Pub Date : 2018-10-17DOI: 10.5772/INTECHOPEN.79382
D. González-Otero, S. R. D. Gauna, J. Gutiérrez, P. Sáiz, J. Ruiz
Defibrillators acquire both the ECG and the transthoracic impedance (TI) signal through defibrillation pads. TI represents the resistance of the thorax to current flow, and is mea sured by defibrillators to check that defibrillation pads are correctly attached to the chest of the patient. Additionally, some defibrillators use the TI measurement to adjust the energy of the defibrillation pulse. Changes in tissue composition due to redistribution and movement of fluids induce fluctuations in the TI. Blood flow during the cardiac cycle generates small fluctuations synchronized to each heartbeat. Respiration (or assisted ventilation) also causes changes in the TI. Additionally, during cardiopulmonary resus citation (CPR), chest compressions cause a disturbance in the electrode-skin interface, inducing artifacts in the TI signal. These fluctuations may provide useful information regarding CPR quality, length of pauses in chest compressions (no flow time), presence of circulation, etc. This chapter explores the new applications of the transthoracic imped ance signal acquired through defibrillation pads during resuscitative attempts.
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Pub Date : 2018-10-17DOI: 10.5772/INTECHOPEN.80916
Theodoros Aslanidis
Almost 45 years since the inception of first modern emergency medical services (EMS) in the United States with the Highway Safety Act of 1966 and the EMS Services Development Act of 1973 [1, 2], the American Board of Medical Specialties (ABMS) voted in 2011 to create a new physician subspecialty called “emergency medical services” [3]. The American Board of Emergency Medicine was named the parent board for this subspecialty and held its first board certification exam in 2013. The first suggestions about an EMS subspecialty head back to late 1990s by the creation of an ABEM task force and later, in 2001, by National Association of Emergency Medical Society Physicians (NAEMSP’s EMS Physician) Certification Task Force. Yet, it took another ten years and the continuous tremendous advance in prehospital care in the last decades that finally led to the new emergency medicine subspecialty [4]. Today, the list of the existing subspecialties of emergency medicine [5] is:
自1966年《高速公路安全法》和1973年《EMS服务发展法案》在美国建立第一个现代紧急医疗服务(EMS)以来的近45年[1,2]，美国医学专业委员会(ABMS)于2011年投票决定创建一个新的医生亚专业，称为“紧急医疗服务”[3]。美国急诊医学委员会(American Board of Emergency Medicine)被任命为该专科的母委员会，并于2013年举行了第一次委员会认证考试。关于EMS亚专业的第一个建议可以追溯到20世纪90年代末，当时建立了一个ABEM工作组，后来在2001年，由全国急诊医学会医师协会(NAEMSP的EMS医师)认证工作组提出。然而，又过了十年，近几十年来院前护理不断取得巨大进步，最终产生了新的急诊医学亚专科[4]。目前，急诊医学现有亚专科列表[5]如下:
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Pub Date : 2018-10-17DOI: 10.5772/INTECHOPEN.79400
A. Kasatkin, A. Urakov, A. Nigmatullina
The chapter considers the possibilities for using ultrasound to increase the efficiency and safety of the intravascular access in patients during cardiac arrest, cardiopulmonary resuscitation, and advanced life support. It provides the grounds for the real-time use of ultrasound for ensuring satisfactory central vascular access; the main principles of this methodology and current recommendations are described as well. In addition, the article presents special aspects of visualization of ultrasound vessels in cardiopulmonary resuscitation, as well as puncture and catheterization techniques. It is crucial that resuscitators, who are often at the forefront of patient resuscitation, understand how to properly use this potentially life-saving procedure.
