Tension pneumothorax is a cause of traumatic cardiac arrest that must be considered and rapidly treated if suspected. Finger thoracostomy can be performed quickly and with a low rate of complications. It appears acceptable for use as a method of chest decompression in the pre-hospital environment. Further research is required to evaluate its use by non-HEMS crews, with consideration to integrating ultrasound detection into the clinical decision making where feasible.
Showing posts with label resuscitation. Show all posts
Showing posts with label resuscitation. Show all posts
Friday, 23 June 2017
Joint NMC/RCN statement regarding Decisions Relating to Cardiopulmonary Resuscitation
Guidance from the British Medical Association, the Resuscitation Council (UK), and the RCN regarding anticipatory decisions about whether or not to attempt resuscitation in a person when their heart stops or they stop breathing. The NMC is supportive of this guidance.
Thursday, 30 March 2017
Response to concerns about our guidance for doctors on attempting CPR and DNACPR orders
Clarification on the GMC's guidance on the Treatment and care towards the end of life,
Monday, 13 March 2017
Resuscitation to Recovery
A National Framework to improve
care of people with out-of-hospital cardiac arrest (OHCA) in England
Wednesday, 8 March 2017
In septic patients requiring fluid resuscitation does the bedside lung ultrasound be used to assess the pulmonary fluid status?
In [critically ill patients presenting to the emergency department with sepsis requiring fluid resuscitation], does [bedside lung ultrasound or b-lines assessment] be used to determine the [pulmonary fluid status]?
In patients presenting to the emergency department with severe sepsis requiring fluid resuscitation the use of lung ultrasound for determining the pulmonary fluid status remains unknown. The current data supporting this practice is missing. A coming prospective observational study will better document this clinical question by measuring the effect of fluid bolus with lung ultrasound in children diagnosed with sepsis.
In patients presenting to the emergency department with severe sepsis requiring fluid resuscitation the use of lung ultrasound for determining the pulmonary fluid status remains unknown. The current data supporting this practice is missing. A coming prospective observational study will better document this clinical question by measuring the effect of fluid bolus with lung ultrasound in children diagnosed with sepsis.
Monday, 20 February 2017
Should real resuscitationists use airway checklists?
New from BestBETs:
In [critically ill patients requiring endotracheal intubation] does [the use of a preprocedural checklist] reduce [the incidence of adverse events].
Current evidence suggests there may be a potential reduction in adverse events with the use of preprocedural checklists, during intubation of the critically ill patient outside a theatre environment. However, this evidence is level 3 at best and should be considered hypothesis generating. Further evidence is required before airway checklists can be considered a standard of care.
In [critically ill patients requiring endotracheal intubation] does [the use of a preprocedural checklist] reduce [the incidence of adverse events].
Current evidence suggests there may be a potential reduction in adverse events with the use of preprocedural checklists, during intubation of the critically ill patient outside a theatre environment. However, this evidence is level 3 at best and should be considered hypothesis generating. Further evidence is required before airway checklists can be considered a standard of care.
Tuesday, 24 January 2017
Confirmation of traumatic cardiac arrest in children
New from BestBETs
In [paediatric patients in (traumatic) cardiac arrest], [palpation of pulses] OR [auscultation of heart sounds] or [ultrasound] (or combinations of these) most accurately [confirms cardiac arrest].
Palpation of pulses is the only universally available method for which evidence exists, but this is unreliable – ensuring that the operator has sufficient clinical experience is essential. POCUS may increase diagnostic accuracy when available. Further work is needed in this area to be able to determine the optimal method or combination of methods for assessing cardiac arrest. In clinical settings, these methods are likely to be combined with other elements including clinical examination and physiological measurements in order to decide whether a cardiac arrest protocol should be initiated.
Palpation of pulses is the only universally available method for which evidence exists, but this is unreliable – ensuring that the operator has sufficient clinical experience is essential. POCUS may increase diagnostic accuracy when available. Further work is needed in this area to be able to determine the optimal method or combination of methods for assessing cardiac arrest. In clinical settings, these methods are likely to be combined with other elements including clinical examination and physiological measurements in order to decide whether a cardiac arrest protocol should be initiated.
Markers of futility of resuscitation for paediatric patients following a traumatic cardiac arrest:: a literature review to inform the PERUKI (PTCA) consensus study
New from BestBETs
In [paediatric patients (<18years)] with a [traumatic cardiac arrest] what are the [markers of futility for starting and terminating the resuscitation?]
Prolonged resuscitation beyond 15 minutes, fixed pupils, asystole and an absent pulse are all associated with a very poor outcome in terms of survival and neurological outcome in survivors. Despite this however, there are case reports of small numbers of children having a good outcome despite prolonged resuscitation.
In [paediatric patients (<18years)] with a [traumatic cardiac arrest] what are the [markers of futility for starting and terminating the resuscitation?]
Prolonged resuscitation beyond 15 minutes, fixed pupils, asystole and an absent pulse are all associated with a very poor outcome in terms of survival and neurological outcome in survivors. Despite this however, there are case reports of small numbers of children having a good outcome despite prolonged resuscitation.
Can the value of end tidal CO2 prognosticate ROSC in patients coming into ED with an out of hospital cardiac arrest (OOHCA)?
