DOCSLIB.ORG

Drowning Three Peaks

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Drowning Three Peaks Drowning Three Peaks • Toddlers • Adolescents • Elderly In drowning... air hunger and usually panic Reflex inspiratory efforts lead to aspiration of water and laryngospasm asphyxia and hypoxaemia / acidosis Hypoxemia Occlusion of airways with water & particulate debris Changes in surfactant activity Bronchospasm Right-to-left shunting increased Physiologic dead space increased Asphyxia Laryngospasm maintained Relaxation of the airway Respiratory arrest Water enters lungs Cardiac arrest Surfactant washout V / Q mismatch* “Dry drowning” “Wet drowning” *mechanism in fresh and salt water slightly different Near Drowning Pulmonary Injury • Aspiration as little as 1-3 cc/kg can cause significant effect on gas exchange – Increased permeability – Exudation of proteinaceous material in alveoli – Pulmonary edema – decreased compliance Anoxic-ischemic injury • All organs may injured from hypoxia and ischemia . • CNS injury (ICP ,cerebral edema) The most frequent cause of mortality and long- term morbidity Pathophysiologic Changes Neurologic Effects • Cerebral edema 24 - 72 hours following injury • Loss of autoregulation of blood flow • Reperfusion injury Anoxic-ischemic injury • Pulmonary: wash out surfactant Pulmonary edema, ARDS • Cardiovascular: Arrhythmia( hypothermia ,hypoxemia) • Acid-base • Electrolytes Anoxic-ischemic injury • Renal ATN (hypoxemia,shock, hemoglobinuria) • Gasterointestinal hepatic trasaminases and serum pancratic enzymes are often acutely elevated Hypothermia • Mild hypothermia:T(34-36) • Moderate hypothermia T(30-34) increase oxygen consumption. • Below T 30: (sever hypothermia) shivering ceases and cellular metabolic rate decreases On moderate to sever hypothermia we have progressive bardycardia and hypotention hypoventilation • Deep coma with fixed and dilated pupils and absent reflexes at T (25-29) may give the false appearance of death Initial Assessment and Resuscitation Restating the obvious Initial Assessment and Resuscitation • Specialized issues – Abdominal thrust should not be used: thought to clear airways of liquid obstruction • Amount of fluid is usually small and non- obstructive • May increase risk of aspiration of gastric contents • Do not waste time, correcting hypoxia is paramount Immediate hospital management • Assess and manage ABC • 100% oxygen • Pulse oximetry (watch for false readings caused by peripheral shutdown and acidosis) • ABGs, FBC, U&E • CXR • Observation • Management of associated hypothermia Initial Assessment and Resuscitation • IV fluids N/S 10-20CC/kg or ringer lactate • Don’t use hypotonic serum or glucose • Marked vasoconstriction:epinephrine Hospital-based evaluation • Observed least 6-8 hr if they are asymptomatic on presentation to the ED serial monitoring of vital sign and pulmonary and neurologic assesment • 50% asypmtomatic child experience some level of respiratory distress • Pulmonary edema during the 1st 4-8 hr after submersion Laboratory • Arterial blood gases • Electrolytes • BUN/ Creatinine • Platelets/ PT & PTT/ CBC • Serum & Urine Hemoglobin Labs & tests • Very mild electrolyte changes • EKG – Sinus tachycardia & nonspecific • Moderate leukocytosis ST-segment and T-wave • Hct and Hgb usually normal changes initally – Reverts to normal within hours – Fresh water aspiration, the Hct – Ominous - ventricular arrhythmias, complete heart may fall slightly in the first 24 hrs block due to hemolysis • CXR – Increase in free Hgb without a change in Hct is common – May be normal initially despite severe respiratory disturbances • DIC occasionally – Patchy infiltrates • ABG – metabolic acidosis & – Pulmonary edema hypoxemia Imaging • Head CT scan is not helpful unless : 1. Suspicion of associated trauma injury 2. to rule out other possible causes of coma • MRI may detect change associated with hypoxic- ischemic injuries Therapy for the lungs • CPAP or PEEP • Aerosolized β-agonists for bronchospasm • Bronchoscopy • Prophylactic antibiotics have not been shown to be beneficial • Steroids: – No controlled human studies to support use – Animal models and retrospective studies in humans have failed to demonstrate benefit Brain therapy • ICP monitoring - not indicated, typically irreversible hypoxic cellular injury • Brain CT – not indicated, • Mild hyperventilation-Osmotherapy – diuretic-barbiturates not indicated • Corticosteroids (dexamethasone) - no proven benefit • Seizures - treat aggressively with fosphenytoin or phenytoin • Shivering or random, purposeless movements can increase ICP • Hypothermia and barbiturate coma - highly controversial & unlikely to benefit the patient Bad prognostic indicators • Submerged >10 min • Age <3 years • Time till BLS >10 min • Initial ABG pH <7.1 • CPR >25 min • Initial core temp <33o • Initial GCS <5 deep • hyperglycemia coma • apnea Good Prognostic Factors • Older child or young adult • Cold water • Adequate CPR/on scene ACLS/BLS • Conscious • Short submersion • Healthy Outcomes Long Term Prognosis • Overall, >15% survivors with significant neurologic deficits • Children with spontaneous, purposeful movements and had a normal brainstem examination at 24 hours progressed to full recovery • Those without these findings by 24 hours suffered severe neurologic deficits or death Recommendations • Pre-hospital resuscitation, including early intubation, ventilation, vascular access, and administration of advanced life support medications • Continued resuscitation and stabilization in the ED • Full supportive care in the ICU for a minimum of 48 hrs.
