(A207) Resuscitation of Casualties Following Exposure to Toxic Chemicals: What is New?

Injury following exposure to toxic chemical agents has potential life–threatening effects, particularly on the respiratory system. Antidotes alone often are not sufficient to reverse this situation, and the need to provide early and effective advanced life support for chemical casualties increasingly has been accepted by emergency services around the world. Although the principles of life support are the same for toxic as for conventional casualties, the requirement for responders to wear personal protective equipment makes airway and ventilation management more difficult. Special training and familiarity with devices and equipment used are essential to ensure effectiveness. Recent studies have indicated both the limitations and the possibilities for resuscitation of casualties in a contaminated environment before decontamination. Ventilation of patients with respiratory failure or arrest requires the use of devices which are able to operate and be used by responders wearing protective equipment. The laryngeal mask airway has been shown to be an easier and viable alternative to intubation in this situation. Portable automatic ventilators have been developed which can be used to provide controlled ventilation in a contaminated zone. The ideal mode of ventilation for potentially damaged lungs, following exposure to agents such as chlorine and phosgene has yet to be established. There may be a case for early application of the protective lung ventilation strategies that are now common in intensive care units. This presentation will review recent human and animal studies related to resuscitation in a contaminated zone and provide illustrations of the practical approaches currently used by emergency medical services.

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Life-threatening emergencies

Oxford Handbook of Emergency Medicine ◽

10.1093/med/9780199589562.003.0002 ◽

2012 ◽

pp. 40-61

Author(s):

Jonathan P. Wyatt ◽

Robin N. Illingworth ◽

Colin A. Graham ◽

Kerstin Hogg ◽

Michael J. Clancy ◽

...

Keyword(s):

Cardiac Arrest ◽

Basic Life Support ◽

Life Support ◽

Central Venous Access ◽

Treatment Algorithm ◽

Advanced Life Support ◽

Venous Access ◽

Central Venous ◽

Life Threatening

Anaphylaxis 42 Treatment algorithm for adults with anaphylaxis 44 Choking 45 Cardiac arrest 46 In-hospital resuscitation algorithm 47 Adult basic life support 48 Cardiac arrest management 50 Advanced life support algorithm 52 Notes on using the advanced life support algorithm 53 Post-resuscitation care 54 Central venous access ...

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Do radiologists want/need training in cardiopulmonary resuscitation?: Results of an internet questionnaire

Acta Radiologica ◽

10.1258/rsmacta.44.1.56 ◽

2003 ◽

Vol 44 (1) ◽

pp. 56-58

Author(s):

F. Schellhammer

Keyword(s):

Cardiopulmonary Resuscitation ◽

Life Support ◽

Response Rate ◽

Cardiopulmonary Arrest ◽

Advanced Life Support ◽

Further Education ◽

German Speaking ◽

Life Threatening ◽

Training Courses ◽

E Mail

Purpose: Prompt and effective cardiopulmonary resuscitation (CPR) decreases morbidity and mortality following cardiopulmonary arrest. Radiologists are frequently confronted with severely ill patients, who may deteriorate at any time. Furthermore, they have to be aware of life-threatening reactions towards contrast media. This study was designed to assess experience and self-estimation of German-speaking radiologists in CPR and cardiac defibrillation (CD). Material and Methods: 650 German-speaking radiologists were audited by a specially designed questionnaire, which was sent via e-mail. The answers were expected to be re-mailed within a 2-month period. Results: The response rate was 12.6%. 72.8% of the responders had performed at least 1 CPR (range 9.5±13.1) and 37% at least 1 CD. 67.9% had had opportunities to attend training courses, which had been utilized by 41.8% of them. The last training of the responders was more than 2 years ago in 69.2% and more than 5 years ago in 37%. Of all responders 75.6% expressed the need for further education. Conclusion: The small response rate indicates the small importance of CPR in the subpopulation surveyed. The vast majority of the responders, however, showed interest in basic and advanced life support and advocated regular updates. It seems reasonable that radiological departments themselves should organize courses in order to cope with their specific situations.

