Assuntos
Humanos , Masculino , Adulto , Pneumoperitônio/complicações , Pneumoperitônio/diagnóstico , Pneumoperitônio/tratamento farmacológico , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/tendências , Anestesia Local , Intubação Intratraqueal/métodos , Pneumoperitônio/cirurgia , Pneumoperitônio , Hemorragia/complicações , Hemorragia/tratamento farmacológico , Máscaras Laríngeas , Tomografia Computadorizada de Emissão/métodosRESUMO
The outcome for patients after an out-of-hospital cardiac arrest (OHCA) has been poor over many decades and single interventions have mostly resulted in disappointing results. More recently, some regions have observed better outcomes after redesigning their cardiac arrest pathways. Optimised resuscitation and prehospital care is absolutely key, but in-hospital care appears to be at least as important. OHCA treatment requires a multidisciplinary approach, comparable to trauma care; the development of cardiac arrest pathways and cardiac arrest centres may dramatically improve patient care and outcomes. Besides emergency medicine physicians, intensivists and neurologists, cardiologists are playing an increasingly crucial role in the post-resuscitation management, especially by optimising cardiac output and undertaking urgent coronary angiography/intervention.
Assuntos
Serviço Hospitalar de Cardiologia/tendências , Procedimentos Clínicos/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Parada Cardíaca Extra-Hospitalar/terapia , Reanimação Cardiopulmonar/tendências , Angiografia Coronária/tendências , Prestação Integrada de Cuidados de Saúde/tendências , Serviços Médicos de Emergência/tendências , Humanos , Hipotermia Induzida/tendências , Monitorização Fisiológica/tendências , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/diagnóstico , Equipe de Assistência ao Paciente/tendências , Prognóstico , Fatores de TempoAssuntos
Reanimação Cardiopulmonar/tendências , Cardioversão Elétrica/tendências , Parada Cardíaca/terapia , Fibrilação Ventricular/história , Cardiografia de Impedância/história , Cardiografia de Impedância/tendências , Reanimação Cardiopulmonar/história , Reanimação Cardiopulmonar/métodos , Cardioversão Elétrica/história , Eletrocardiografia/história , Eletrocardiografia/tendências , Feminino , Parada Cardíaca/diagnóstico , Parada Cardíaca/epidemiologia , História do Século XVIII , História do Século XIX , História do Século XX , História Antiga , Humanos , Masculino , Irlanda do Norte/epidemiologia , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/terapiaRESUMO
A strong consensus was reached for several changes in the guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) in the 1992 conference on CPR and ECC held by the Emergency Cardiac Care Committee of the American Heart Association. These new recommendations, together with differing recommendations of the European Resuscitation Council, are described. An unresponsive person with spontaneous respirations should be placed in the recovery position if no cervical trauma is suspected. Compared with endotracheal intubation, other airway-protecting devices such as combination esophageal-tracheal tubes are of minor acceptance. During ventilation, the time for filling the lungs is increased to 1.5-2 s to decrease the likelihood of gastric insufflation. Delivery of i.v. drugs can be enhanced by an i.v. flush of sodium chloride. In endotracheal drug administration, higher doses and drug dilution are recommended. In infants and children up to 6 years of age, the value of intraosseous drug administration is emphasized. For pulseless adult victims, the initial dosage of epinephrine of 1 mg i.v. remains unchanged. For repeat doses, high-dose epinephrine up to 0.1 mg/kg is classified as of uncertain but possible efficacy. For lidocaine, the recommended i.v. dosage is 1.5 mg/kg. Sodium bicarbonate and calcium are not routinely recommended for resuscitation. For atropine, the maximum dose is 0.04 mg/kg. If hypomagnesaemia is present in recurrent and refractory ventricular fibrillation, it should be corrected by administration of 1 to 2 g magnesium sulfate i.v. Thrombolytic agents are classified as useful and effective in acute myocardial infarction and should be administered as early as possible. Glucose-containing fluids are discouraged for resuscitative efforts.