Load more

Recommended publications
  • Influence of a Six-Week Swimming Training with Added Respiratory
    International Journal of Environmental Research and Public Health Article Influence of a Six-Week Swimming Training with Added Respiratory Dead Space on Respiratory Muscle Strength and Pulmonary Function in Recreational Swimmers Stefan Szczepan 1,* , Natalia Danek 2 , Kamil Michalik 2 , Zofia Wróblewska 3 and Krystyna Zato ´n 1 1 Department of Swimming, Faculty of Physical Education, University School of Physical Education in Wroclaw, Ignacego Jana Paderewskiego 35, Swimming Pool, 51-612 Wroclaw, Poland; [email protected] 2 Department of Physiology and Biochemistry, Faculty of Physical Education, University School of Physical Education in Wroclaw, Ignacego Jana Paderewskiego 35, P-3 Building, 51-612 Wroclaw, Poland; [email protected] (N.D.); [email protected] (K.M.) 3 Faculty of Pure and Applied Mathematics, Wroclaw University of Science and Technology, Zygmunta Janiszewskiego 14a, C-11 Building, 50-372 Wroclaw, Poland; zofi[email protected] * Correspondence: [email protected]; Tel.: +48-713-473-404 Received: 5 July 2020; Accepted: 6 August 2020; Published: 8 August 2020 Abstract: The avoidance of respiratory muscle fatigue and its repercussions may play an important role in swimmers’ health and physical performance. Thus, the aim of this study was to investigate whether a six-week moderate-intensity swimming intervention with added respiratory dead space (ARDS) resulted in any differences in respiratory muscle variables and pulmonary function in recreational swimmers. A sample of 22 individuals (recreational swimmers) were divided into an experimental (E) and a control (C) group, observed for maximal oxygen uptake (VO2max). The intervention involved 50 min of front crawl swimming performed at 60% VO2max twice weekly for six weeks.
    [Show full text]
  • Calculation of Dead Space - Relevance in Critical Care
    CALCULATION OF DEAD SPACE - RELEVANCE IN CRITICAL CARE Kodati Rakesh Dead space • Dead space calculation • CO2 measurement • Effect of mechanical ventilation • ARDS • Recruitment & proning • Pulmonary embolism • Weaning DEAD SPACE CALCULATION Dead space • Volume of the airways and lungs that does not participate in gas exchange • Anatomical dead space – Volume of conducting airways – Upper airways, larynx, trachea, bronchi and bronchioles – Does not include respiratory bronchioles and alveoli • Physiologic dead space (VDphys) – Total volume of the lungs that does not participate in gas exchange – Includes anatomic dead space plus a functional dead space in the alveoli Dead space Dead space Difference b/w expected & actual composition of the effluent media Basis for calculating dead space and shunt Dead space Rileys 3 compartment model Alveoli groups according to V/Q ratios A – normal perfusion, no ventilation (shunt V/Q of 0) B – normal perfusion & ventilation (shunt V/Q of 1) C – normal ventilation, no perfusion (shunt V/Q of infinity) Physiological dead space (VD phys) Airway dead space (VD aw) Alveolar dead space (VD alv) Riley RL et al, J App Physiol 1949 Dead space Bohrs dead space • Danish physiologist Christian Bohr in 1891 • Mass balance calculation dilution of the expired gas by the inspiratory gas filling the conductive airways FACO2 - mean alveolar CO2 concentration sample of gas collected late in exhalation FECO2 fractional CO2 concentration in the total mixed exhaled breath H. Thomas Robertson, Eur Respir J 2015; 45 Tusman G et al, Anesth Analg 2012 Bohrs dead space • Fractions or partial pressures of CO2 are used interchangeably • FACO2 is the mean value of CO2 within the alveolar compartment • FE CO2 is calculated using formula VCO2/VT x (Pb – PH2O) H.
