end of the chapter) to reinforce the material presented in the chapter. While each case is specific and relevant to the information in that chapter, it also builds on information that was presented in the previous chapters. For example, the Chapter 5 "ECG Monitoring and Dysrhythmia Recognition" case study focuses on dysrhythmia recognition but also incorporates respiratory and intravenous therapy concepts from the previous two chapters. This cumulative approach to the case studies allows the reader to review previously learned material while applying it to a practical scenario. In Chapter 11, the core case scenarios are presented to help the reader integrate and apply learned knowledge.Review Questions.Each chapter ends with a set of multiple-choice or short-answer items that can be used for self-assessment and review. The answers, with rationales, are provided in the back of the text. This feature makes the book especially useful for those who need to review when repeating an ACLS course. Reinforcement.A key feature of this text is the inclusion of four distinct levels of information reinforcement. This systematic reinforcement should aid the reader in mastering the informati

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