tailieunhanh - The essentials and more of critical care medicine: Part 2

(BQ) Continued part 1, part 2 of the document The essentials and more of critical care medicine has contents: Venous thromboembolism, obstructive disease and ventilatory failure, thermal disorders, hepatic failure, drug overdose and poisoning, neurologic emergencies,. and other contents. Invite you to refer. | Chapter 20 Cardiopulmonary Arrest Key Points 1. The success hospital discharge without neurological impairment of cardiopulmonary resuscitation is highly variable among patient populations. Cardiopulmonary resuscitation is very effective when applied promptly to patients with sudden cardiac death because of electrical instability but is quite ineffective when applied in chronically debilitated patients and those suffering arrest as part of the natural progression of multiple organ failure. 2. The goal of resuscitation is to preserve neurological function by rapidly restoring oxygenation ventilation and circulation to patients with arrested circulation. 3. The resuscitation status of every patient admitted to the ICU should be considered at admission. When a clear determination regarding resuscitation status cannot be made quickly the physician generally should err on the side of promptly initiating resuscitation efforts. Obvious exceptions to this recommendation apply when cardiopulmonary resuscitation is prohibited by patient mandate or not indicated because it cannot produce successful results. 4. Most successful resuscitations require only 2 to 3 minutes. In these establishing a patent airway and promptly applying direct current shocks to reestablish a perfusing rhythm are the key actions necessary. It is quite uncommon to successfully resuscitate a patient after more than 20 to 30 minutes of effort. A notable exception to this rule occurs in patients with hypothermia who are occasionally resuscitated after hours of effort. 5. Although widely published guidelines provide a framework for resuscitation cardiopulmonary arrest in a hospitalized patient often has a specific cause therefore resuscitative efforts should be individualized. Common situations are outlined in Table 20-1. 6. In most cases reestablishing an effective rhythm involves either the application of direct current shocks to terminate ventricular fibrillation or tachyarrhythmia or the acceleration of