New from BestBETs
A 60-year old gentleman is brought into the Emergency Department with an OOHCA. All monitoring is attached whilst ALS protocol is ongoing, including CO2 monitoring. You want to assess whether the patient is going to survive and thereby achieve a return of spontaneous circulation (ROSC) and you wonder whether the patient’s ETCO2 level can prognosticate this.
Current literature suggests that: 1) Our current ETCO2 aim of 10-20mmHg may be inadequate and should be modified to 25mmHg. 2) A 3-5 minute ETCO2 level of ≤10mmHg is associated with bad prognosis and as such, it may be beneficial to consider stopping patient resuscitation should this be the clinical case. 3) It is important to see the trend of ETCO2 rather than making a decision solely on one specific value, as sometimes an abrupt increase in ETCO2 could be a sign of impending ROSC. 4) More robust prospective data on the optimal ETCO2 value that is associated with ROSC would be helpful in defining a more accurate future target for intervention.
A 60-year old gentleman is brought into the Emergency Department with an OOHCA. All monitoring is attached whilst ALS protocol is ongoing, including CO2 monitoring. You want to assess whether the patient is going to survive and thereby achieve a return of spontaneous circulation (ROSC) and you wonder whether the patient’s ETCO2 level can prognosticate this.
Current literature suggests that: 1) Our current ETCO2 aim of 10-20mmHg may be inadequate and should be modified to 25mmHg. 2) A 3-5 minute ETCO2 level of ≤10mmHg is associated with bad prognosis and as such, it may be beneficial to consider stopping patient resuscitation should this be the clinical case. 3) It is important to see the trend of ETCO2 rather than making a decision solely on one specific value, as sometimes an abrupt increase in ETCO2 could be a sign of impending ROSC. 4) More robust prospective data on the optimal ETCO2 value that is associated with ROSC would be helpful in defining a more accurate future target for intervention.
Wednesday, 23 November 2016
Resus Estimated Times of Arrival – Just How Accurate Are They?
Emerg Med J 2016;33:922-923 doi:10.1136/emermed-2016-206402.42
Effective use of staff and facilities is one of the cornerstones of good Emergency Departments (EDs). An accurate estimated time of arrival (ETA) at the point of the alert call to the ED allows us to prepare efficiently prior to patients arriving.
If the patient arrives too early the receiving team may not be fully assembled and specialist equipment not readily available; too late and team members are inadvertently wasting time that could have been allocated to other tasks, or leave the Resuscitation Area (Resus).
We aimed to compare estimated versus actual time of arrival (ATA) of patients to Resus at UHCW ED in order to determine and quantify any difference.
UHCW Research: C Turner, H Patten and M Williams
Effective use of staff and facilities is one of the cornerstones of good Emergency Departments (EDs). An accurate estimated time of arrival (ETA) at the point of the alert call to the ED allows us to prepare efficiently prior to patients arriving.
If the patient arrives too early the receiving team may not be fully assembled and specialist equipment not readily available; too late and team members are inadvertently wasting time that could have been allocated to other tasks, or leave the Resuscitation Area (Resus).
We aimed to compare estimated versus actual time of arrival (ATA) of patients to Resus at UHCW ED in order to determine and quantify any difference.
UHCW Research: C Turner, H Patten and M Williams
Wednesday, 12 October 2016
Improving patient-practitioner communication
The NHS in Wales has run a nationwide campaign to improve dialogue between patients and healthcare practitioners on the issue of “do not attempt cardiopulmonary resuscitation” (DNACPR) orders among patients with a terminal illness.
This case study is most relevant to acute trusts, ambulance trusts, foundation trusts and NHS trusts.
This case study is most relevant to acute trusts, ambulance trusts, foundation trusts and NHS trusts.
Monday, 5 September 2016
Do Not Attempt Cardiopulmonary Resuscitation (DNACPR): Integrated Adult Policy
This policy from the Scottish Government is intended to prevent inappropriate, contraindicated and/or unwanted attempts at CPR which are of no benefit and may cause significant distress to patients and families
Thursday, 1 September 2016
Wednesday, 6 July 2016
Cardiovascular implanted electronic devices in people towards the end of life, during cardiopulmonary resuscitation and after death
New guidance from the Resuscitation Council (UK), British Cardiovascular Society and National Council for Palliative Care on cardiovascular implanted electronic devices in people towards the end of life, during cardiopulmonary resuscitation and after death.
Updated CPR advice aims to support decisions
Guidance on doctors’ responsibilities in relation to decisions concerning CPR (cardiopulmonary resuscitation) has been reviewed in light of recent statutory changes and a high court ruling.
The BMA, the Royal College of Nursing and the Resuscitation Council (UK) have produced updated joint guidance on the ethical principles that should inform how decisions about CPR are made and communicated.
The BMA, the Royal College of Nursing and the Resuscitation Council (UK) have produced updated joint guidance on the ethical principles that should inform how decisions about CPR are made and communicated.
Wednesday, 22 June 2016
How to improve ‘do not resuscitate’ decisions in England
This review has highlighted some variations in how ‘do not attempt cardiopulmonary resuscitation’ decisions are made across NHS hospitals. By describing the literature and giving examples where things have gone well and less well in the past it begins to surface promising areas for improvement. These include the designing and implementing of structured forms to record decisions, talking sensitively about the decisions with patients and their families early and letting other health professionals know what has been decided.
From the NIHR Dissemination Centre
From the NIHR Dissemination Centre
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