By Michael Colquhoun, Anthony J. Handley, T. R. Evans
This advisor has concise and functional details on all facets of resuscitation. New guidance are only one of many adjustments to the fifth version of this publication as a number of the chapters were thoroughly rewritten.
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Should the patient’s condition deteriorate and adverse signs develop, immediate electrical cardioversion should be undertaken. Narrow complex tachycardia A narrow complex tachycardia is virtually always supraventricular in origin—that is, the activating impulse of the tachycardia passes through the AV node. ) access No Pulse Use VF protocol Yes Adverse signs? v. v. v. v. v. v. over 10 minutes, then 300 mg over 1 hour and repeat shock Further cardioversion as necessary For refractory cases consider additional pharmacological agents: amiodarone, lidocaine, procainamide or sotalol; or overdrive pacing Caution: drug induced myocardial depression Doses throughout are based on an adult of average body weight * Note 1: DC shock always given under sedation/general anaesthesia.
The first question that determines management is whether a palpable pulse is present. Pulseless ventricular tachycardia should be treated as cardiac arrest using the ventricular fibrillation or pulseless ventricular tachycardia protocols described in Chapter 2. If a pulse is present oxygen should be administered and intravenous access established if this has not already been done. Treatment will then be determined by the presence or absence of adverse signs. The algorithm describes four such signs: ● ● ● ● A systolic blood pressure less than 90 mmHg.
This is described in Chapter 1. Airway patency maintained by the head tilt/chin lift Spinal injury The casualty with suspected spinal injuries requires careful handling and should be managed supine, with the head and cervical spine maintained in the neutral anatomical position; constant attention is needed to ensure that the airway remains patent. The head and neck should be maintained in a neutral position using a combination of manual inline immobilisation, a semi-rigid collar, sandbags, spinal board, and securing straps.