Prehospital Advanced Cardiac Life Support
by Mistovich, Joseph J.; Benner, Randall W.; Margolis, Gregg S.-
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Summary
Author Biography
Table of Contents
| Preface | p. xiii |
| Acknowledgments | p. xv |
| About the Authors | p. xvii |
| Key Concepts of Advanced Cardiac Life Support for Prehospital Care Providers | p. 1 |
| Introduction | p. 2 |
| Key Elements of Prehospital Cardiac Resuscitation | p. 3 |
| Cardiac Arrest in the Prehospital Environment | p. 4 |
| The Stress of Prehospital Resuscitation | p. 4 |
| Cerebral Resuscitation: The Fundamental Goal | p. 5 |
| Treat the Patient--Not the Rhythm | p. 5 |
| Basic-to-Advanced Life Support: A Continuum | p. 6 |
| Time: A Critical Factor | p. 6 |
| Manage Conditions That May Lead to a Cardiac Arrest | p. 7 |
| Care Does Not Stop After Successful Resuscitation | p. 7 |
| The Phased-Response Approach: A Standardized Structure | p. 7 |
| Use Judgement about Futile Resuscitation Attempts | p. 9 |
| Apply the Chain of Survival to All Situations | p. 9 |
| Legal and Ethical Considerations in Prehospital Cardiac Resuscitation | p. 10 |
| Living Wills and Advance Directives | p. 10 |
| Do-Not-Attempt-Resuscitation Orders | p. 11 |
| When Not to Start Resuscitation | p. 12 |
| Systematic Approach to Emergency Cardiac Care: The Primary and Secondary Surveys | p. 15 |
| Introduction | p. 16 |
| Preliminary, Presurvey Actions | p. 16 |
| Assess the Scene for Safety Hazards | p. 16 |
| Assess for Unresponsiveness | p. 18 |
| Call for Advanced Life Support and Backup | p. 18 |
| Position the Patient | p. 20 |
| Position the Members of the Resuscitation Team | p. 21 |
| Primary Survey | p. 21 |
| A = Airway: Open the Airway | p. 21 |
| B = Breathing: Assess for Breathlessness and Provide Ventilation | p. 22 |
| C = Circulation: Assess for Pulselessness and Provide Chest Compressions | p. 24 |
| D = Defibrillation: Defibrillate Ventricular Fibrillation and Pulseless Ventricular Tachycardia | p. 24 |
| Secondary Survey | p. 26 |
| A = Airway: Perform Invasive Airway Control by Inserting an Advanced Airway | p. 27 |
| B = Breathing: Assess Tracheal Tube Placement and Effectiveness of Ventilation | p. 28 |
| C = Circulation: Attach the ECG, Establish an IV Line, and Administer Cardiac Medications | p. 29 |
| D = Differential Diagnosis: Consider the Etiology of the Cardiac Arrest or Rhythm | p. 30 |
| Airway Management, Ventilation, and Oxygen Therapy | p. 35 |
| Introduction | p. 36 |
| Airway Assessment | p. 36 |
| Basic Airway Management Techniques | p. 39 |
| Manual Airway Maneuvers | p. 39 |
| Basic Mechanical Airway Adjuncts | p. 40 |
| Advanced Airway Management Techniques | p. 46 |
| Tracheal Intubation | p. 47 |
| Alternative Orotracheal Intubation Techniques | p. 64 |
| Digital Intubation | p. 64 |
| Transillumination (Lighted Stylet) Intubation | p. 66 |
| Alternative Airway Adjuncts | p. 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 Airways | p. 78 |
| Transtracheal Catheter Ventilation | p. 78 |
| Cricothyrotomy | p. 80 |
| Tracheostomy | p. 81 |
| Ventilation Techniques | p. 81 |
| Mouth-to-Mouth and Mouth-to-Nose Ventilation | p. 81 |
| Mouth-to-Mask Ventilation | p. 82 |
| Bag-Valve Devices | p. 83 |
| Flow-Restricted, Oxygen-Powered, Manually Triggered Ventilation Device (FROPVD) | p. 87 |
