Life-threatening emergencies

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.

Life-threatening emergencies

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 ...

Anesthestic-related Cardiac Arrest and Its Mortality

2002 ◽  
Vol 97 (1) ◽  
pp. 108-115 ◽  
Author(s):  
Myrna C. Newland ◽  
Sheila J. Ellis ◽  
Carol A. Lydiatt ◽  
K. Reed Peters ◽  
John H. Tinker ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
Airway Management ◽  
Central Venous Access ◽  
Venous Access ◽  
Medication Administration ◽  
Central Venous ◽  
Retrospective Case ◽  
Technical Problems ◽  
Risk Of Death

Background A prospective and retrospective case analysis study of all perioperative cardiac arrests occurring during a 10-yr period from 1989 to 1999 was done to determine the incidence, cause, and outcome of cardiac arrests attributable to anesthesia. Methods One hundred forty-four cases of cardiac arrest within 24 h of surgery were identified over a 10-yr period from an anesthesia database of 72,959 anesthetics. Case abstracts were reviewed by a Study Commission composed of external and internal members in order to judge which cardiac arrests were anesthesia-attributable and which were anesthesia-contributory. The rates of anesthesia-attributable and anesthesia-contributory cardiac arrest were estimated. Results Fifteen cardiac arrests out of a total number of 144 were judged to be related to anesthesia. Five cardiac arrests were anesthesia-attributable, resulting in an anesthesia-attributable cardiac arrest rate of 0.69 per 10,000 anesthetics (95% confidence interval, 0.085-1.29). Ten cardiac arrests were found to be anesthesia-contributory, resulting in an anesthesia-contributory rate of 1.37 per 10,000 anesthetics (95% confidence interval, 0.52-2.22). Causes of the cardiac arrests included medication-related events (40%), complications associated with central venous access (20%), problems in airway management (20%), unknown or possible vagal reaction in (13%), and one perioperative myocardial infarction. The risk of death related to anesthesia-attributable perioperative cardiac arrest was 0.55 per 10,000 anesthetics (95% confidence interval, 0.011-1.09). Conclusions Most perioperative cardiac arrests were related to medication administration, airway management, and technical problems of central venous access. Improvements focused on these three areas may result in better outcomes.

Does Advanced Life Support Provide Benefits to Patients?: A Literature Review

2005 ◽  
Vol 20 (4) ◽  
pp. 265-270 ◽  
Author(s):  
Derek L. Isenberg ◽  
Richard Bissell
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Cardiac Arrest ◽  
Literature Review ◽  
Mental Status ◽  
Life Support ◽  
Advanced Life Support ◽  
Altered Mental Status ◽  
Trauma Patients ◽  
Early Defibrillation

