Resp Care
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Almost half of patients respond acutely to resuscitation but most die within the first several days after arrest. The incidence of survival to discharge from the hospital after cardiopulmonary arrest is about 15%; one third of those surviving have evidence of neurologic deficits. Although some prognostic variables are useful in determining which patients are most likely to die prior to discharge from the hospital, each patient needs to be evaluated on an individual basis and the various risk factors weighed carefully. ⋯ Coma, hypoxic myoclonus, and absent reflexes, while not useful immediately following arrest, are of greater prognostic significance 48 hours later. Only 5% of patients who are unconscious 48 hours after arrest will have a full neurologic recovery. The Glasgow Coma Scale has also been used for prognostication.(ABSTRACT TRUNCATED AT 400 WORDS)
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In summary, the value of the ECC training programs is improving the outcome for patients in cardiac arrest. It is believed that, by giving clinicians overall guidelines to use for this emergency situation, better decisions will be made. The Guidelines are in a dynamic state of re-evaluation, and the development process for guidelines is imperfect. ⋯ The ACLS course is now interactive and based on clinical scenarios. The emphasis is on improving the knowledge and skills of the participants who take the course rather than on certification or evaluation. The effect of these changes will be evaluated over the next several years.
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The development of the AHA Guidelines for CPR and ECC and the AARC RACH Clinical Practice Guideline should both be instrumental in improving the performance of RCPs on in-hospital resuscitation teams. The AARC and AHA are assuming important leadership roles in this movement by publishing CPGs for CPR and ECC. RCPs with ACLS training are in a prime position to assume more responsibility on resuscitation teams within acute care facilities. ⋯ Successful CPR outcome should be carefully defined using the patient's disease category. Each patient should be individually evaluated for DNR orders. As suggested by Schwenzer, "Patients' perception of their quality of life before and after CPR should guide their and our decisions." However, we must all accept the responsibility for defining the limitations of medical technology and try to determine when CPR is futile.
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Existing guidelines for equipment and personnel have been described. In addition, the ASA guidelines on management of the difficult airway have been presented as an example of the type of algorithm that might be used for management of the difficult airway. Whereas guidelines are not standards, it is important to recognize that as guidelines are adopted by more and more practitioners, they become "standards of care" to which we are all held accountable.