Emergency medicine clinics of North America
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Caring in the emergency department for the patient with return of spontaneous circulation after cardiac arrest is challenging. A coordinated and systematic approach to post-cardiac arrest care can improve the mortality and the chance of meaningful neurologic recovery. By achieving appropriate targets for oxygenation, ventilation, and hemodynamic parameters, along with initiating therapeutic hypothermia and arranging early percutaneous coronary intervention, the emergency physician can have the most significant impact on patients who have just been revived from death.
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Recognition and appropriate treatment of ventricular fibrillation or pulseless ventricular tachycardia is an essential skill for healthcare providers. Appropriate defibrillation can improve survival and benefit patient outcome. ⋯ When combined with high-quality cardiopulmonary resuscitation, electrical therapies are an important aspect of resuscitation in the patient with cardiac arrest. This article focuses on the use of electrical therapies, including defibrillation, cardiac pacing, and automated external defibrillators, in cardiac arrest.
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This article reviews out-of-hospital cardiac arrest from a public health perspective. Case definitions are discussed. ⋯ Study of variation in outcome in other related conditions suggest that this is due to differences in organizational culture rather than processes of care. A public health approach to improving outcomes is recommended that includes ongoing monitoring and improvement of processes and outcome of care.
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Emerg. Med. Clin. North Am. · Feb 2012
Review"Putting it all together" to improve resuscitation quality.
Solutions to improve care provided during cardiac arrest resuscitation attempts must be multifaceted and targeted to the diverse number of care providers to be successful. In this article, new approaches to improving cardiac arrest resuscitation performance are reviewed. The focus is on a continuous quality improvement paradigm highlighting improving training methods before actual cardiac arrest events, monitoring quality during resuscitation attempts, and using quantitative debriefing programs after events to educate frontline care providers.
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Cardiac arrest in children is, fortunately, a relatively infrequent event. Mortality rate after cardiac arrest is greater than 50%. ⋯ These strategies focus on suggestions for organizing a system prepared to care for critically ill children, incorporating the 2010 American Heart Association resuscitation guidelines into clinical practice, and encouraging physicians to become advocates of decreasing the occurrence of pediatric cardiac arrest. Providing the best-prepared system available to care for critically ill children will, it is hoped, decrease the number of preventable deaths in children.