AbstractIntroduction:Emergency medical services have invested substantial resources to establish advanced life support (ALS) programs. However, it is unclear whether ALS care provides better outcomes to patients compared to basic life support (BLS) care.Objective:To evaluate the current evidence regarding the benefits of ALS.Methods:Electronic medical databases were searched to identify articles that directly compared ALS versus BLS care. A total of 455 articles were found. Articles were excluded for the following reasons: (1) the article was not written in English; (2) BLS response was not compared to an ALS response; (3) a physician or nurse was included as part of the ALS response; (4) it was an aeromedical response; or (5) defibrillation was included in the ALS, but not the BLS, scope of care. Twenty-one articles met the inclusion criteria for this literature review.Results:Results were divided into four categories: (1) trauma; (2) cardiac arrest; (3) myocardial infarction; and (4) altered mental status.Trauma:The majority of articles showed that ALS provided no benefits over BLS in urban trauma patients. In fact, most studies showed higher mortality rates for trauma patients receiving ALS care. Further research is needed to evaluate the benefits of ALS for rural trauma patients, and whether ALS care improves outcomes in subgroups of urban trauma patients.Cardiac Arrest:Cardiac arrest studies show that early CPR plus early defibrillation provide the greatest improvement in survival. However, most cardiac arrest research includes defibrillation as an ALS skill which has now moved into the BLS scope of care. The 2004 multi-center OPALS study provided good evidence that ALS does not improve cardiac arrest survival over early defibrillation. Further research is needed to address whether any ALS interventions improve cardiac arrest outcome.Myocardial Infarction:Only one study directly compared the outcome of BLS and ALS care on myocardial infarction. The study found no difference in outcomes between BLS and ALS care in an urban setting.Advanced Life Support:Only one study directly compared the outcome of BLS and ALS care on patients with altered mental status. The study found that the same number of patients had improved to “alert” on arrival at the emergency department, but there was a decreased length of emergency department stay for patients treated by ALS for hypoglycemia.Limitations:This review article does not take into account the benefits of ALS interventions, such as thrombolytics, dextrose, or nitroglycerin, since no studies directly compared these interventions to BLS care. Furthermore, only one study in this literature review was a large, multi-center trial.Conclusions:ALS shows little, if any, benefits for urban trauma patients. Cardiac arrest studies show that ALS does not provide additional benefits over BLS-defibrillation care, but more research is needed in this area. In two small studies, ALS care did not provide benefits over BLS care for patients with myocardial infarctions or altered mental status. Larger-scale studies are needed to evaluate which specific ALS interventions improve patient outcomes.

Pharmacotherapy of Pediatric Advanced Life Support and Toxicological Emergencies

2012 ◽  
Vol 23 (4) ◽  
pp. 398-412
Author(s):  
Lauren M. Dandeles ◽  
Kirsten H. Ohler
Keyword(s):  
Cardiac Arrest ◽  
Mechanism Of Action ◽  
Life Support ◽  
Advanced Life Support ◽  
Advanced Cardiac Life Support ◽  
Venous Access ◽  
Pediatric Age ◽  
Pharmacological Management ◽  
Unique Mechanism

Guidelines for pediatric advanced life support have been available for nearly a quarter of a century. Recommendations for the pharmacological management of pediatric cardiac arrest have changed over these years. Several important differences have been observed between adult advanced cardiac life support and pediatric advanced life support that must be recognized when children require resuscitation, such as the cause of the arrest, age-specific monitoring parameters, weight-based medication dosing, and obstacles in obtaining venous access. To make matters more complicated, differences also exist across neonatal and pediatric age spectrums. In addition, some toxicological emergencies commonly occurring in children require pharmacological management with agents that have a unique mechanism of action for cardiac support.

scholarly journals A novel technique to restore access in patients with central venous occlusion using the Surfacer® Inside-Out® Access Catheter System

2020 ◽  
Vol 21 (5) ◽  
pp. 778-782
Author(s):  
Tarik R Baetens ◽  
Joris I Rotmans ◽  
Rutger W van der Meer ◽  
Carla SP van Rijswijk
Keyword(s):  
San Antonio ◽  
Central Venous Access ◽  
Venous Access ◽  
Venous Occlusion ◽  
Central Venous ◽  
Catheter System ◽  
Life Threatening ◽  
Central Venous Occlusion ◽  
Threatening Situation ◽  
Inside Out

Exhausted central venous access is a potentially life-threatening situation for patients dependent on haemodialysis. If standard guidewire recanalisation fails, unconventional venous access or central venous needle recanalisation can be considered but are often associated with higher rates of complications and/or dysfunction. Here, we report about two patients treated successfully with the Surfacer® Inside-Out® Access Catheter System (Bluegrass Vascular Technologies, San Antonio, TX, USA) to achieve transmediastinal central venous access.

Successful Long-Term Central Venous Access

1998 ◽  
Vol 2 (1) ◽  
pp. 38-40
Author(s):  
Franco Tesio ◽  
Hamurabi De Baz ◽  
Giacomo Panarello
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Central Venous
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