s u m m a r y because <strong>of</strong> significant variability in effectiveness <strong>and</strong> <strong>the</strong> potential <strong>for</strong> adverse effects, including tissue destruction with induction <strong>of</strong> a proembolic state <strong>and</strong> potential <strong>the</strong>rmal injury. Snakebites <strong>2010</strong> (New): Applying a pressure immobilization b<strong>and</strong>age with a pressure between 40 <strong>and</strong> 70 mm Hg in <strong>the</strong> upper extremity <strong>and</strong> between 55 <strong>and</strong> 70 mm Hg in <strong>the</strong> lower extremity around <strong>the</strong> entire length <strong>of</strong> <strong>the</strong> bitten extremity is an effective <strong>and</strong> safe way to slow lymph flow <strong>and</strong> <strong>the</strong>re<strong>for</strong>e <strong>the</strong> dissemination <strong>of</strong> venom. 2005 (Old): In 2005, use <strong>of</strong> pressure immobilization b<strong>and</strong>ages to slow <strong>the</strong> spread <strong>of</strong> <strong>the</strong> toxin was recommended only <strong>for</strong> victims <strong>of</strong> bites by snakes with neurotoxic venom. Why: Effectiveness <strong>of</strong> pressure immobilization has now also been demonstrated <strong>for</strong> bites by o<strong>the</strong>r venomous American snakes. Jellyfish Stings <strong>2010</strong> (New): To inactivate venom load <strong>and</strong> prevent fur<strong>the</strong>r envenomation, jellyfish stings should be liberally washed with vinegar (4% to 6% acetic acid solution) as soon as possible <strong>and</strong> <strong>for</strong> at least 30 seconds. After <strong>the</strong> nematocysts are removed or deactivated, <strong>the</strong> pain from jellyfish stings should be treated with hot-water immersion when possible. Why: There are 2 actions necessary <strong>for</strong> treatment <strong>of</strong> jellyfish stings: preventing fur<strong>the</strong>r nematocyst discharge <strong>and</strong> pain relief. A number <strong>of</strong> topical treatments have been used, but a critical evaluation <strong>of</strong> <strong>the</strong> literature shows that vinegar is most effective <strong>for</strong> inactivation <strong>of</strong> <strong>the</strong> nematocysts. Immersion with water, as hot as tolerated <strong>for</strong> about 20 minutes, is most effective <strong>for</strong> treating <strong>the</strong> pain. Heat Emergencies <strong>2010</strong> (No Change From 2005): First aid <strong>for</strong> heat cramps includes rest, cooling <strong>of</strong>f, <strong>and</strong> drinking an electrolytecarbohydrate mixture that can include juice, milk, or a commercial electrolyte-carbohydrate drink. Stretching, icing, <strong>and</strong> massaging <strong>the</strong> painful muscles may be helpful. Heat exhaustion must be vigorously treated by having <strong>the</strong> victim lie down in a cool place, removing as many <strong>of</strong> <strong>the</strong> victim’s clo<strong>the</strong>s as possible, cooling, preferably by immersing <strong>the</strong> victim in cold water, <strong>and</strong> activating EMS. Heat stroke requires emergency treatment by EMS providers <strong>and</strong> will require treatment with IV fluids. The first aid provider should not try to <strong>for</strong>ce <strong>the</strong> victim <strong>of</strong> heat stroke to drink fluids. SUMMARY In <strong>the</strong> years since <strong>the</strong> publication <strong>of</strong> <strong>the</strong> 2005 AHA <strong>Guidelines</strong> <strong>for</strong> <strong>CPR</strong> <strong>and</strong> <strong>ECC</strong>, many resuscitation systems <strong>and</strong> communities have documented improved survival <strong>for</strong> victims <strong>of</strong> cardiac arrest. However, too few victims <strong>of</strong> cardiac arrest receive byst<strong>and</strong>er <strong>CPR</strong>. We know that <strong>CPR</strong> quality must be high <strong>and</strong> that victims require excellent post–cardiac arrest care by organized teams with members who function well toge<strong>the</strong>r. Education <strong>and</strong> frequent refresher training are likely <strong>the</strong> keys to improving resuscitation per<strong>for</strong>mance. In this 50th year since <strong>the</strong> publication <strong>of</strong> <strong>the</strong> l<strong>and</strong>mark Kouwenhoven, Jude, <strong>and</strong> Knickerbocker description <strong>of</strong> successful closed chest compression, 4 we must all rededicate ourselves to improving <strong>the</strong> frequency <strong>of</strong> byst<strong>and</strong>er <strong>CPR</strong> <strong>and</strong> <strong>the</strong> quality <strong>of</strong> all <strong>CPR</strong> <strong>and</strong> post–cardiac arrest care. REFERENCES 1. Field JM, Hazinski MF, Sayre M, et al. Part 1: Executive Summary <strong>of</strong> <strong>2010</strong> AHA <strong>Guidelines</strong> <strong>for</strong> <strong>CPR</strong> <strong>and</strong> <strong>ECC</strong>. Circulation. In press. 2. Hazinski MF, Nolan JP, Billi JE, et al. Part 1: Executive Summary: <strong>2010</strong> International Consensus on Cardiopulmonary Resuscitation <strong>and</strong> Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. In press. 3. Nolan JP, Hazinski MF, Billi JE, et al. Part 1: Executive Summary: <strong>2010</strong> International Consensus on Cardiopulmonary Resuscitation <strong>and</strong> 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 <strong>and</strong> in-hospital mortality. JAMA. <strong>2010</strong>;303:2165-2171. 6. Surawicz B, Childers R, Deal BJ, et al. AHA/ACCF/HRS Recommendations <strong>for</strong> <strong>the</strong> St<strong>and</strong>ardization <strong>and</strong> Interpretation <strong>of</strong> <strong>the</strong> Electrocardiogram, Part III: Intraventricular Conduction Disturbances. Circulation. 2009;119:e235-e240. Why: The <strong>2010</strong> AHA/ARC <strong>Guidelines</strong> <strong>for</strong> First Aid have divided heat emergencies into 3 categories <strong>of</strong> increasing severity: heat cramps, heat exhaustion, <strong>and</strong>, <strong>the</strong> most severe, heat stroke. Signs <strong>of</strong> heat stroke include those <strong>of</strong> heat exhaustion plus signs <strong>of</strong> central nervous system involvement. As a result, heat stroke requires emergency care including IV fluid <strong>the</strong>rapy. 28 A m e r i c a n H e a r t A s s o c i a t i o n
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