{"title":"Ultrasound-Guided Vascular Access during Cardiopulmonary Resuscitation","authors":"A. Kasatkin, A. Urakov, A. Nigmatullina","doi":"10.5772/INTECHOPEN.79400","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79400","url":null,"abstract":"The chapter considers the possibilities for using ultrasound to increase the efficiency and safety of the intravascular access in patients during cardiac arrest, cardiopulmonary resuscitation, and advanced life support. It provides the grounds for the real-time use of ultrasound for ensuring satisfactory central vascular access; the main principles of this methodology and current recommendations are described as well. In addition, the article presents special aspects of visualization of ultrasound vessels in cardiopulmonary resuscitation, as well as puncture and catheterization techniques. It is crucial that resuscitators, who are often at the forefront of patient resuscitation, understand how to properly use this potentially life-saving procedure.","PeriodicalId":313221,"journal":{"name":"Special Topics in Resuscitation","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124226485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-17DOI: 10.5772/INTECHOPEN.79651
A. Kalmar, N. D. Vekens, H. Vanoverschelde, D. V. Sassenbroeck, J. Heerman, Tom Verbeke
In hospitalized patients, cardiorespiratory collapse mostly occurs after a distinct period of deterioration. This deterioration can be discovered by a systematic quantification of a set of clinical parameters. The combination of such a detection system—to identify patients at risk in an early stage —and a rapid response team—which can intervene immediately—can be implemented to prevent life-threatening situations and reduce the incidence of in-hospital cardiac arrests outside the intensive care setting. The effectiveness of both of these systems is influenced by the used trigger criteria, the number of rapid response team (RRT) activa - tions, the in- or exclusion of patients with a DNR code >3, proactive rounding, the team composition, and its response time. Each of those elements should be optimized for maxi- mal efficacy, and both systems need to work in tandem with little delay between patient deterioration, accurate detection, and swift intervention. Dependable diagnostics and scoring protocols must be implemented, as well as the organization of a 24/7 vigilant and functional experienced RRT. This implies a significant financial investment to provide an only sporadically required fast intervention and sustained alertness of the people involved.
{"title":"Managing the Prevention of In-Hospital Resuscitation by Early Detection and Treatment of High-Risk Patients","authors":"A. Kalmar, N. D. Vekens, H. Vanoverschelde, D. V. Sassenbroeck, J. Heerman, Tom Verbeke","doi":"10.5772/INTECHOPEN.79651","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79651","url":null,"abstract":"In hospitalized patients, cardiorespiratory collapse mostly occurs after a distinct period of deterioration. This deterioration can be discovered by a systematic quantification of a set of clinical parameters. The combination of such a detection system—to identify patients at risk in an early stage —and a rapid response team—which can intervene immediately—can be implemented to prevent life-threatening situations and reduce the incidence of in-hospital cardiac arrests outside the intensive care setting. The effectiveness of both of these systems is influenced by the used trigger criteria, the number of rapid response team (RRT) activa - tions, the in- or exclusion of patients with a DNR code >3, proactive rounding, the team composition, and its response time. Each of those elements should be optimized for maxi- mal efficacy, and both systems need to work in tandem with little delay between patient deterioration, accurate detection, and swift intervention. Dependable diagnostics and scoring protocols must be implemented, as well as the organization of a 24/7 vigilant and functional experienced RRT. This implies a significant financial investment to provide an only sporadically required fast intervention and sustained alertness of the people involved.","PeriodicalId":313221,"journal":{"name":"Special Topics in Resuscitation","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129469098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-17DOI: 10.5772/INTECHOPEN.79394
Francesca Viaroli, G. Schmölzer
The majority of newborn infants make the transition from fetal-to-neonatal live without help. However, around 20% of newborn infants fail to initiate breathing at birth. In these cases, the clinical team has to provide respiratory support, which remains the cornerstone of neonatal resuscitation. This chapter will discuss respiratory support during neonatal resuscitation in both term and preterm infants. The chapter will discuss the respiratory fetal-to-neonatal transition, use of oxygen, mask ventilation and their pitfalls, the application of sustained inflation, positive end expiratory pressure, continuous positive airway pressures, and whether extremely low birth weight infants should be intubated immediately after birth or supported noninvasively.
{"title":"Resuscitation of Term Infants in the Delivery Room","authors":"Francesca Viaroli, G. Schmölzer","doi":"10.5772/INTECHOPEN.79394","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79394","url":null,"abstract":"The majority of newborn infants make the transition from fetal-to-neonatal live without help. However, around 20% of newborn infants fail to initiate breathing at birth. In these cases, the clinical team has to provide respiratory support, which remains the cornerstone of neonatal resuscitation. This chapter will discuss respiratory support during neonatal resuscitation in both term and preterm infants. The chapter will discuss the respiratory fetal-to-neonatal transition, use of oxygen, mask ventilation and their pitfalls, the application of sustained inflation, positive end expiratory pressure, continuous positive airway pressures, and whether extremely low birth weight infants should be intubated immediately after birth or supported noninvasively.","PeriodicalId":313221,"journal":{"name":"Special Topics in Resuscitation","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132717671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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