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Basic Life Support Training in School

PEDIATRICS ◽

10.1542/peds.91.1.158 ◽

1993 ◽

Vol 91 (1) ◽

pp. 158-159

Author(s):

Keyword(s):

High School Students ◽

Emergency Response ◽

Emergency Services ◽

Basic Life Support ◽

Life Support ◽

Early Recognition ◽

School Students ◽

Response Team ◽

Life Threatening ◽

The Impact

The American Academy of Pediatrics recommends that high school students receive training in Basic Life Support (BLS) and Pediatric Basic Life Support (PBLS) as part of their health education program. The skills taught, such as recognition of symptoms, establishment of an airway, and rescue breathing, will help prepare students to deal with individuals who need their assistance due to aspiration or cardiorespiratory emergencies. Individual efforts using only BLS/PBLS skills can be effective in rescuing patients in these circumstances.1-3 Prompt initiation of cardiopulmonary resuscitation (CPR) after early recognition of a cardiac arrest has limited success alone. This education must be supported by a community emergency response system. Immediate CPR coupled with access to the community emergency response team maximizes the impact of school education programs.4,5 School-based programs have been successful in training students to have BLS skills.6,7 The Academy does not expect that BLS/PBLS training will prepare students for all emergencies, nor does it intend that students should be made to believe they are solely responsible for rescuing victims or for the survival of individuals with life-threatening events in their school or community. Younger students should be reassured that their responsibility is limited during emergency events, particularly when adults are available. In addition to the potential benefits of BLS/PBLS, a realistic perspective of resuscitation abilities as only a link in the "chain of survival" should be provided. The limitations of BLS/PBLS and of all emergency services on the eventual outcome of cardiac arrests also should be explained.8 Students should be given information about avoiding the acquisition of transmissible diseases during CPR.

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Life-threatening emergencies

Oxford Handbook of Emergency Medicine ◽

10.1093/med/9780198784197.003.0002 ◽

2020 ◽

pp. 43-65

Author(s):

Jonathan P. Wyatt ◽

Robert G. Taylor ◽

Kerstin de Wit ◽

Emily J. Hotton ◽

Robin J. Illingworth ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Cardiac Arrest ◽

Life Support ◽

Central Venous Access ◽

Advanced Life Support ◽

Venous Access ◽

Central Venous ◽

Sick Patient ◽

Life Threatening

This chapter in the Oxford Handbook of Emergency Medicine examines all aspects of life-threatening emergencies encountered in the emergency department (ED). It examines anaphylaxis and its treatment, as well as choking. It discusses cardiac arrest and its management, as well as in-hospital resuscitation and adult Basic and Advanced Life Support algorithm use, post-resuscitation care, and central venous access. It explores recognition of the sick patient, sepsis, and shock.

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Does ‘heads-up’ cardiopulmonary resuscitation improve outcomes for patients in out-of-hospital cardiac arrest? A systematic review

British Paramedic Journal ◽

10.29045/14784726.2020.12.4.4.16 ◽

2020 ◽

Vol 4 (4) ◽

pp. 16-24

Author(s):

Andrew Elphinstone ◽

Samantha Laws

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Animal Studies ◽

Life Support ◽

Survival Rates ◽

Advanced Life Support ◽

Coronary Perfusion Pressure ◽

Coronary Perfusion ◽

Hospital Cardiac Arrest

Introduction: Survival rates for patients in out-of-hospital cardiac arrest have remained around 10% in the United Kingdom for the past seven years. If outcomes are to be improved, research into new methods of advanced life support is required. One such method may be ‘heads-up’ cardiopulmonary resuscitation.Methods: A systematic review of literature exploring heads-up cardiopulmonary resuscitation was conducted in an attempt to identify its effects on survival to discharge and neurological outcome.Results: A comprehensive search of CINAHL, MEDLINE and Google Scholar was undertaken. Six papers were classed as sufficiently relevant for inclusion. Included studies were generally of low quality and none studied the effect of heads-up cardiopulmonary resuscitation on out-of-hospital cardiac arrest patients. Animal studies identified a significant reduction in intracranial pressure and increase in cerebral and coronary perfusion pressure for use of augmented heads-up cardiopulmonary resuscitation in the porcine model of cardiac arrest.Conclusion: Further research is required to analyse the effects and potential benefits of augmented heads-up cardiopulmonary resuscitation in out-of-hospital cardiac arrest.