    [Show full text]
  • Dead Space and CO2 Elimination Related to Pattern of Inspiratory Gas
    Aboab et al. Critical Care 2012, 16:R39 http://ccforum.com/content/16/2/R39 RESEARCH Open Access Dead space and CO2 elimination related to pattern of inspiratory gas delivery in ARDS patients Jerome Aboab1, Lisbet Niklason2, Leif Uttman2, Laurent Brochard1,3 and Björn Jonson1,2* Abstract Introduction: The inspiratory flow pattern influences CO2 elimination by affecting the time the tidal volume remains resident in alveoli. This time is expressed in terms of mean distribution time (MDT), which is the time available for distribution and diffusion of inspired tidal gas within resident alveolar gas. In healthy and sick pigs, abrupt cessation of inspiratory flow (that is, high end-inspiratory flow (EIF)), enhances CO2 elimination. The objective was to test the hypothesis that effects of inspiratory gas delivery pattern on CO2 exchange can be comprehensively described from the effects of MDT and EIF in patients with acute respiratory distress syndrome (ARDS). Methods: In a medical intensive care unit of a university hospital, ARDS patients were studied during sequences of breaths with varying inspiratory flow patterns. Patients were ventilated with a computer-controlled ventilator allowing single breaths to be modified with respect to durations of inspiratory flow and postinspiratory pause (TP), as well as the shape of the inspiratory flow wave. From the single-breath test for CO2, the volume of CO2 eliminated by each tidal breath was derived. Results: A long MDT, caused primarily by a long TP, led to importantly enhanced CO2 elimination. So did a high EIF. Effects of MDT and EIF were comprehensively described with a simple equation.
    [Show full text]
  • Effect of Dead Space on Breathing Stability at Exercise in Hypoxia Eric Hermand, François Lhuissier, Jean-Paul Richalet
    Effect of dead space on breathing stability at exercise in hypoxia Eric Hermand, François Lhuissier, Jean-Paul Richalet To cite this version: Eric Hermand, François Lhuissier, Jean-Paul Richalet. Effect of dead space on breathing sta- bility at exercise in hypoxia. Respiratory Physiology & Neurobiology, 2017, 246, pp.26-32. 10.1016/j.resp.2017.07.008. hal-03189523 HAL Id: hal-03189523 https://hal.archives-ouvertes.fr/hal-03189523 Submitted on 3 Apr 2021 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. 1 Effect of dead space on breathing stability at exercise in hypoxia. 2 3 Eric Hermand1, François J Lhuissier1,2, Jean-Paul Richalet1 4 5 1Université Paris 13, Sorbonne Paris Cité, Laboratoire “Hypoxie et poumon”, EA2363, 6 Bobigny, France 7 2Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Physiologie, 8 explorations fonctionnelles et médecine du sport, 93009 Bobigny, France 9 10 11 Corresponding author [email protected] (J.P. Richalet) [email protected] (E. Hermand) 12 13 Laboratoire “Hypoxie & poumon”, EA2363 14 74 rue Marcel Cachin 15 93017 Bobigny Cedex, FRANCE 16 Tel: +33148387758 / Fax: +33148388924 17 18 19 Word count for manuscript: 2946 20 21 22 Key words: Control of ventilation, hypoxia, exercise, periodic breathing, breathing 23 instability, dead space, alveolar ventilation 24 25 26 27 28 29 30 Abstract 31 Recent studies have shown that normal subjects exhibit periodic breathing when submitted to 32 concomitant environmental (hypoxia) and physiological (exercise) stresses.
