Current concepts in cardiac resuscitation:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1995
|
| Schriftenreihe: | Anesthesiology clinics of North America
13,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XI S., S. 751 - 1035 Ill., graph. Darst. |
Internformat
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Datensatz im Suchindex
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| adam_text | CURRENT CONCEPTS IN CARDIAC RESUSCITATION
CONTENTS
Foreword xiii
Jonathan L. Benumof
Preface xv
David M. Rothenberg
On the History of Modern Resuscitation 751
Peter Safar
For the reversal of airway obstruction, apnea, and pulselessness,
much but not all of the present knowledge existed around 1900
but laid dormant for half a century. Starting in the 1950s, modern
standard external cardiopulmonary resuscitation methods, which
might be initiated by anyone anywhere, have been developed,
applied, and evaluated for use inside and outside hospitals. This
happened through the cross fertilization of work by a few reani
matologists (including anesthesiologists), basic scientists, and res¬
cuers. Modern resuscitation medicine includes the pathophysiol
ogy of dying and cardiopulmonary cerebral resuscitation (CPCR);
basic, advanced, and prolonged life support methods (BLS, ALS,
PLS)—the topic of this article—and also cerebral resuscitation
research, intensive (critical) care medicine, and emergency medi¬
cal services organization, education, and evaluation. Each has its
own history. Recent CPCR results in hospitals special care units
have been impressive but are contrasted by suboptimal results
elsewhere in and outside hospitals. Resuscitation researchers and
practitioners, who are eager to maximize the saving of hearts
and brains too good to die, will benefit from learning about the
history of resuscitation over the past 100 years.
ANESTHESIOLOGY CLINICS OF NORTH AMERICA VOLUME 13 • NUMBER 4 • DECEMBER 1995 vii
Mechanisms and Methods of Cardiopulmonary Resuscitation 767
William H. Montgomery
The mechanisms for blood flow during CPR have been clarified
during the last 10 years. Increasing emphasis has been placed on
the thoracic pump mechanism, although it is generally accepted
that both the thoracic and cardiac pump mechanisms may be
operating. Irrespective of the mechanism of blood flow during
CPR, investigators have sought to improve survival from sudden
cardiac death by a variety of methods. Most have chosen to
exploit the thoracic pump mechanism, but others rely on the
heart as the pump. Interposed abdominal compression CPR (IAC
CPR), vest CPR, and active compression decompression CPR
(ACD CPR) have shown some promise with respect to improving
return of spontaneous circulation and neurologic outcome. Con¬
tinued research and clinical trials of these methods will hopefully
lead to improved survival from sudden cardiac death. Until such
time, however, standard CPR should continue to be performed
in cases of cardiac arrest and obviously should serve as the
benchmark against which all new CPR methods are compared.
End Tidal Carbon Dioxide Physiology and Monitoring
During Resuscitation 785
Ahamed H. Idris
This article discusses the measurement, physiology, and clinical
use of end tidal CO2, especially during low blood flow states.
End tidal CO2 concentration depends on both pulmonary blood
flow and minute ventilation. CO2, if present, is helpful in con¬
firming tracheal intubation, even in cardiac arrest. Poor blood
flow during CPR is associated with a low end tidal CO2 concen¬
tration and a poor chance for resuscitation and survival from
cardiac arrest. The limitation of end tidal CO2 monitoring is that
levels are affected by perfusion, ventilation, and CO2 production.
Acid Base Physiology During Advanced Cardiac Life Support 799
Nicholas G. Bircher
Buffer therapy does have a role in resuscitation but should not
be used carelessly. Airway control and adequate alveolar ventila¬
tion are immediate priorities in the first minutes of resuscitation.
If the patient has had a witnessed cardiac arrest, an arterial blood
gas should be sent after endorracheal intubation. If the arrest is
of unknown duration, a small dose of sodium bicarbonate may
prove to be beneficial. Sodium bicarbonate should not be viewed
as a therapy itself, but rather as an adjunct to the many other
components of a well performed resuscitation.
