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  • Image not available.Cardiopulmonary resuscitation and emergency cardiac care should be considered any time an individual cannot adequately oxygenate or perfuse vital organs—not only following cardiac or respiratory arrest.
  • Image not available.Regardless of which transtracheal jet ventilation system is chosen, it must be readily available, use low-compliance tubing, and have secure connections.
  • Image not available.Ventilation (and chest compressions) should not be delayed for intubation if a patent airway is established by a jaw-thrust maneuver.
  • Image not available.Attempts at intubation should not interrupt ventilation for more than 30 s.
  • Image not available.Chest compressions should be immediately initiated in the pulseless patient.
  • Image not available.Whether adult resuscitation is performed by a single rescuer or by two rescuers, two breaths are administered every 15 compressions (15:2), allowing 2 s for each breath. The cardiac compression rate should be 100/min regardless of the number of rescuers.
  • Image not available.Health care personnel working in hospitals and ambulatory care facilities must be able to provide early defibrillation to collapsed patients with ventricular fibrillation as soon as possible. Shock should be delivered within 3 min (± 1 min) of arrest.
  • Image not available.Lidocaine, epinephrine, atropine, and vasopressin but not sodium bicarbonate can be delivered down a catheter whose tip extends past the tracheal tube. Dosages 2–2½ times higher than recommended for intravenous use, diluted in 10 mL of normal saline or distilled water, are recommended for adult patients.
  • Image not available.If intravenous cannulation is difficult, an intraosseous infusion can provide emergency vascular access in children.
  • Image not available.Because carbon dioxide, but not bicarbonate, readily crosses cell membranes and the blood–brain barrier, the resulting arterial hypercapnia will cause intracellular tissue acidosis.
  • Image not available.A wide QRS complex following a pacing spike signals electrical capture, but mechanical (ventricular) capture must be confirmed by an improving pulse or blood pressure.


Image not available.One goal of anesthesiology is to maintain the function of vital organ systems during surgery. It is not surprising, therefore, that anesthesiologists have played a major role in the development of cardiopulmonary resuscitation techniques outside the operating room. Cardiopulmonary resuscitation and emergency cardiac care (CPR-ECC) should be considered any time an individual cannot adequately oxygenate or perfuse vital organs–not only following cardiac or respiratory arrest.


This chapter presents an overview of the American Heart Association and the International Liaison Committee on Resuscitation (ILCOR) Year 2000 recommendations for establishing and maintaining the ABCDs of cardiopulmonary resuscitation: Airway, Breathing, Circulation, and Defibrillation. The best outcomes, however, come from instituting ECC (Table 47–1, Figures 47–1 and 47–2). The guidelines have been updated for 2000 with new guidelines planned for 2006, and they are now more than ever evidence based and international. Major changes for the layperson are that the pulse should not be checked, and chest compression without ventilation may be as effective as compression with ventilation for the first several minutes. If a lay-bystander is unwilling to perform mouth-to-mouth ventilation, chest compressions alone are preferred to doing nothing. For the health care provider, defibrillation using biphasic electrical current works best, tracheal tube (TT) placement should be confirmed with a qualitative end-tidal CO2...

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