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Determinants of On-Scene Time in Injured Patients Treated by Physicians at the Site

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00041303 ◽

1994 ◽

Vol 9 (3) ◽

pp. 178-188 ◽

Cited By ~ 20

Author(s):

John S. Sampalis ◽

André Lavoie ◽

Maribel Salas ◽

Andreas Nikolis ◽

Jack I. Williams

Keyword(s):

Life Support ◽

Advanced Life Support ◽

Medication Administration ◽

Intravenous Route ◽

Severe Injuries ◽

Prehospital Management ◽

Life Threatening ◽

Regression Techniques ◽

Injured Patients ◽

Prehospital Time

AbstractIntroduction:The controversy surrounding the use of advanced life support (ALS) for the prehospital management of trauma pivots on the fact that these procedures could cause significant and life-threatening delays to definitive in-hospital care.In Montreal, Québec, on-site ALS to injured patients is provided by physicians only. The purpose of this study was to identify parameters associated with the duration of scene time for patients with moderate to severe injuries treated by physicians at the scene.Hypothesis:The use of on-site ALS by physicians is associated with a significant increase in scene time.Methods:A total of 576 patients with moderate to severe injuries are included in the analysis. This group was part of a larger cohort used in the prospective evaluation of trauma care in Montreal. Descriptive statistics, analysis of variance, multiple linear regression, and multiple logistic regression techniques were use to analyze the data.Results:Use of ALS in general was associated with a statistically significant increase in the mean scene time of 6.5 min. (p = .0001). Significant increases in mean scene time were observed for initiation of an intravenous route (mean = 6.6 min., p = .0001), medication administration (mean =5.7 min., p = .0001), and pneumatic antishock garment (PASG) application (mean = 9.3 min., p = .03). Similar differences were observed for total prehospital time. A significant increase in the relative odds for having long scene times (>20 min.) also was associated with the use of ALS. This level of scene time was associated with a significant increase in the odds of dying (OR = 2.6, p = .009).Conclusion:This study shows that physician-provided, on-site ALS causes significant increase in scene time and total prehospital time. These delays are associated with an increase in the risk for death in patients with an severe injuries.

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Use of Advanced Life Support Technology in Patients with Life Threatening Degenerative Conditions (SA515)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2015.12.272 ◽

2016 ◽

Vol 51 (2) ◽

pp. 391

Author(s):

David Steinhorn ◽

Rachel Thienprayoon ◽

Rani Ganesan ◽

Joel Frader

Keyword(s):

Life Support ◽

Advanced Life Support ◽

Life Threatening

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Pediatric disaster triage education and skills assessment: A coalition approach

Journal of Emergency Management ◽

10.5055/jem.2014.0168 ◽

2014 ◽

Vol 12 (2) ◽

pp. 141 ◽

Cited By ~ 4

Author(s):

Katherine Kenningham, MD ◽

Kathryn Koelemay, MD, MPH ◽

Mary A. King, MD, MPH

Keyword(s):

Disaster Preparedness ◽

Life Support ◽

De Novo ◽

Advanced Life Support ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Washington State ◽

King County ◽

Cross Sectional ◽

Life Threatening

Objective: This study aims to 1) demonstrate one method of pediatric disaster preparedness education using a regional disaster coalition organized workshop and 2) evaluate factors reflecting the greatest shortfall in pediatric mass casualty incident (MCI) triage skills in a varied population of medical providers in King County,WA.Design: Educational intervention and cross-sectional survey.Setting: Pediatric disaster preparedness conference created de novo and offered by the King County Healthcare Coalition, with didactic sessions and workshops including a scored mock pediatric MCI triage. Participants: Ninety-eight providers from throughout the King County, WA, region selected by their own institutions following invitation to participate, with 88 completing exit surveys.Interventions: Didactic lectures regarding pediatric MCI triage followed by scored exercises.Main outcome measures: Mock triage scores were analyzed and compared according to participant characteristics and workplace environment.Results: A half-day regional pediatric disaster preparedness educational conference convened in September 2011 by the King County Healthcare Coalition in partnership with regional pediatric experts was so effective and well-received that it has been rescheduled yearly (2012 and 2013) and has expanded to three Washington State venues sponsored by the Washington State Department of Health. Emergency department (ED) or intensive care unit (ICU) employment and regular exposure to pediatric patients best predicted higher mock pediatric MCI triage scores (ED/ICU 80 percent vs non-ED/ICU 73 percent, p = 0.026; regular pediatric exposure 80 percent vs less exposure 77 percent, p = 0.038, respectively). Pediatric Advanced Life Support training was not found to be associated with improved triage performance, and mock patients whose injuries were not immediately life threatening tended to be over-triaged (observed trend).Conclusions: A regional coalition can effectively organize member hospitals and provide education for focused populations using specialty experts such as pediatricians. Providers working in higher acuity environments and those with regular pediatric patient exposure perform better mock pediatric MCI triage than their counterparts after just-in-time training. Pediatric MCI patients with less than life-threatening injuries tended to be over-triaged.

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