| Automatic Transport Ventilator (ATV) | p. 89 |
| Noninvasive Ventilatory Support | p. 91 |
| Suction | p. 92 |
| Oropharyngeal Suctioning | p. 92 |
| Tracheobronchial Suctioning | p. 92 |
| Oxygen Therapy | p. 94 |
| Equipment | p. 94 |
| Gaining Intravenous Access | p. 101 |
| Introduction | p. 102 |
| IV Cannulas | p. 103 |
| Peripheral IV Lines | p. 104 |
| Techniques for Cannulating Peripheral Veins | p. 106 |
| Cannulating an Arm or Leg Vein | p. 106 |
| Cannulating an External Jugular Vein | p. 107 |
| Complications | p. 107 |
| ECG Monitoring and Dysrhythmia Recognition | p. 111 |
| Introduction | p. 112 |
| Basic Electrophysiology | p. 112 |
| Working Cells | p. 113 |
| Pacemaker Cells | p. 113 |
| Conduction Cells | p. 113 |
| The Electrocardiogram | p. 114 |
| Monitoring Systems | p. 115 |
| Analyzing the ECG | p. 115 |
| Rate | p. 116 |
| Regularity | p. 117 |
| The QRS Complex | p. 118 |
| The P Waves | p. 119 |
| The P-R Interval | p. 119 |
| The Normal ECG and Sinus Rhythms | p. 119 |
| Normal Sinus Rhythm | p. 120 |
| Sinus Tachycardia | p. 121 |
| Sinus Bradycardia | p. 122 |
| Sinus Dysrhythmia | p. 123 |
| Abnormal ECGs | p. 124 |
| Fibrillatory Dysrhythmias | p. 124 |
| Reentry and Atrial Dysrhythmias | p. 127 |
| The Absence of Rhythm: Asystole | p. 134 |
| The Blocks | p. 135 |
| Ectopic Beats | p. 140 |
| Junctional and Ventricular Escape Rhythms | p. 144 |
| 12-Lead Electrocardiographic Interpretation | p. 153 |
| Introduction | p. 154 |
| Coronary Artery Anatomy | p. 154 |
| ECG Leads | p. 155 |
| Basics of 12-Lead ECG Interpretation | p. 158 |
| Axis | p. 158 |
| The ST Segment | p. 160 |
| Ischemia, Injury, and Infarction | p. 160 |
| Findings in Inferior Wall MI | p. 163 |
| Findings in Anterior Wall MI | p. 166 |
| ECG Findings in Other Medical Conditions | p. 168 |
| Bundle Branch Blocks | p. 168 |
| Pericarditis | p. 170 |
| Pulmonary Embolism | p. 171 |
| Hyperkalemia | p. 172 |
| Hypokalemia | p. 173 |
| Hypocalcemia | p. 174 |
| Hypothermia | p. 175 |
| Electrical Therapy: Defibrillation, Cardioversion, and Cardiac Pacing | p. 179 |
| Introduction | p. 180 |
| Defibrillation | p. 180 |
| Importance of Defibrillation | p. 182 |
| Components of a Defibrillator | p. 182 |
| Transthoracic Resistance to Energy Flow | p. 183 |
| Procedure for Defibrillation | p. 186 |
| Defibrillation and Asystolic Hearts | p. 188 |
| Current-Based Defibrillation: "Smart Defibrillators" | p. 188 |
| Automated External Defibrillation | p. 189 |
| Components of an Automated External Defibrillator | p. 189 |
| Semi-automated AEDs | p. 189 |
| AED Use in Children Less than 8 Years of Age | p. 189 |
| Procedure for Defibrillation with an AED | p. 190 |
| Coordination of ACLS with AEDs | p. 193 |
| Emergency Synchronized Cardioversion | p. 194 |
| Indications for Synchronized Cardioversion | p. 194 |
| Procedure for Synchronized Cardioversion | p. 194 |
| Special Situations Involving Electrical Therapy | p. 195 |
| Defibrillation of Hypothermic Patients | p. 195 |
| Defibrillation of Patients with Automatic Implantable Cardioverter/Defibrillator (AICD) | p. 197 |
| Interruption of CPR | p. 197 |
| Monitor/Defibrillator and AED Maintenance | p. 197 |
| Emergency Cardiac Pacing | p. 198 |
| Components of a Cardiac Pacemaker | p. 198 |
| Indications for Emergency Cardiac Pacing | p. 198 |
| Transcutaneous Pacing Equipment | p. 199 |
