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Extra resources for A Resuscitation Room Guide Banerjee

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Procedure for defibrillation • Confirm cardiac arrest: unresponsive and apnoeic • Switch on ECG (connect red leads to right shoulder, yellow to left shoulder, and green anywhere): check rhythm on lead II • Switch on defibrillator • Confirm VF from ECG monitor or defibrillator paddlesâ rhythm check • Apply gel pads to right clavicle and over the cardiac apex (apico-anterior configuration) • Apply paddles firmly onto water-based gel pads • Remove nitrate patches or ointments in order to prevent explosions • Avoid placement on ECG electrodes and on implanted pacemaker or defibrillator casing • Select required energy level: for biphasic defibrillators 150J at least or if unsure of effective energy range of device use 200J; for monophasic defibrillators 360J • Stop high flow oxygen • Ensure that the synchronization switch is OFF • Charge paddles by pressing charge buttons on handles; do not charge paddles in the air or wave charged paddles in the air (only charge paddles when on the patient)â Charging!

100 Patterns of altered breathing These mainly occur when there has been an extensive brain injury and in the presence of raised intracranial pressure. The patient will normally be deeply unconscious with a low GCS. They are usually an indicator of the need for intubation to control gas exchange and intracranial pressure, as well as protecting the airway. • Cheyne-Stokes breathing: periodic and rhythmic waxing and waning in rate and depth followed by apnoea; seen with bilateral lesions involving the basal ganglia and thalamus • Central neurogenic hyperventilation: increased rate and depth; seen with lesions in the midbrain and upper pons • Apneustic breathing: 2-3s pauses after full or prolonged inspiration; seen with lesions in the lower pons • Cluster breathing: clusters of irregular breathing and periods of apnoea at irregular intervals; seen 56 57 with lesions in the lower pons and upper medulla • Ataxic breathing: irregular and unpredictable pattern of breathing; seen with lesions in the medulla.

Heimlich manoeuvre (subdiaphragmatic abdominal thrust) • Wrap arms around the victim's waist • Interlock hands, making a fist with one hand • Place the thumb side of the fist against the upper abdomen, just below the xiphoid • Press into the upper abdomen with quick upward thrusts. Foreign body removal • A blind finger sweep can be used for a conscious adult in extremis, but not in children. A hooking manoeuvre may be used to remove the impacted foreign body 64 65 • Direct vision removal using a laryngoscope and Magill forceps should be considered.

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