Advanced Cardiac Life Support

Phil Jevon qualified as an RGN in 1986. He worked on CCU between the years 1987 and 1993 during which time he gained considerable experience in coronary care nursing. He has been the Resuscitation Officer/Clinical Skills Lead at The Manor Hospital, Walsall since 1993 and is an Honorary Clinical Lecturer at the Birmingham Medical School. While working on CCU and since then in his role as a member of the hospital cardiac arrest team, he has got considerable experience in advanced cardiac life support.

"Praised in its previous edition as a concise source of essential information, this new edition presents the most recent information in an accessible format and serves as an excellent reference source for all cardiologists, radiologists and nuclear medicine physicians". (TMCnet.com, 19 January 2011)

• Chapter 1: Resuscitation Service: An Overview 1Introduction 1Learning outcomes 1Concept of the chain of survival 1Cardiopulmonary Resuscitation: Standards for Clinical Practice and Training 3Role of the Resuscitation Council (UK) 8Principles of safer handling during CPR 9Chapter summary 12Chapter 2: Resuscitation Equipment 13Introduction 13Learning outcomes 13Recommended minimum equipment for the management of an adult cardiac arrest 14Routine checking of resuscitation equipment 17Checking resuscitation equipment following use 18Chapter summary 18Chapter 3: Recognition and Treatment of the Critically Ill Patient 20Introduction 20Learning outcomes 20Prevention of in-hospital cardiopulmonary arrest 21Clinical signs of critical illness 24Early warning scores and calling criteria 24Role of outreach and medical emergency teams 29Assessment and emergency treatment of the critically ill patient 31Chapter summary 43Chapter 4: Principles of Cardiac Monitoring and ECG Recognition 47Introduction 47Learning outcomes 47The conduction system of the heart 48The ECG and its relation to cardiac contraction 49Methods of cardiac monitoring 49Problems encountered with cardiac monitoring 51Systematic approach to ECG interpretation 52Cardiac arrhythmias associated with cardiac arrest 56Peri-arrest arrhythmias 58Chapter summary 62Chapter 5: Bystander Basic Life Support 64Introduction 64Learning outcomes 64Potential hazards when attempting BLS 65Initial assessment and sequence of actions in bystander BLS 66Principles of chest compressions 70Principles of mouth-to-mouth ventilation 73The recovery position 77Treatment for foreign body airway obstruction 81Chapter summary 85Chapter 6: Airway Management and Ventilation 88Introduction 88Learning outcomes 88Causes of airway obstruction 89Recognition of airway obstruction 89Simple techniques to open and clear the airway 90Use of oropharyngeal and nasopharyngeal airways 94Insertion of the laryngeal mask airway (LMA) 102Insertion of the combitube 106Procedure for application of cricoid pressure 107Principles of tracheal intubation 111Methods for ventilation 116Chapter summary 121Chapter 7: Defibrillation and Electrical Cardioversion 124Introduction 124Learning objectives 125Ventricular fibrillation 125Physiology of defibrillation 126Factors affecting successful defibrillation 127Safety issues and defibrillation 132Procedure for manual defibrillation 134Procedure for automated external defibrillation 138Synchronised electrical cardioversion 140New technological advances in defibrillation 143Chapter summary 144Chapter 8: Advanced Life Support 147Introduction 147Learning objectives 147Background to the Resuscitation Council (UK) ALS algorithm 148Overview of the ALS algorithm 149Chest compressions 160Precordial thump 165Reversible causes 167Drug delivery routes 170Resuscitation drugs 172Use of pre-filled syringes 174Principles of external pacing 176Chapter summary 179Chapter 9: Resuscitation in Special Situations 182Introduction 182Learning outcomes 182Life-threatening electrolyte abnormalities 183Hypothermia 186Drowning 189Acute severe asthma 191Electrocution 195Pregnancy 197Poisoning 199Trauma 202Cardiovascular collapse or cardiac arrest caused by local anaesthetic 203Chapter summary 204Chapter 10: Anaphylaxis 209Introduction 209Learning outcomes 209Definition 209Incidence 210Pathophysiology 211Causes 211Clinical features and diagnosis 211Treatment of anaphylaxis 213Chapter summary 217Chapter 11: Acute Coronary Syndromes 219Introduction 219Learning outcomes 219Pathogenesis of ACS 219Classification of ACS 220Diagnosis of ACS 221Immediate treatment of ACS 228Chapter summary 232Chapter 12: Management of Peri-Arrest Arrhythmias 234Introduction 234Learning outcomes 234Principles of the use of the peri-arrest algorithms 235Adverse clinical signs associated with peri-arrest arrhythmias 235Management of bradycardia 236Management of a tachycardia 238Chapter summary 242Chapter 13: Post-Resuscitation Care 244Introduction 244Learning objectives 244Goals of post-resuscitation care 245Initial assessment priorities 245Transfer to definitive care 253Measures to limit damage to vital organs 254Temperature control and therapeutic hypothermia 257Prediction of poor outcome 262Chapter summary 263Chapter 14: Bereavement 266Introduction 266Learning objectives 266Ideal layout for the relatives room 266Breaking bad news 267Telephone notification of relatives 268Practical arrangements following a death 269Relatives witnessing resuscitation 270Chapter summary 272Chapter 15: Ethical Issues in Resuscitation 273Introduction 273Learning outcomes 274Ethical principles that guide medical practice 274Historical background to DNAR decisions 275Importance of DNAR decisions 277Key messages in Decisions Relating toCardiopulmonary Resuscitation 278Overview of the DNAR decision-making process 279Factors underpinning DNAR decisions 279Documentation of DNAR decisions 286Information for patients and relatives 287Chapter summary 288Chapter 16: Resuscitation Records 291Introduction 291Learning outcomes 291Why maintaining accurate resuscitation records is important 291Examples of poor record keeping 292Factors underpinning effective record keeping 292Importance of auditing resuscitation records 294Legal issues associated with record keeping 294Audit and reporting standards 295Chapter summary 296Chapter 17: Resuscitation Training 297Introduction 297Learning outcomes 297Why resuscitation training is important 298Principles of adult learning 298Resuscitation training methods 299Recommendations for resuscitation training for healthcare staff 302Training mannequins/models 304Resuscitation Council (UK) courses 304Chapter summary 306Index 309