| Procedure for Transcutaneous Pacing | p. 200 |
| Standby Pacing | p. 201 |
| Complications of Transcutaneous Pacing | p. 201 |
| Contraindications to Transcutaneous Pacing | p. 202 |
| Other Pacing Techniques | p. 202 |
| Pharmacological Therapy | p. 207 |
| Introduction: Cardiovascular Pharmacology | p. 208 |
| Organization of This Chapter | p. 209 |
| Oxygen | p. 209 |
| Oxygen | p. 209 |
| Sympathomimetics | p. 211 |
| Epinephrine | p. 213 |
| Vasopressin | p. 215 |
| Norepinephrine | p. 216 |
| Isoproterenol | p. 217 |
| Dopamine | p. 219 |
| Dobutamine | p. 221 |
| Sympatholytics | p. 222 |
| Beta Blockers | p. 222 |
| Antidysrhythmics | p. 224 |
| Rhythm Control | p. 224 |
| Amiodarone | p. 224 |
| Lidocaine | p. 226 |
| Procainamide | p. 230 |
| Magnesium Sulfate | p. 231 |
| Rate Control | p. 232 |
| Atropine Sulfate | p. 232 |
| Adenosine | p. 236 |
| Calcium Channel Blockers: Verapamil and Diltiazem | p. 237 |
| Digitalis Glycosides | p. 240 |
| Analgesics and Antianginal Agents | p. 242 |
| Morphine Sulfate | p. 242 |
| Nitroglycerin | p. 244 |
| Diuretics | p. 245 |
| Furosemide | p. 245 |
| Antihypertensives | p. 246 |
| Sodium Nitroprusside | p. 246 |
| Fibrinolytics (Thrombolytics) and other ACS Agents | p. 247 |
| Aspirin | p. 248 |
| Glycoprotein (GP) IIB/IIIA Antagonists | p. 249 |
| Angiotensin Converting Enzyme (ACE) Inhibitors | p. 249 |
| Heparin | p. 250 |
| Fibrinolytic (Thrombolytic) Therapy | p. 252 |
| Other Cardiovascular Drugs | p. 253 |
| Sodium Bicarbonate | p. 253 |
| Calcium Chloride | p. 255 |
| Acute Coronary Syndromes | p. 265 |
| Introduction | p. 266 |
| The Heart as a Pump | p. 266 |
| The Right-Side Pump | p. 267 |
| The Left-Side Pump | p. 267 |
| The Cardiac Output | p. 268 |
| Pathophysiology of an AMI | p. 269 |
| Who Is at Risk? | p. 272 |
| General Presentation of an Acute Myocardial Infarction | p. 273 |
| Assessment of the Ischemic Chest Pain/AMI Patient | p. 274 |
| General Presentation | p. 274 |
| The ABCs | p. 274 |
| Vital Signs | p. 275 |
| ECG Tracings | p. 276 |
| History | p. 276 |
| Conclusions | p. 279 |
| Management of Ischemic Chest Pain/AMI: Prehospital, ED, and Hospital Considerations | p. 279 |
| Alleviation of Pain and Apprehension | p. 279 |
| Prevention and Management of Dysrhythmias | p. 280 |
| Limitation of the Infarct Size | p. 280 |
| Initiation of Fibrinolytic Therapy or Percutaneous Coronary Intervention (PCI) | p. 280 |
| Management of Specific AMI Presentations | p. 280 |
| Management of the Uncomplicated AMI | p. 281 |
| Management of AMI Complicated by Dysrhythmia | p. 291 |
| Management of AMI with Hemodynamic Alteration | p. 294 |
| Prehospital Algorithms and Emergency Cardiac Care Protocols | p. 301 |
| Introduction | p. 302 |
| Key Considerations in the Algorithm Approach to Emergency Cardiac Care | p. 302 |
| Prehospital Algorithms and Emergency Cardiac Care Protocols for Patients in Cardiac Arrest | p. 303 |
| General Approach to the Cardiac Patient | p. 303 |
| Ventricular Fibrillation/Pulseless Ventricular Tachycardia (VF/Pulseless VT) Algorithm | p. 306 |
| Pulseless Electrical Activity (PEA) Algorithm | p. 311 |
| Asystole Algorithm | p. 314 |
| Postresuscitation Patient Management in the Prehospital Setting | p. 316 |
| Postresuscitation Interventions | p. 317 |
| Special Considerations in Postresuscitation Care | p. 318 |
