++
KEY CONCEPTS
Cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) should be considered any time an individual cannot adequately oxygenate or perfuse vital organs—not only following cardiac or respiratory arrest.
Regardless of which transtracheal jet ventilation system is chosen, it must be readily available, use low-compliance tubing, and have secure connections.
Chest compressions should not be delayed; intubation may take place during CPR or during the pulse check.
Attempts at intubation should not interrupt ventilation for more than 10 s.
Chest compressions should begin before the delivery of breaths in the pulseless patient. Circulation takes precedence over airway interventions and breathing in the cardiac arrest patient.
Whether adult resuscitation is performed by a single rescuer or by two rescuers, two breaths are administered every 30 compressions (30:2), allowing 3 to 4 s for every two breaths. The cardiac compression rate should be 100 to 120/min regardless of the number of rescuers.
Health care personnel working in hospitals and ambulatory care facilities must be able to provide early defibrillation to patients with ventricular fibrillation as soon as possible. The time from collapse to defibrillation is the most important determinant of survival. The chances for survival decline 7% to 10% for every minute without defibrillation.
If intravenous cannulation is difficult, an intraosseous infusion can provide emergency vascular access in children and adults.
Lidocaine, epinephrine, atropine, naloxone, and vasopressin (but not sodium bicarbonate) can be delivered via a catheter whose tip extends past the endotracheal tube. Dosages 2 to 2½ times higher than recommended for intravenous use, diluted in 5 to 10 mL of normal saline or distilled water, are recommended for adult patients.
Because carbon dioxide, but not bicarbonate, readily crosses cell membranes and the blood–brain barrier, arterial hypercapnia causes intracellular tissue acidosis.
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.
++
Cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (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 2020 American Heart Association (AHA) Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, which provides revised recommendations for establishing and maintaining the CABDs of cardiopulmonary resuscitation: Circulation, Airway, Breathing, and Defibrillation (Table 55–1, Figures 55–1 and 55–2). The 2020 CPR-ECC guidelines have been updated with new evidence-based recommendations. Points of particular importance 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 second lay rescuer is unavailable to perform mouth-to-mask ventilation, chest compressions alone are preferred to the primary rescuer attempting to do both. For the qualified health care provider, defibrillation using biphasic electrical current works best, and endotracheal tube (ETT) ...