Highlights of the 2010 Guidelines for CPR and ECC - ECC Guidelines

s u m m a r y
because of significant variability in effectiveness and the
potential for adverse effects, including tissue destruction with
induction of a proembolic state and potential thermal injury.
Snakebites
2010 (New): Applying a pressure immobilization bandage
with a pressure between 40 and 70 mm Hg in the upper
extremity and between 55 and 70 mm Hg in the lower
extremity around the entire length of the bitten extremity is an
effective and safe way to slow lymph flow and therefore the
dissemination of venom.
2005 (Old): In 2005, use of pressure immobilization bandages
to slow the spread of the toxin was recommended only for
victims of bites by snakes with neurotoxic venom.
Why: Effectiveness of pressure immobilization has now also been
demonstrated for bites by other venomous American snakes.
Jellyfish Stings
2010 (New): To inactivate venom load and prevent further
envenomation, jellyfish stings should be liberally washed with
vinegar (4% to 6% acetic acid solution) as soon as possible
and for at least 30 seconds. After the nematocysts are removed
or deactivated, the pain from jellyfish stings should be treated
with hot-water immersion when possible.
Why: There are 2 actions necessary for treatment of jellyfish
stings: preventing further nematocyst discharge and pain relief.
A number of topical treatments have been used, but a critical
evaluation of the literature shows that vinegar is most effective
for inactivation of the nematocysts. Immersion with water, as
hot as tolerated for about 20 minutes, is most effective for
treating the pain.
Heat Emergencies
2010 (No Change From 2005): First aid for heat cramps
includes rest, cooling off, and drinking an electrolytecarbohydrate
mixture that can include juice, milk, or a
commercial electrolyte-carbohydrate drink. Stretching, icing,
and massaging the painful muscles may be helpful. Heat
exhaustion must be vigorously treated by having the victim lie
down in a cool place, removing as many of the victim’s clothes
as possible, cooling, preferably by immersing the victim in cold
water, and activating EMS. Heat stroke requires emergency
treatment by EMS providers and will require treatment with IV
fluids. The first aid provider should not try to force the victim of
heat stroke to drink fluids.
SUMMARY
In the years since the publication of the 2005 AHA Guidelines
for CPR and ECC, many resuscitation systems and
communities have documented improved survival for victims
of cardiac arrest. However, too few victims of cardiac arrest
receive bystander CPR. We know that CPR quality must be
high and that victims require excellent post–cardiac arrest
care by organized teams with members who function well
together. Education and frequent refresher training are likely
the keys to improving resuscitation performance. In this 50th
year since the publication of the landmark Kouwenhoven, Jude,
and Knickerbocker description of successful closed chest
compression, 4 we must all rededicate ourselves to improving
the frequency of bystander CPR and the quality of all CPR and
post–cardiac arrest care.
REFERENCES
1. Field JM, Hazinski MF, Sayre M, et al. Part 1: Executive Summary of
2010 AHA Guidelines for CPR and ECC. Circulation. In press.
2. Hazinski MF, Nolan JP, Billi JE, et al. Part 1: Executive Summary:
2010 International Consensus on Cardiopulmonary Resuscitation
and Emergency Cardiovascular Care Science With Treatment
Recommendations. Circulation. In press.
3. Nolan JP, Hazinski MF, Billi JE, et al. Part 1: Executive Summary:
2010 International Consensus on Cardiopulmonary Resuscitation
and Emergency Cardiovascular Care Science With Treatment
Recommendations. Resuscitation. In press.
4. Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed-chest cardiac
massage. JAMA. 1960;173:1064-1067.
5. Kilgannon JH, Jones AE, Shapiro NI, et al. Association between arterial
hyperoxia following resuscitation from cardiac arrest and in-hospital
mortality. JAMA. 2010;303:2165-2171.
6. Surawicz B, Childers R, Deal BJ, et al. AHA/ACCF/HRS
Recommendations for the Standardization and Interpretation of the
Electrocardiogram, Part III: Intraventricular Conduction Disturbances.
Circulation. 2009;119:e235-e240.
Why: The 2010 AHA/ARC Guidelines for First Aid have divided
heat emergencies into 3 categories of increasing severity: heat
cramps, heat exhaustion, and, the most severe, heat stroke.
Signs of heat stroke include those of heat exhaustion plus
signs of central nervous system involvement. As a result, heat
stroke requires emergency care including IV fluid therapy.
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