    [Show full text]
  • How Am I Supposed to Breathe with No Air? Nikki Lewis, CVT, VTS (ECC) 2016 ISVMA Conference Proceedings
    How am I supposed to breathe with no air? Nikki Lewis, CVT, VTS (ECC) 2016 ISVMA Conference Proceedings When the respiratory center begins to fail, functions such as oxygenation and elimination of carbon dioxide are compromised. This results in hypercapnia and hypoxemia. The major components of gas exchange are the lungs and the respiratory muscles which provide a force or pump to the lungs. If either one of these primary functions are compromised it can result in respiratory failure. Assessment of oxygenation and ventilation To accurately define respiratory failure, you must evaluate arterial blood gasses. A partial pressure of oxygen (PaO2) that’s less than 60mmHg and a partial pressure of carbon dioxide (PaCO2) of greater than 50mmHg define respiratory failure. The term partial pressure refers to the total pressure exerted by a single molecule of this gas. There are several molecules all combined in a cell; however, the partial pressure is the single gas’ pressure. Pulse oximetry is another method of quantifying oxygenation, although not as precise as arterial blood gasses. This is an indirect measurement of PaO2. A pulse oximetry measurement of 91-100% typically reflects a PaO2 of 80-100mmHg, which is a normal value. If the pulse oximetry falls below 91% this results in a rapid drop of the PaO2. Several factors can make the pulse oximetry reading false. These include pigmented tissues, motion and methemoglobinemia. Lastly, the measurement of end-tidal CO2 (ETCO2) will evaluate proper gas exchange. This is done by intubating the patient and using capnography. Capnography measures the expired CO2. Normal ETCO2 range is 35-45mmHg.
    [Show full text]
  • Miniaturization of Respiratory Measurement System in Artificial
    sensors Article Miniaturization of Respiratory Measurement System in Artificial Ventilator for Small Animal Experiments to Reduce Dead Space and Its Application to Lung Elasticity Evaluation Homare Yoshida 1,*, Yoshihiro Hasegawa 1, Miyoko Matsushima 2, Tomoshi Sugiyama 3, Tsutomu Kawabe 2 and Mitsuhiro Shikida 1 1 Department of Biomedical Information Sciences, Hiroshima City University, Hiroshima 731-3194, Japan; [email protected] (Y.H.); [email protected] (M.S.) 2 Division of Host Defense Sciences, Omics Health Sciences, Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya 461-0047, Japan; [email protected] (M.M.); [email protected] (T.K.) 3 Department of Thoracic Surgery, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; [email protected] * Correspondence: [email protected] Abstract: A respiratory measurement system composed of pressure and airflow sensors was intro- duced to precisely control the respiratory condition during animal experiments. The flow sensor was a hot-wire thermal airflow meter with a directional detection and airflow temperature change compensation function based on MEMS technology, and the pressure sensor was a commercially available one also produced by MEMS. The artificial dead space in the system was minimized to × Citation: Yoshida, H.; Hasegawa, Y.; the value of 0.11 mL by integrating the two sensors on the same plate (26.0 mm 15.0 mm). A Matsushima, M.; Sugiyama, T.; Kawabe, balloon made of a silicone resin with a hardness of A30 was utilized as the simulated lung system T.; Shikida, M.
    [Show full text]
  • Underwater Physiology Is As Important As a Knowledge of Diving Gear and Proce- Dures
    CHAPTER 3 8QGHUZDWHU3K\VLRORJ\ 3-1 INTRODUCTION 3-1.1 Purpose. This chapter provides basic information on human physiology and anatomy as it relates to working in the underwater environment. Physiology is the study of the processes and functions of the body. Anatomy is the study of the structure of the organs of the body. 3-1.2 Scope. This chapter contains basic information intended to provide a fundamental understanding of the physiological processes and functions that are affected when humans are exposed to the underwater environment. A diver’s knowledge of underwater physiology is as important as a knowledge of diving gear and proce- dures. Safe diving is only possible when the diver fully understands the fundamental physiological processes and limitations at work on the human body in the underwater environment. 3-1.3 General. A body at work requires coordinated functioning of all organs and systems. The heart pumps blood to all parts of the body, the tissue fluids exchange dissolved materials with the blood, and the lungs keep the blood supplied with oxygen and cleared of excess carbon dioxide. Most of these processes are controlled directly by the brain, nervous system, and various glands. The indi- vidual is generally unaware that these functions are taking place. As efficient as it is, the human body lacks effective ways of compensating for many of the effects of increased pressure at depth and can do little to keep its internal environment from being upset. Such external effects set definite limits on what a diver can do and, if not understood, can give rise to serious accidents.