Defibrillation and Cardioversion 809
Suzette C. Hong j
The use of electrical current in the treatment of arrhythmias can¬
not be understated. With proper precautions, defibrillation/cardio
Viii CONTENTS
version is a safe and effective means of treating ventricular and
atrial tachyarrhythmias. In the event of ventricular fibrillation,
early defibrillation is the first and most important intervention
that must be implemented. With the increased availability of
automatic external defibrillators in the prehospital setting, early
defibrillation will become more common, thus leading to in¬
creased survival.
Initiating Electrical Therapy for Acute
Intraoperative Arrhythmias 817
James R. Zaidan
When intraoperative arrhythmias cause hemodynamic compro¬
mise, it is important to determine what kind of therapy best suits
the patient. Unfortunately, electrical termination of arrhythmias
usually is not included in first line therapy. Pacing, cardioversion,
and defibrillation should be considered early in the therapeutic
plan, because they offer quick and generally predictable results
without further compromising the patients. This article offers
suggestions regarding the use of electrical therapy for controlling
intraoperative arrhythmias.
Vasopressor Therapy for Advanced Cardiac Life Support 835
Charles W. Otto
Epinephrine has been the standard vasopressor for use during
cardiac arrest since the inception of modern CPR. The effective¬
ness of epinephrine is due to its ability to increase myocardial
oxygen supply by improving coronary blood flow and pressure
through peripheral vasoconstriction. Myocardial stimulation
through beta adrenergic receptors is unimportant for resuscita¬
tion. Pure alpha adrenergic agents have been found to have simi¬
lar success to epinephrine but no better. When used for initial
therapy for cardiac arrest, higher doses of epinephrine have not
been found to promote better survival than the standard 0.015
mg/kg dose.
Pharmacologic Management of Arrhythmias During
Advanced Cardiac Life Support 849
Roger D. White
Clinicians providing acute cardiac care have a variety of drugs
available for treatment of supraventricular and ventricular ar¬
rhythmias. No single drug is effective in all circumstances. Drug
actions are typically nonspecific relative to the site of origin of
the arrhythmia, and adverse effects may accompany their use.
Therefore, an understanding of the appropriate drug to use for
each arrhythmia is essential as is a knowledge of proper doses
and adverse effects. Finally, in many situations the intervention
needed is electrical, not pharmacologic.
CONTENTS ix
Improving Neurologic Outcome Following Cardiac Arrest 869
C. Thomas Wass and William L. Lanier
In this article we discuss mechanisms by which the brain becomes
injured during circulatory arrest. We also discuss the use of
therapies with proven or potential efficacy for improving out¬
come and the ideal delivery of those therapies. Finally, physio¬
logic conditions and pharmacologic interventions that should be
avoided because they offer no benefit to the patient and may
diminish the patient s chances for optimal recovery are reviewed.
Intraoperative Cardiac Arrest 905
Christopher J. O Connor
Cardiac arrest during the intraoperative period is not an uncom¬
mon event and may be associated with a high mortality. This
article reviews the incidence, etiology, and pathophysiology of
intraoperative cardiac arrest. In addition, the potential role of
portable percutaneous cardiopulmonary bypass systems in the
treatment of refractory intraoperative cardiac arrest is discussed.
Management of Acute Myocardial Infarction 923
Gary L. Schaer
The therapy of acute myocardial infarction has undergone dra¬
matic evolution over the past 15 years. Randomized clinical trials
have proven that reperfusion of the occluded coronary artery
with intravenous thrombolytic therapy or immediate coronary
angioplasty results in substantial clinical benefit. Additional clini¬
cal benefits have been demonstrated with adjunctive therapies
such as aspirin, heparin, p blockers, and angiotensin converting
enzyme inhibitors. These therapies aim to enhance the speed of
coronary reperfusion, reduce postinfarction angina and rein
farction, lessen left ventricular remodeling and aneurysm forma¬
tion, and decrease early and late cardiac mortality. Complications
of myocardial infarction, including postinfarction angina, cardio
genic shock and right ventricular infarction, require rapid diagno¬
sis and aggressive treatment.
Pediatric Cardiopulmonary Resuscitation 943
Charles L. Schleien, Barry Gelman, and John W. Kuluz
Successful outcome following cardiopulmonary arrest in children
remains low even with all of the advances in CPR methods and
drug therapies. The pathophysiologic principles as they apply to
pediatric CPR are discussed along with newer methods, including
the use of intraosseous access during resuscitation. The contro¬
versies regarding epinephrine dosing, the use of sodium bicar¬
bonate, calcium chloride, and glucose are reviewed. Other spe¬
cific pediatric problems such as treatment for SVT with
adenosine, neonatal resuscitation, and congenital heart disease
also are discussed.
