Resuscitation

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Resuscitation is the process of correcting physiological disorders (such as lack of breathing or heartbeat) in an acutely ill patient. It is an important part of intensive care medicine, trauma surgery and emergency medicine. Well known examples are cardiopulmonary resuscitation and mouth-to-mouth resuscitation.

In medicine, describing a disease as acute denotes that it is of short duration and, as a corollary of that, of recent onset. The quantitation of how much time constitutes "short" and "recent" varies by disease and by context, but the core denotation of "acute" is always qualitatively in contrast with "chronic", which denotes long-lasting disease. In addition, "acute" also often connotes two other meanings: sudden onset and severity, such as in acute myocardial infarction (AMI), where suddenness and severity are both established aspects of the meaning. It thus often connotes that the condition is fulminant, but not always. The one thing that acute MI and acute rhinitis have in common is that they are not chronic. They can happen again, but they are not the same case ongoing for months or years.

Intensive care medicine medical specialty concerned with patients who have potentially life-threatening organ failure

Intensive care medicine, or critical care medicine, is a branch of medicine concerned with the diagnosis and management of life-threatening conditions that may require sophisticated life support and intensive monitoring.

Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. Trauma surgeons generally complete residency training in General Surgery and often fellowship training in trauma or surgical critical care. The trauma surgeon is responsible for initially resuscitating and stabilizing and later evaluating and managing the patient. The attending trauma surgeon also leads the trauma team, which typically includes nurses and support staff as well as resident physicians in teaching hospitals.

Variables

SystemExample causesBiomarkerTreatment
Hypoperfusion (Circulatory shock) Haemorrhagic shock Hypovolemia (Hypovolemic shock) Intravascular volume status (Preload) Heart rate (Tachycardia) / Systolic blood pressure (Hypotension) / Decreased urine output Intravenous fluid / Intraosseous infusion / Blood transfusion with packed red blood cells
Cardiogenic shock Cardiac output Positive inotropic agents / Chronotropes
Distributive shock Sepsis (Septic shock) Vascular permeability Vasopressors
Neurogenic shock Total peripheral resistance
Obstructive shock Cardiac tamponade Beck's triad Pericardiocentesis/Thoracotomy with pericardial window
Tension pneumothorax Thoracentesis/Chest drain
Pulmonary embolism Thrombolysis/Embolectomy
Acid–base imbalance Acidosis pH Sodium bicarbonate
Alkalosis Interventional/Supportive
Gas exchange (Respiratory failure) Hypercapnia PaCO2 Interventional/Supportive
Hypoxia PaO2 Oxygen therapy
Altered level of consciousness Coma Narcosis (Drug overdose) / Stroke (Intracranial hemorrhage) Glasgow Coma Scale Interventional/Supportive
Blood sugar regulation Hyperglycemia Blood sugar Insulin
Hypoglycemia Glucose
Electrolyte imbalance Hyperkalemia Serum potassium Calcium chloride/Calcium diglutamate, others
Hypokalemia Potassium
Coagulopathy Hypocoagulability Coagulation screen Fresh frozen plasma/Cryoprecipitate/Platelets

See also

Advanced life support life-saving protocols

Advanced Life Support (ALS) is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation (breathing).

Advanced cardiac life support a set of clinical interventions for the urgent treatment of cardiac arrest, stroke and other life-threatening medical emergencies, as well as the knowledge and skills to deploy those interventions

Advanced cardiac life support, or advanced cardiovascular life support, often referred to by its abbreviation as "ACLS", refers to a set of clinical algorithms for the urgent treatment of cardiac arrest, stroke, myocardial infarction, and other life-threatening cardiovascular emergencies. Outside North America, Advanced Life Support (ALS) is used.

Advanced trauma life support Advance trauma life support

Advanced trauma life support (ATLS) is a training program for medical providers in the management of acute trauma cases, developed by the American College of Surgeons. Similar programs exist for immediate care providers such as paramedics. The program has been adopted worldwide in over 60 countries, sometimes under the name of Early Management of Severe Trauma, especially outside North America. Its goal is to teach a simplified and standardized approach to trauma patients. Originally designed for emergency situations where only one doctor and one nurse are present, ATLS is now widely accepted as the standard of care for initial assessment and treatment in trauma centers. The premise of the ATLS program is to treat the greatest threat to life first. It also advocates that the lack of a definitive diagnosis and a detailed history should not slow the application of indicated treatment for life-threatening injury, with the most time-critical interventions performed early. However, there is no high-quality evidence to show that ATLS improves patient outcomes as it has not been studied.

Related Research Articles

Cardiac arrest sudden stop in effective blood flow due to the failure of the heart to contract effectively

Cardiac arrest is a sudden loss of blood flow resulting from the failure of the heart to effectively pump. Signs include loss of consciousness and abnormal or absent breathing. Some individuals may experience chest pain, shortness of breath, or nausea before cardiac arrest. If not treated within minutes, it typically leads to death.

Cardiopulmonary resuscitation Emergency first-aid procedure for cardiac arrest.

Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is recommended in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.

