European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution
Section snippets
Overview
Electrolyte abnormalities can cause cardiac arrhythmias or cardiopulmonary arrest. Life-threatening arrhythmias are associated most commonly with potassium disorders, particularly hyperkalaemia, and less commonly with disorders of serum calcium and magnesium. In some cases therapy for life-threatening electrolyte disorders should start before laboratory results become available.
The electrolyte values for definitions have been chosen as a guide to clinical decision-making. The precise values
General considerations
Poisoning rarely causes cardiac arrest, but is a leading cause of death in victims younger than 40 years of age.22 Evidence for treatment consists primarily of small case-series, animal studies and case reports. Poisoning by therapeutic or recreational drugs and by household products are the main reasons for hospital admission and poison centre calls. Inappropriate drug dosing, drug interactions and other medication errors can also cause harm. Accidental poisoning is commonest in children.
Overview
Drowning is a common cause of accidental death in Europe. After drowning the duration of hypoxia is the most critical factor in determining the victim's outcome; therefore, oxygenation, ventilation, and perfusion should be restored as rapidly as possible. Immediate resuscitation at the scene is essential for survival and neurological recovery after a drowning incident. This will require provision of CPR by a bystander and immediate activation of the EMS system. Victims who have spontaneous
Definition
Accidental hypothermia exists when the body core temperature unintentionally drops below 35 °C. Hypothermia can be classified arbitrarily as mild (35–32 °C), moderate (32–28 °C) or severe (less than 28 °C).230 The Swiss staging system231 based on clinical signs can be used by rescuers at the scene to describe victims: stage I – clearly conscious and shivering; stage II – impaired consciousness without shivering; stage III – unconscious; stage IV – no breathing; and stage V – death due to
Definition
Hyperthermia occurs when the body's ability to thermoregulate fails and core temperature exceeds that normally maintained by homeostatic mechanisms. Hyperthermia may be exogenous, caused by environmental conditions, or secondary to endogenous heat production.
Environment-related hyperthermia occurs where heat, usually in the form of radiant energy, is absorbed by the body at a rate faster than can be lost by thermoregulatory mechanisms. Hyperthermia occurs along a continuum of heat-related
Definition of anaphylaxis
A precise definition of anaphylaxis is not important for its emergency treatment. There is no universally agreed definition. The European Academy of Allergology and Clinical Immunology Nomenclature Committee proposed the following broad definition342: Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction. This is characterised by rapidly developing life-threatening airway and/or breathing and/or circulation problems usually associated with skin and mucosal
8h. Cardiac arrest following cardiac surgery
Cardiac arrest following major cardiac surgery is relatively common in the immediate post-operative phase, with a reported incidence of 0.7–2.9%.392, 393, 394, 395, 396, 397, 398, 399, 400 It is usually preceded by physiological deterioration,401 although it can occur suddenly in stable patients.398 There are usually specific causes of cardiac arrest, such as tamponade, hypovolaemia, myocardial ischaemia, tension pneumothorax, or pacing failure. These are all potentially reversible and if
Diagnosis of traumatic cardiorespiratory arrest
The diagnosis of TCRA is made clinically: the trauma patient is
Overview
Mortality related to pregnancy in developed countries is rare, occurring in an estimated 1:30,000 deliveries.478 The fetus must always be considered when an adverse cardiovascular event occurs in a pregnant woman. Fetal survival usually depends on maternal survival. Resuscitation guidelines for pregnancy are based largely on case series, extrapolation from non-pregnant arrests, manikin studies and expert opinion based on the physiology of pregnancy and changes that occur in normal labour.
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