Emergency medicine clinics of North America
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Resuscitations are complex events that require teamwork to succeed. In addition to the technical skills involved, a host of nontechnical skills are critical for optimal medical care delivery. ⋯ Debriefing after the event helps identify learning points to carry forward for the next resuscitation. Support of the team providing this intense form of care is crucial to protect the mental health and function of providers.
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Best practices in cardiac arrest depend on continuous high-quality chest compressions, appropriate ventilatory management, early defibrillation of shockable rhythms, and identification and treatment of reversible causes. Although most patients can be treated according to highly vetted treatment guidelines, some special situations in cardiac arrest arise where additional skills and preparation can improve outcomes. Situations covered in this section involve cardiac arrest in context of electrical injuries, asthma, allergic reactions, pregnancy, trauma, electrolyte imbalances, toxic exposures, hypothermia, drowning, pulmonary embolism, and left ventricular assist devices.
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Survival from out-of-hospital cardiac arrest (OHCA) is predicated on a community and system-wide approach that includes rapid recognition of cardiac arrest, capable bystander CPR, effective basic and advanced life support (BLS and ALS) by EMS providers, and coordinated postresuscitation care. Management of these critically ill patients continues to evolve. This article focuses on the management of OHCA by EMS providers.
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Sudden cardiac arrest has a large public health impact, especially, because its incidence continues to increase across the globe. Data for low-to-middle income countries is incomplete. CPR training and automatic external defibrillator availability are important points for focusing future efforts.