ABC of Resuscitation

Using over 100 illustrations and clear explanation, this fifth edition of the ABC of Resuscitation ABC FIFTH OF RESUSCITATION EDITION is a comprehensive and accessible guide containing practical information on all aspects of resuscitation including the latest advances in drugs, automated external defibrillators, and advanced life support. It has been revised in accordance with the latest guidelines from the European Resuscitation Council. Chapters include: ABC • Basic life support OF • Automated external defibrillators • Resuscitation in pregnancy • Resuscitation of infants and children • Cardiopulmonary resuscitation in primary care • Resuscitation of the patient with major trauma RESUSCITATION • Drugs and their delivery • The ethics of resuscitation Fifth edition The ABC of Resuscitation is an invaluable text for medical and paramedical practitioners, students, and all healthcare workers who need up to date information on resuscitation issues. Related titles from BMJ Books ABC of Intensive Care Acute Medical Emergencies Advanced Paediatric Life Support Major Incident Medical Management and Support Major Incident Management System Safe Transfer and Retrieval of Patients Special Incident Medical Management and Support Paediatric and Neonatal Critical Care Transport Pre-Hospital Paediatric Life Support Resuscitation Rules Colquhoun, Handley and Evans General Practice Edited by M C Colquhoun, A J Handley and T R Evans www.bmjbooks.com ABC OF RESUSCITATION Fifth Edition ABC OF RESUSCITATION Fifth Edition Edited by M C Colquhoun Chairman of the Resuscitation Council (UK) A J Handley Past chairman of the Resuscitation Council (UK) and Chairman of ILCOR working party on basic life support and T R Evans Past chairman of the Resuscitation Council (UK) © BMJ Publishing Group 2004 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission of the publishers. First edition 1986 Second edition 1990 Third edition 1995 Fourth edition 1999 This edition published in 2004 by BMJ Publishing Group, BMA House, Tavistock Square, London WC1H 9JR www.bmjbooks.com British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN 0 72791669 6 Typeset by Newgen Imaging Systems (P) Ltd., Chennai, India Printed and bound in Malaysia by Times Offset Cover image shows a computer-enhanced image of an electrocardiogram trace showing showing an abnormal heart beat (red). A healthy heartbeat is seen at the top (yellow) for comparison with permission from Mehan Kulyk/Science Photo Library Contents Contributors vi Introduction vii Introduction to the Fifth Edition ix Notes on the algorithm approach to resuscitation xi Acknowledgements xiii 1 Basic life support 1 Anthony J Handley 2 Ventricular fibrillation 5 Michael Colquhoun, Charles D Deakin, Douglas Chamberlain 3 The automated external defibrillator 12 Roy Liddle, C Sian Davies, Michael Colquhoun, Anthony J Handley 4 Asystole and pulseless electrical activity 16 Michael Colquhoun, A John Camm 5 Management of peri-arrest arrhythmias 20 Michael Colquhoun, Richard Vincent 6 Airway control, ventilation, and oxygenation 25 Robert Simons 7 Post-resuscitation care 32 Peter A Oakley, Anthony D Redmond 8 Resuscitation in pregnancy 36 Stephen Morris, Mark Stacey 9 Resuscitation at birth 39 Anthony D Milner 10 Resuscitation of infants and children 43 David A Zideman, Kenneth Spearpoint 11 Resuscitation in the ambulance service 50 Andrew K Marsden 12 Resuscitation in hospital 54 T R Evans 13 Cardiopulmonary resuscitation in primary care 58 Michael Colquhoun, Brian Steggles 14 Resuscitation of the patient with major trauma 63 Charles D Deakin 15 Near drowning 72 Mark Harries 16 Drugs and their delivery 75 Michael Colquhoun, David Pitcher, Jerry Nolan 17 Cardiac pacing and implantable cardioverter defibrillators 81 Michael Colquhoun, A John Camm 18 Infection risks and resuscitation 87 A J Harry Walmsley, David A Zideman 19 Teaching resuscitation 90 Ian Bullock, Geralyn Wynn, Carl Gwinnutt, Jerry Nolan, Sam Richmond, Jonathan Wylie, Bob Bingham, Michael Colquhoun, Anthony J Handley 20 Training manikins 97 Gavin D Perkins, Michael Colquhoun, Robert Simons 21 The ethics of resuscitation 102 Peter J F Baskett Index 107 v Contributors Peter J F Baskett Jerry Nolan Consultant Anaesthetist Emeritus, Frenchay Hospital and the Consultant Anaesthetist, Royal United Hospital, Bath Royal Infirmary, Bristol Peter A Oakley Bob Bingham Consultant in anaesthesia and trauma, Department of Consultant Anaesthetist, Great Ormond Street Hospital for Trauma Research, University Hospital of North Staffordshire, Children NHS Trust, London Stoke on Trent Ian Bullock Gavin D Perkins Head of Education and Training, Royal Brompton and