Mouth-to-mouth resuscitation Artificial ventilation using exhaled air from the rescuer

Mouth-to-mouth resuscitation, a form of artificial ventilation, is the act of assisting or stimulating respiration in which a rescuer presses his or her mouth against that of the victim and blows air into the person's lungs. Artificial respiration takes many forms, but generally entails providing air for a person who is not breathing or is not making sufficient respiratory effort on his/her own. It is used on a patient with a beating heart or as part of cardiopulmonary resuscitation (CPR) to achieve the internal respiration.

Dead on arrival (DOA), also dead in the field and brought in dead (BID), indicates that a patient was found to be already clinically dead upon the arrival of professional medical assistance, often in the form of first responders such as emergency medical technicians, paramedics, or police.

Basic life support (BLS) is a level of medical care which is used for victims of life-threatening illnesses or injuries until they can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by qualified bystanders.

Airway management medical procedure ensuring an unobstructed airway

Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (aspiration).

Major trauma injury that could cause prolonged disability or death

Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Depending on the severity of injury, quickness of management and transportation to an appropriate medical facility may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment.

Pulseless electrical activity (PEA), refers to cardiac arrest in which the electrocardiogram shows a heart rhythm that should produce a pulse, but does not. Pulseless electrical activity is found initially in about 55% of people in cardiac arrest.

Intraosseous infusion the medical process of introducing medication directly into the bone marrow

Intraosseous infusion (IO) is the process of injecting directly into the marrow of a bone. This provides a non-collapsible entry point into the systemic venous system. This technique is used to provide fluids and medication when intravenous access is not available or not feasible. Intraosseous infusions allow for the administered medications and fluids to go directly into the vascular system. A comparison of intravenous (IV), intramuscular (IM), and intraosseous (IO) routes of administration concluded that the intraosseous route is demonstrably superior to intramuscular and comparable to intravenous administration. This route of fluid and medication administration is an alternative one to the preferred intravascular route when the latter cannot be established in a timely manner. Intraosseous infusions are utilized when trauma patients have compromised intravenous access and need immediate delivery of life saving fluids and medications.

Bag valve mask Artificial Manual Breathing Unit (AMBU Bag)

A bag valve mask, abbreviated to BVM and sometimes known by the proprietary name Ambu bag or generically as a manual resuscitator or "self-inflating bag", is a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately. The device is a required part of resuscitation kits for trained professionals in out-of-hospital settings (such as ambulance crews) and is also frequently used in hospitals as part of standard equipment found on a crash cart, in emergency rooms or other critical care settings. Underscoring the frequency and prominence of BVM use in the United States, the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care recommend that "all healthcare providers should be familiar with the use of the bag-mask device." Manual resuscitators are also used within the hospital for temporary ventilation of patients dependent on mechanical ventilators when the mechanical ventilator needs to be examined for possible malfunction or when ventilator-dependent patients are transported within the hospital. Two principal types of manual resuscitators exist; one version is self-filling with air, although additional oxygen (O2) can be added but is not necessary for the device to function. The other principal type of manual resuscitator (flow-inflation) is heavily used in non-emergency applications in the operating room to ventilate patients during anesthesia induction and recovery.

ABC (medicine) initialism mnemonics

ABC and its variations are initialism mnemonics for essential steps used by both medical professionals and lay persons when dealing with a patient. In its original form it stands for Airway, Breathing, and Circulation. The protocol was originally developed as a memory aid for rescuers performing cardiopulmonary resuscitation, and the most widely known use of the initialism is in the care of the unconscious or unresponsive patient, although it is also used as a reminder of the priorities for assessment and treatment of patients in many acute medical and trauma situations, from first-aid to hospital medical treatment. Airway, breathing, and circulation are all vital for life, and each is required, in that order, for the next to be effective. Since its development, the mnemonic has been extended and modified to fit the different areas in which it is used, with different versions changing the meaning of letters or adding other letters.

International Liaison Committee on Resuscitation

The International Liaison Committee on Resuscitation (ILCOR) was formed in 1992 to provide an opportunity for the major organizations in resuscitation to work together on CPR and ECC protocols. The name was chosen in 1996 to be a deliberate play on words relating to the treatment of sick hearts – "ill cor".

Pediatric Advanced Life Support (PALS) is a 2-day American Heart Association training program co-branded with the American Academy of Pediatrics. The goal of the course is to aid the pediatric healthcare provider in developing the knowledge and skills necessary to efficiently and effectively manage critically ill infants and children, resulting in improved outcomes. Professional healthcare providers use PALS during the stabilization and transportation phases of a pediatric emergency, in or out of hospital.

The following outline is provided as an overview of and topical guide to emergency medicine:

The H's and T's is a mnemonic used to aid in remembering the possible reversible causes of cardiac arrest. A variety of disease processes can lead to a cardiac arrest; however, they usually boil down to one or more of the "H's and T's".

Resuscitative thoracotomy thoracotomy performed to resuscitate a major trauma patient in cardiac arrest

A resuscitative thoracotomy is a thoracotomy performed to resuscitate a major trauma patient who has sustained severe thoracic or abdominal trauma and who has entered cardiac arrest because of this. The procedure allows immediate direct access to the thoracic cavity, permitting rescuers to control hemorrhage, relieve cardiac tamponade, repair or control major injuries to the heart, lungs or thoracic vasculature, and perform direct cardiac massage or defibrillation. For most persons with thoracic trauma the procedure is not necessary; only 15% of those with thoracic injury require the procedure.