    [Show full text]
  • Diving Physiology 3
    Diving Physiology 3 SECTION PAGE SECTION PAGE 3.0 GENERAL ...................................................3- 1 3.3.3.3 Oxygen Toxicity ........................3-21 3.1 SYSTEMS OF THE BODY ...............................3- 1 3.3.3.3.1 CNS: Central 3.1.1 Musculoskeletal System ............................3- 1 Nervous System .........................3-21 3.1.2 Nervous System ......................................3- 1 3.3.3.3.2 Lung and 3.1.3 Digestive System.....................................3- 2 “Whole Body” ..........................3-21 3.2 RESPIRATION AND CIRCULATION ...............3- 2 3.2.1 Process of Respiration ..............................3- 2 3.3.3.3.3 Variations In 3.2.2 Mechanics of Respiration ..........................3- 3 Tolerance .................................3-22 3.2.3 Control of Respiration..............................3- 4 3.3.3.3.4 Benefits of 3.2.4 Circulation ............................................3- 4 Intermittent Exposure..................3-22 3.2.4.1 Blood Transport of Oxygen 3.3.3.3.5 Concepts of and Carbon Dioxide ......................3- 5 Oxygen Exposure 3.2.4.2 Tissue Gas Exchange.....................3- 6 Management .............................3-22 3.2.4.3 Tissue Use of Oxygen ....................3- 6 3.3.3.3.6 Prevention of 3.2.5 Summary of Respiration CNS Poisoning ..........................3-22 and Circulation Processes .........................3- 8 3.2.6 Respiratory Problems ...............................3- 8 3.3.3.3.7 The “Oxygen Clock” 3.2.6.1 Hypoxia .....................................3-
    [Show full text]
  • Analysis of Alveolar Ventilation Inthe Newborn
    Arch Dis Child: first published as 10.1136/adc.59.6.542 on 1 June 1984. Downloaded from Archives of Disease in Childhood, 1984, 59, 542-547 Analysis of alveolar ventilation in the newborn K SANDBERG, B A SJOQVIST, 0 HJALMARSON, AND T OLSSON Department of Paediatrics I, University of Goteborg and Research Laboratory of Medical Electronics, Chalmers University of Technology, Goteborg, Sweden SUMMARY Twelve healthy term infants were examined at the median ages of 21/2 and 26 hours. Their alveolar ventilation, efficiency of ventilation, functional residual capacity, and lung nitrogen elimination patterns were studied by means of a computerised nitrogen wash out method. The results showed that alveolar ventilation and functional residual capacity increased over the period studied. At the same time effective dead space decreased leaving minute ventilation unchanged. Distribution of ventilation did not change. In one critical phase at birth the lungs of the interrupted and repeated. A second test was not newborn take over the gas exchange function from performed for at least 15 minutes to allow for gas the placenta by establishing effective ventilation. In equilibration. The nitrogen concentration in the face the healthy infant sufficient function is achieved mask and the respiratory flow rate were sampled by within the first few breaths and steady state condi- a computer for subsequent calculations. The analy- tions are present after a few hours.' sis of the nitrogen wash out curve was performed on The efficiency of the ventilation obtained de- a PDP 11/40 computer and the software was written pends mainly on the volume of the ventilated in FORTRAN.
    [Show full text]
  • AIRWAY MANAGEMENT: HYPE ABOUT VENTILATION and the ANETHETIZED PATIENT Donna M
    AIRWAY MANAGEMENT: HYPE ABOUT VENTILATION AND THE ANETHETIZED PATIENT Donna M. Sisak, CVT, LVT, VTS (Anesthesia/Analgesia) Seattle Veterinary Specialists Kirkland, WA [email protected] “Life is not measured by the number of breaths we take but by the moments that take our breath away.” Author unknown An anesthetic event can be divided into the following components: premedication, induction, maintenance, and recovery. Each component is equally important and requires extreme vigilance by the anesthetist. Most of the drugs used (anesthetics/analgesics) throughout an anesthetic event are respiratory depressants. Until we obtain the patient’s airway (intubation) we really have no control over our patient’s ventilatory status and well-being. The patient is at risk of becoming hypoxic (inadequate O2 at the tissue level); eventually leading to other possible complications – aspiration pneumonia, decreased cardiac output (CO), decreased perfusion, and potentially cardiac arrest. Induction of an anesthetic event is defined as: drug administration to change the state of the patient from AWAKE to ANESTHETIZED and eventually securing the patient’s airway by placing a flexible rubber (endotracheal) down the trachea. Endotracheal intubation allows us to isolate the patient’s airway and support respiratory function during an anesthetic event. Safe anesthetic management requires adequate support and function to the respiratory system. It is the responsibility of the anesthetist to assure appropriate airway management during an anesthetic event. The anesthetist should be familiar with respiratory terminology as well as the equipment available for the patient. Endotracheal Intubation Endotracheal intubation is the placement of an endotracheal (ET) tube positioned between the vocal cords and down the trachea.