X CONTENTS
Outcome Analysis of Basic and Advanced Cardiac Life
Support 981
Paul E. Pepe
Existing programs and operational plans for delivering basic and
advanced cardiac life support are usually assumed to be of clear
value and efficacy. In turn, failure to resuscitate a given cardiac
arrest patient is often seen as a physiologic problem of that
individual patient and not a failure of the system of care. Never¬
theless, several large scale outcome analyses have recently re¬
vealed fairly bleak survival rates in many emergency cardiac care
(ECC) systems generally thought to provide adequate service. As
a result, researchers have now promulgated conceptual para¬
digms (e.g., the Chain of Survival metaphor) for analyzing the
effectiveness of ECC systems, both in and outside of the hospital.
Still, a closer and qualified understanding of each link in such
chains (and the chain as a whole) is required to effectively evalu¬
ate weaknesses in the system, and, in turn, identify and provide
systemic interventions for poor outcomes.
Ethical Considerations for Cardiopulmonary Resuscitation 999
David M. Rothenberg
From its inception, CPR was designed to salvage patients who
suffered unexpected cardiac arrests. Children, drowning and elec¬
trocution victims, and patients undergoing anesthesia would ap¬
pear to benefit from this therapy. Unfortunately the application
of CPR to patients in the end stages of their disease processes
has created new ethical dilemmas primarily in regard to with¬
holding and withdrawing life support. By identifying patients in
whom CPR would have no benefit, i.e., by defining futility and
by instituting do not resuscitate (DNR) orders, these concerns
might be obviated. Futility of resuscitation, the DNR order, and
other ethical considerations as they apply to CPR are discussed
in this article.
Cumulative Index 1995 1017
Subscription Information Inside back cover
CONTENTS Xi
I
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| spelling | Current concepts in cardiac resuscitation David M. Rothenberg guest ed. Philadelphia [u.a.] Saunders 1995 XI S., S. 751 - 1035 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Anesthesiology clinics of North America 13,4 Wiederbelebung (DE-588)4065960-4 gnd rswk-swf Kardiovaskuläre Krankheit (DE-588)4024666-8 gnd rswk-swf Akutes Herzversagen (DE-588)4205992-6 gnd rswk-swf Intensivtherapie (DE-588)4027258-8 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Akutes Herzversagen (DE-588)4205992-6 s Wiederbelebung (DE-588)4065960-4 s DE-604 Kardiovaskuläre Krankheit (DE-588)4024666-8 s Intensivtherapie (DE-588)4027258-8 s Rothenberg, David M. Sonstige oth Anesthesiology clinics of North America 13,4 (DE-604)BV000600896 13,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007078405&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Current concepts in cardiac resuscitation Anesthesiology clinics of North America Wiederbelebung (DE-588)4065960-4 gnd Kardiovaskuläre Krankheit (DE-588)4024666-8 gnd Akutes Herzversagen (DE-588)4205992-6 gnd Intensivtherapie (DE-588)4027258-8 gnd |
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| title | Current concepts in cardiac resuscitation |
| title_auth | Current concepts in cardiac resuscitation |
| title_exact_search | Current concepts in cardiac resuscitation |
| title_full | Current concepts in cardiac resuscitation David M. Rothenberg guest ed. |
| title_fullStr | Current concepts in cardiac resuscitation David M. Rothenberg guest ed. |
| title_full_unstemmed | Current concepts in cardiac resuscitation David M. Rothenberg guest ed. |
| title_short | Current concepts in cardiac resuscitation |
| title_sort | current concepts in cardiac resuscitation |
| topic | Wiederbelebung (DE-588)4065960-4 gnd Kardiovaskuläre Krankheit (DE-588)4024666-8 gnd Akutes Herzversagen (DE-588)4205992-6 gnd Intensivtherapie (DE-588)4027258-8 gnd |
| topic_facet | Wiederbelebung Kardiovaskuläre Krankheit Akutes Herzversagen Intensivtherapie Aufsatzsammlung |
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