European Resuscitation Council Guidelines for Resuscitation ... - CPR

18 de 0ctubre de 2010 www.elsuapdetodos.com1310 C.D. Deakin et al. / Resuscitation 81 (2010) 1305–1352Immediate actions for a collapsed patient in a hospital• Shout for help (if not already)An algorithm for the initial management of in-hospital cardiacarrest is shown in Fig. 4.1.• Ensure personal safety.• Check the victim for a response.• When healthcare professionals see a patient collapse or find apatient apparently unconscious in a clinical area, they should firstshout for help, then assess if the patient is responsive. Gentlyshake the shoulders and ask loudly: ‘Are you all right?’• If other members of staff are nearby, it will be possible to undertakeactions simultaneously.The responsive patientUrgent medical assessment is required. Depending on the localprotocols, this may take the form of a resuscitation team (e.g., MET,RRT). While awaiting this team, give the patient oxygen, attachmonitoring and insert an intravenous cannula.The unresponsive patientThe exact sequence will depend on the training of staff andexperience in assessment of breathing and circulation. Trainedhealthcare staff cannot assess the breathing and pulse sufficientlyreliably to confirm cardiac arrest. 226–235 Agonal breathing (occasionalgasps, slow, laboured or noisy breathing) is common in theearly stages of cardiac arrest and is a sign of cardiac arrest andshould not be confused as a sign of life/circulation. 236–239 Agonalbreathing can also occur during chest compressions as cerebral perfusionimproves, but is not indicative of a return of spontaneouscirculation.Turn the victim on to his back and then open the airway:• Open Airway and check breathing:◦ Open the airway using a head tilt chin lift.◦ Look in the mouth. If a foreign body or debris is visible attemptto remove with a finger sweep, forceps or suction as appropriate.◦ If you suspect that there may have been an injury to the neck,try to open the airway using a jaw thrust. Remember that maintainingan airway and adequate ventilation is the overridingpriority in managing a patient with a suspected spinal injury. Ifthis is unsuccessful, use just enough head tilt to clear the airway.Use manual in-line stabilisation to minimise head movement ifsufficient rescuers are available. Efforts to protect the cervicalspine must not jeopardise oxygenation and ventilation.Keeping the airway open, look, listen, and feel for normal breathing(an occasional gasp, slow, laboured or noisy breathing is notnormal):• Look for chest movement;• Listen at the victim’s mouth for breath sounds;• Feel for air on your cheek.Look, listen, and feel for no more than 10 s to determine if thevictim is breathing normally• Check for signs of a circulation:◦ It may be difficult to be certain that there is no pulse. If thepatient has no signs of life (consciousness, purposeful movement,normal breathing, or coughing), start CPR until moreexperience help arrives or the patient shows signs of life.www.elsuapdetodos.comFig. 4.1. Algorithm for the treatment of in-hospital cardiac arrest. © 2010 ERC.