| Prehospital Algorithms for Patients Not in Cardiac Arrest | p. 319 |
| Bradycardia Algorithm | p. 320 |
| Tachycardia Algorithm | p. 323 |
| Prehospital Cardiac Emergency Scenarios: Application Exercises | p. 337 |
| Introduction | p. 338 |
| Responsibilities at the Cardiac Arrest Scene | p. 338 |
| Core Emergency Cardiac Scenarios | p. 339 |
| Respiratory Arrest | p. 339 |
| Ventricular Fibrillation With AED Intervention | p. 342 |
| Adult Ventricular Fibrillation/Pulseless Ventricular Tachycardia | p. 344 |
| Pulseless Electrical Activity | p. 349 |
| Asystole | p. 352 |
| Acute Coronary Syndrome | p. 354 |
| Bradycardia | p. 358 |
| Unstable Wide Complex Tachycardia | p. 360 |
| Stable Narrow Complex Tachycardia | p. 362 |
| Stable Wide Complex Tachycardia | p. 365 |
| Acute Stroke | p. 371 |
| Introduction | p. 372 |
| Acute Stroke and Transient Ischemic Attack (TIA) | p. 372 |
| Etiology of an Acute Stroke | p. 372 |
| Etiology of a Transient Ischemic Attack (TIA) | p. 373 |
| Clinical Presentation of an Acute Stroke or TIA | p. 373 |
| Initial Assessment of the Patient with an Acute Stroke or TIA | p. 375 |
| Airway | p. 375 |
| Vital Signs | p. 375 |
| Respiratory Effort | p. 376 |
| Circulatory Status | p. 376 |
| Neurological Assessment | p. 376 |
| Differential Diagnosis for the Acute Stroke/TIA | p. 380 |
| Treatment Strategies for the Acute Stroke Patient | p. 382 |
| General Considerations in Initial Care of Acute Stroke | p. 383 |
| Special Considerations in the Management of the Acute Stroke Patient | p. 385 |
| Overall Goals of Acute Stroke/TIA Management | p. 390 |
| Special Resuscitation Situations | p. 395 |
| Introduction | p. 396 |
| Traumatic Cardiac Arrests | p. 396 |
| Approach to the Traumatic Cardiac Arrest Patient | p. 397 |
| Treatment of the Traumatic Cardiac Arrest Patient | p. 398 |
| Cardiac Arrest and Pregnancy | p. 399 |
| Treatment of the Pregnant Cardiac Arrest Patient | p. 399 |
| Lightning Strikes | p. 400 |
| Treatment of the Patient in Cardiac Arrest from a Lightning Strike | p. 401 |
| Hypothermia Induced Arrest | p. 401 |
| Basic-Life-Support Treatment | p. 402 |
| Advanced-Life-Support Treatment | p. 403 |
| Water Submersion Emergencies | p. 403 |
| Basic-Life-Support Treatment | p. 404 |
| Advanced-Life-Support Treatment | p. 404 |
| Toxicologic Cardiac Emergencies and Arrest | p. 405 |
| Special Treatment Considerations in the Prehospital Environment | p. 411 |
| Introduction | p. 412 |
| Cerebral Resuscitation | p. 412 |
| Cerebral Perfusion Pressures | p. 413 |
| Oxygenation | p. 413 |
| Hyperventilation | p. 414 |
| Metabolic Acidosis Correction | p. 415 |
| Temperature Regulation | p. 415 |
| Glucose Requirements | p. 415 |
| Sedation and Anticonvulsant Therapy | p. 415 |
| Brain Resuscitation after Cardiopulmonary Arrest | p. 416 |
| Advanced Monitoring Interventions for Cardiac Arrest Patients | p. 416 |
| Arterial Cannulation | p. 416 |
| Cannulation of the Pulmonary Artery | p. 416 |
| Arterial Puncture | p. 417 |
| Adjuncts for Artificial Circulation | p. 417 |
| Alternative Techniques to Compressions | p. 417 |
| Mechanical Devices for CPR | p. 418 |
| CPR Assessment | p. 419 |
| Review Questions: Answers and Rationales | p. 423 |
| Index | p. 451 |
| Table of Contents provided by Rittenhouse. All Rights Reserved. |
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