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Anesthesiology, 2002-2003 Edition
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Anesthesiology, 2002-2003 Edition
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by Mark R. Ezekiel
Sales Rank : 1609472
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Paperback: 200 pages
Publisher: Current Clinical Strategies Publishing; 3rd edition May 2001
Language: English
ISBN-10: 1929622120
ISBN-13: 978-1929622122
Product Dimensions:
6.5 x 4.1 x 0.5 inches
Shipping Weight: 5.6 ounces
Product Description
This handbook is a current manual of Anesthesiology practice. It includes many useful reference tables and charts, and it is very popular with medical students, residents, and anesthesiologists. New information on pain management makes this book essential reading for primary care physicians and anesthesiologists.
Excerpt. © Reprinted by permission. All rights reserved.
Resuscitation Algorithms Primary and Secondary ABCD Survey 1. Primary ABCD survey (basic CPR and defibrillation) A. Check responsiveness; activate EMS; call for defibrillator. B. Airway: assess and manage the airway with noninvasive devices. C. Breathing: assess and manage breathing (look, listen, and feel). If the patient is not breathing, give two slow breaths. D. Circulation: assess and manage the circulation; if no pulse, start CPR. E. Defibrillation: assess and manage rhythm/defibrillation; shock VF/VT up to 3 times (200 J, 300 J, 360 J, or equivalent biphasic) if necessary. 2. Secondary ABCD survey (advanced assessments and treatments) A. Airway: place airway device as soon as possible. B. Breathing: assess adequacy of airway device placement and performance; secure airway device; confirm effective oxygenation and ventilation. C. Circulation: establish IV access; administer drugs appropriate for rhythm and condition. D. Differential diagnosis: search for and treat identified reversible causes. Ventricular Fibrillation and Pulseless Ventricular Tachycardia 1. Primary ABCD 2. Assess rhythm after 3 shocks; continue CPR for persistent or recurrent VF/VT. 3. Secondary ABCD 4. Epinephrine 1.0 mg IVP, repeat every 3-5 minutes, or vasopressin 40 units IV, single dose, 1 time only. 5. Resume attempts to defibrillate, 360 J, within 30-60 seconds. 6. Consider antiarrhythmics. A. Amiodarone B. Lidocaine 1.5 mg/kg IVP, repeat every 3-5 minutes to a total loading dose of 3 mg/kg; then use. C. Magnesium sulfate 1-2 grams IV in Torsades de Pointes or suspected hypomagnesemic state or severe refractory VF. D. Procainamide 30 mg/min in refractory ventricular fibrillation (maximum total 17 mg/kg). 7. Defibrillate 360 J, 30-60 sec after each dose of medication. 8. Consider bicarbonate 1mEq/kg (if known preexisting bicarbonate responsive acidosis; overdose with tricyclic antidepressant; if intubated and continued long arrest interval; hypoxic lactic acidosis; hypercarbic acidosis). Asystole 1. Primary ABCD survey. 2. Confirm asystole in two or more leads. If rhythm is unclear and possible ventricular fibrillation, defibrillate as for VF. 3. Secondary ABCD survey. 6 Resuscitation Algorithms 4. Consider possible causes: hypoxia, hyperkalemia, hypokalemia, hypothermia, preexisting acidosis, and drug overdose. 5. Consider transcutaneous cardiac pacing (if considered, performimmediately) 6. Epinephrine 1.0 mg IVP, repeat every 3-5 minutes. 7. Atropine 1.0 mg IV, repeat every 3-5 minutes up to total dose of 0.04 mg/kg. 8. If asystole persists, consider withholding or ceasing resuscitative efforts. A. Consider quality of resuscitation if atypical clinical features present, or if support for cease-efforts protocols in place Pulseless Electrical Activity (PEA) 1. Pulseless electrical activity rhythm on monitor, without detectable pulse. 2. Primary ABC survey. 3. Secondary ABC survey. 4. Consider possible causes: pericardial tamponade, tension pneumothorax, hypovolemia, massive pulmonary embolus, hypoxia, hypothermia, drug overdose (such as tricyclics, digitalis, beta-blockers, calcium channel blockers), hyperkalemia, acidosis, massive acute myocardial infarction. 5. Review for most frequent causes: pulmonary embolism (thrombosis), acidosis, tension pneumothorax, cardiac tamponade, hypovolemia, hypoxia, hyperkalemia, hypokalemia, hypothermia, MI, drug overdose. 6. Epinephrine 1 mg IVP, repeat every 3 to 5 minutes. 7. Atropine 1 mg IVP (if rate less then 60 bpm) repeat every 3 to 5 minutes up to a total does of 0.04 mg/kg. Bradycardia 1. Slow (absolute bradycardia <60 bpm) or relatively slow (rate less than expected relative to underlying conditions or cause) 2. Primary ABC survey. 3. Secondary ABC survey. 4. If unstable (considered unstable if chest pain, shortness of breath, decreased level of consciousness, hypotension, shock, pulmonary congestion, congested heart failure or acute myocardial infarction are present) interventional sequence: A. Atropine 0.5-1.0 mg IVP repeated every 3-5 minutes up to 0.04 mg/kg (denervated transplanted hearts will not respond to atropine, go immediately to TCP, catecholamine infusion or both). B. Transvenous cardiac pacing (TCP): if patient is symptomatic, do not delay TCP while awaiting IV access or atropine to take effect. C. Dopamine 5-20 mcg/kg/min. D. Epinephrine 2-10 mcg/min. 5. If stable and not in type II or type III AV heart block, observe. 6. If type II or type III AV heart block, prepare for transvenous pacer (never treat third-degree heart block plus ventricular escape beats with lidocaine).
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