    [Show full text]
  • Q19 Describe the Types of Dead Space in the Respiratory System (50% Marks)
    Q19 Describe the types of dead space in the respiratory system (50% marks). Explain the consequences of increased dead space on gas exchange (50% mark) (March 2010) Dead space – that component of the tidal volume which does not take part in gas exchange. TYPES OF DEAD SPACE • Apparatus à dead space associated with synthetic breathing apparatus such as ETT and ventilator tubing • Anatomical à that volume of the conducting airways which does not take part in gas exchange (usually 2ml/kg or often estimated at 150ml). Anatomical DS can be measured using the modified Fowler’s method (inspiration of a normal tidal volume breath of 100% oxygen, then expiration against a spirometer and rapid gas analyser – the initial part of exhalation will be 100% oxygen which filled the conducting airways. As alveolar gas is expired, the % of measured CO2 (or N2) will rise and is graphed. A line is drawn such that Va = Vb and that line corresponds to the dead space volume. • Alveolar à that volume of gas reaching the alveoli which does not take part in gas exchange due to inadequate perfusion of those alveoli (this value may be significant in PE, low cardiac output state, or in the patient on PPV or who is hypotensive, in whom alveolar pressure in West’s Zone 1 is greater than pulmonary arterial pressure, compressing the vessels to produce dead space) • Physiological à the entire component of the tidal volume which does not eliminate CO2 (ie, anatomical + alveolar; in fit healthy people the physiological and anatomical values will be very similar).
    [Show full text]
  • 4 Physiology of Ventilation During Cardiac Arrest
    Chapter 4 / Physiology of Ventilation 39 4 Physiology of Ventilation During Cardiac Arrest Andrea Gabrielli, MD, A. Joseph Layon, MD, FACP, and Ahamed H. Idris, MD CONTENTS INTRODUCTION HISTORY OF ARTIFICIAL VENTILATION AND CPR TECHNIQUES PULMONARY PHYSIOLOGY DURING LOW BLOOD FLOW CONDITIONS VENTILATION DURING LOW BLOOD FLOW CONDITIONS TECHNIQUES OF VENTILATION DURING CPR BASIC AIRWAY MANAGEMENT ADVANCED AIRWAY SUPPORT SPECIALIZED AIRWAY DEVICES IN CPR LARYNGEAL MASK AIRWAY COMBITUBE PHARYNGOTRACHEAL LUMEN AIRWAY TRACHEOSTOMY AND CRICOTHYROIDOTOMY ALTERNATIVE METHODS OF VENTILATION AFTER SUCCESSFUL ENDOTRACHEAL INTUBATION TRANSPORT VENTILATORS MONITORING VENTILATION DURING CPR CONCLUSION REFERENCES INTRODUCTION Ventilation—the movement of fresh air or other gas from the outside into the lungs and alveoli in close proximity to blood for the efficient exchange of gases—enriches blood with oxygen (O2) and rids the body of carbon dioxide (CO2)by movement of alveolar gas from the lungs to the outside (1). The importance of ventilation in resuscitation is reflected in the “ABCs” (Airway, Breathing, Circulation), which is the recommended sequence of resuscitation practiced in a broad spectrum of illnesses including traumatic injury, unconsciousness, and respi- ratory and cardiac arrest (CA). Since the modern era of cardiopulmonary resuscitation (CPR) began in the early 1960s, ventilation of the lungs of a victim of CA has been assumed important for successful resuscitation. From: Contemporary Cardiology: Cardiopulmonary Resuscitation Edited by: J. P. Ornato and M. A. Peberdy © Humana Press Inc., Totowa, NJ 39 40 Cardiopulmonary Resuscitation Recently, this assumption has been questioned and is currently being debated (2). Several laboratory studies of CPR have shown no clear benefit to ventilation during the early stages of CA (3–5).
    [Show full text]