tailieunhanh - RESUSCITATION - PART 9

Không có bằng chứng tốt cho việc sử dụng các openchest ép tim ở những bệnh nhân bị ngừng tim asthmaassociated. Làm việc thông qua Hs bốn và Ts bốn sẽ xác định các khóa học có khả năng hồi phục của bệnh hen suyễn có liên quan đến ngừng tim. | European Resuscitation Council Guidelines for Resuscitation 2005 S151 Dynamic hyperinflation increases transthoracic Consider the higher shock energies for defibrillation if initial defibrillation attempts fail. There is no good evidence for the use of openchest cardiac compressions in patients with asthma-associated cardiac arrest. Working through the four Hs and four Ts will identify potentially reversible courses of asthma related cardiac arrest. Tension pneumothorax can be difficult to diagnose in cardiac arrest it may be indicated by unilateral expansion of the chest wall shifting of the trachea and subcutaneous emphysema. Release air from the pleural space with needle decompression. Insert a large-gauge cannula in the second intercostal space in the mid clavicular line being careful to avoid direct puncture of the lung. If air is emitted insert a chest tube. Always consider bilateral pneumothoraces in asthma-related cardiac arrest. Post-resuscitation care The following should be added to usual management after ROSC Optimise the medical management of bronchospasm. Use permissive hypercapnia it may not be possible to achieve normal oxygenation and ventilation in a patient with severe bronchospasm. Efforts to achieve normal arterial blood gas values may worsen lung injury. Mild hypoventilation reduces the risk of barotraumas and hypercap-noea is typically Target lower arterial blood oxygen saturations . 90 . Provide sedation neuromuscular paralysis if needed and controlled ventilation. Despite the absence of formal studies ketamine and inhala-tional anaesthetics have bronchodilator properties that may be useful in the asthmatic patient who is difficult to ventilate. Involve a senior critical care doctor early. 7g. Anaphylaxis Introduction Anaphylaxis is a rare but potentially reversible cause of cardiac arrest. Although the management of cardiac arrest secondary to anaphylaxis follows the general principles described elsewhere