Research Fellow in Intensive Care Medicine, Birmingham Harefield NHS Trust; and Honorary Clinical Teaching Fellow, Heartlands Hospital, Birmingham Imperial College, London David Pitcher A John Camm Consultant Cardiologist, Worcestershire Royal Hospital, Professor of Clinical Cardiology, St George’s Hospital Medical Worcester School, London Anthony D Redmond Douglas Chamberlain Professor of Emergency Medicine, Keele University, and Professor of Resuscitation Medicine, University of Wales Consultant in Emergency Medicine, the North Staffordshire College of Medicine, Cardiff Hospital NHS Trust, Stoke on Trent Michael Colquhoun Sam Richmond Senior Lecturer in Prehospital Care, Wales Heart Research Consultant Neonatologist, Sunderland Royal Hospital, Institute, Cardiff Sunderland C Sian Davies Robert Simons Programme Manager, National Defibrillator Programme, the Consultant Anaesthetist, Royal Free Hospital, London Department of Health, London Kenneth Spearpoint Charles D Deakin Senior Resuscitation Officer, Hammersmith Hospitals NHS Consultant Anaesthetist, Southampton University Hospital, Trust, London Southampton Mark Stacey T R Evans Consultant Obstetric Anaesthetist, Llandough Hospital and Consultant Cardiologist, Royal Free Hospital, London Community NHS Trust, South Glamorgan Carl Gwinnutt Brian Steggles Consultant Anaesthetist, Hope Hospital, Salford Chairman, Faculty of Prehospital Care, Royal College of Anthony J Handley Surgeons, Edinburgh Consultant Physician and Cardiologist, Colchester Richard Vincent Mark Harries Professor of Medicine, Brighton and Sussex Medical School, Consultant Physician, Northwick Park and St Mark’s NHS Brighton Trust, Harrow A J Harry Walmsley Roy Liddle Clinical Director and Consultant in Anaesthetics, East Sussex Resuscitation Training Officer, Wythenshaw Hospital, Hospitals NHS Trust, Eastbourne Manchester Jonathan Wylie Andrew K Marsden Consultant Neonatologist, The James Cook University Hospital, Consultant Medical Director, Scottish Ambulance Service, Middlesbrough Edinburgh Geralyn Wynn Anthony D Milner Resuscitation Training Officer, Royal Free Hospital, London Emetrius Professor of Neonatology, Guy’s and St Thomas’s David A Zideman Hospital Trust, London Consultant Anaesthetist, Hammersmith Hospital NHS Trust, Stephen Morris London Consultant Obstetric Anaesthetist, Llandough Hospital and Community NHS Trust, South Glamorgan vi Introduction The modern era of resuscitation began in 1960 with the publication of the classic paper by Jude, Kouwenhoven, and Knickerbocker on closed chest cardiac compression, which showed that the circulation could be maintained during cardiac arrest without the need for thoracotomy. A few years earlier Elam, Safar, and Gordon had established expired air ventilation as the most effective method for providing artificial ventilation for a patient who had stopped breathing. The effectiveness of closed chest defibrillation had been demonstrated by Zoll a few years earlier. By combining the techniques of chest compression with expired air ventilation, it became possible to maintain the viability of a patient in cardiopulmonary arrest until a defibrillator could be brought to the scene. Special units were established that were able to resuscitate patients at high risk of developing cardiac arrest, and special hospital cardiac arrest teams were created. After coronary care units were established for patients with acute myocardial infarction, it became apparent that most deaths from the condition occurred in the early stages, not because the myocardium was severely damaged, but because of potentially treatable disturbances in the cardiac rhythm. Once the effectiveness of resuscitation in hospital was established, the realisation that two thirds of deaths from coronary heart disease occurred before hospital admission led to attempts to provide coronary care, and particularly defibrillation, in the community. The credit for this development goes to Pantridge in Belfast, who pioneered the first mobile coronary care unit staffed by a doctor and nurse. This early experience confirmed the high incidence of lethal arrhythmias at the onset of myocardial infarction and many patients attended by the mobile units were successfully resuscitated from cardiac arrest. Pantridge and his coworkers also drew attention to the value of cardiopulmonary resuscitation (CPR) performed by bystanders before the arrival of the mobile unit. In the early 1970s, Leonard Cobb, a cardiologist in Seattle, inspired by these results, equipped paramedics with defibrillators and trained firefighters to act as first responders and perform basic life support.

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