CHAPTER 59: Resuscitation Procedures

INTRODUCTION

Emergency medical services primarily came into formal existence in the United States to serve one very important need: to provide field resuscitation to patients with severe cardiopulmonary conditions and major trauma. EMS physicians should be expert resuscitators evidenced by their mastery of all the techniques needed to provide the highest level of care. This is also the skill set needed to train and educate the EMS providers with which they work due to the obvious value of this basic prehospital intervention. ^1,2

PROCEDURES

• Cardiopulmonary resuscitation (CPR)

  • Standard CPR

  • Automated compression devices

  • External defibrillators

    • Automated external defibrillators

    • Multifunction monitor/defibrillators

• Airway and ventilatory management

  • Airwayg positioning

  • Airway adjuncts

    • Nasopharyngeal airways

    • Oropharyngeal airways

    • Bag-valve mask

  • NIPPV

    • Continuous positive airway pressure (CPAP)

    • Bilevel positive airway pressure (BiPAP)

  • Endotracheal Intubation

    • Direct laryngoscopy

    • Video-assisted laryngoscopy

    • Intubation adjuncts

      • Lighted stylets

      • Gum elastic bougie

  • Supraglottic airway devices

  • Rescue airway procedures

    • Percutaneous and surgical cricothyrotomy

    • Needle cricothyrotomy with transtracheal jet insufflation

    • Retrograde intubation

  • Airway placement confirmatory devices

    • Colorimetric carbon dioxide detectors

    • Capnography

  • Ventilators

• Vascular access

  • Peripheral venous access

  • Central venous access

  • Intraosseous access

    • Adult

    • Pediatric

  • Arterial lines

    • Radial

    • Femoral

  • Neonatal vascular access

    • Umbilical lines

    • Central lines

    • Peripheral access

CARDIOPULMONARY RESUSCITATION

Cardiopulmonary Resuscitation (CPR) is the manual or mechanical method of creating artificial circulation to temporarily provide vital organs, especially the brain and heart, with oxygenated blood until normal cardiopulmonary activity can be restored in a person in cardiac arrest.

STANDARD CPR

Indications

Cardiopulmonary arrest

Essential Equipment

• Pocket mask or bag-valve mask

• Automatic external defibrillator or multifunction monitor/defibrillator

Technique

• Step 1: Assess for responsiveness, absence of breathing, or presence of abnormal breathing/gasping.

• Step 2: Apply automatic external defibrillator (AED) or multifunction monitor/defibrillator.

  • If witnessed arrest or CPR initiated prior to arrival, use AED as indicated or multifunction monitor/defibrillator as indicated by rhythm interpretation.

  • Ensure continued CPR during charging. ³

  • If unwitnessed arrest or defibrillation not indicated, go to Step 3.

• Step 3: Assess circulation by checking for a pulse for 10 seconds.

  • Adults and children: carotid/femoral

  • Infants: brachial

• Step 4: If no pulse, begin cycle of compressions to ventilations at a ratio of 30:2 (universally for all ages). In children, if two providers are available for resuscitation, a ratio of 15:2 should be used.

  • Compressions:

    • Adults and children: Compress at least 5 cm (at least 2 in) at a rate no less than 100 compressions/min.

    • Infants: Compress 4cm (1.5 in) at a rate no less than 100 compressions/min.

  • Rescue breathing: Rescue breaths should be given once chest compressions have been initiated. Each breath should be delivered over 1 second with sufficient tidal volume to cause a visible chest rise.

• Step 5: Continue compressions to ventilations at a ratio of 30:2 for 5 cycles. After 5 cycles: stop. Reassess pulse. Reanalyze rhythm. ...