Diana Cimpoesu

By Diana Carmen Cimpoesu and Tudor Ovidiu Popa

Cardiopulmonary resuscitation (CPR) in special circumstances includes the emergency intervention for special causes, special environments and special patients. Special causes cover the potential reversible causes of cardiac arrest that must be identified or excluded during any resuscitation, divided into two groups, 4Hs and 4Ts: hypoxia, hypo-/hyperkalaemia and other electrolyte disorders, hypo-/hyperthermia, hypervolemia, tension pneumothorax, tamponade (cardiac), thrombosis (coronary or pulmonary) and toxins. The special environments section includes recommendations for the treatment of cardiac arrest occurring in specific locations: cardiac surgery, catheterisation laboratory, dialysis unit, dental surgery, commercial airplanes or air ambulances, field of play, difficult environment (e.g. drowning, high altitude, avalanche and electrical injuries) or mass casualty incident. CPR for special patients gives guidance for the patients with severe comorbidities (asthma, heart failure with ventricular assist devices, neurological disease and obesity) and pregnancy women or elderly people.

Part of the book: Resuscitation Aspects

By Tudor Ovidiu Popa, Diana Carmen Cimpoesu and Paul Lucian Nedelea

It is well known at this moment that a systems and systematic approach to trauma care cases is ideal. The prehospital controversies of in-the-field care in trauma cases, resuscitation, and transport, ground or air, are still debated. The most controversial is rapid transport to definitive care (“scoop and run”) versus field stabilization in trauma, which remains a topic of debate and resulted in great variability of prehospital policy. Emergency medical services, including ground and air transportation, significantly extend the reach of tertiary care facilities, leading to rapid transport of critically ill patients. Emergency medical services (EMS) providers are the first link to a trauma care system, and trauma triage made by EMS personnel is also a very important factor in a good outcome of trauma patients. The assessment of patient and the treatment delivered by the first medical crew could have a large impact over the clinical evolution and output of trauma patient; that way, it is necessary to apply a systematic approach in this pathology, guided by clear and simple-to-follow recommendations applied on the scene. Recent review of the literature on helicopter emergency medical services (HEMS) showed an overall benefit of 2.7 additional lives saved per 100 HEMS activations.

Part of the book: Emergency Medicine and Trauma

By Tudor Ovidiu Popa, Mihaela Corlade-Andrei, Paul Nedelea, Emilian Manolescu, Alexandra Hauta and Diana Cimpoesu

The use of Automatic External Defibrillators (AED) present in public access defibrillation programs (PAD) in cardiopulmonary resuscitation (CPR) is a challenge in the effective treatment of cardiac arrest, especially for adult patients. It is already known that the majority of adult cases of out-of-hospital cardiac arrest arise from ventricular fibrillation (VF). The most important factor in determining survival from VF is the time from collapse to defibrillation. If laypersons are trained to perform Basic Life Support (BLS) and to attempt defibrillation using an automatic external defibrillator before the emergency medical services arrive, the survival rate of an out-of-hospital cardiac arrest can be increased. In many countries, the number of public access AEDs has increased but implementation of AED use and CPR performed by public bystanders has not been sufficiently frequent. In fact, only a minority of individuals demonstrate sufficient knowledge and willingness to operate an AED, suggesting that the public is not yet sufficiently prepared. It is also very important to support the permanent campaign of training as many laypersons, starting from school, to properly use such defibrillators in public places. Considering these facts, PAD is an effective way and may be a cost-effective way to improve outcomes in cardiac arrest.

Part of the book: Updates on Cardiac Defibrillation, Cardioversion and AED Development