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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The November 2012 update sees updates to over 70 chapters, focusing on Neurology and Gastroenterology. This update also incorporates a selection of 29 Case Histories taken from related titles in the Oxford Case Histories series, linked to from related chapters. Each case includes several questions followed by detailed answers and discussion to enhance diagnostic and clinical understanding.

Neurology updates include substantial updates to key chapters and new material on a wide range of topics including spinal cord injury, autonomic nervous system disorders, and inherited neurodegenerative diseases. 

Gastroenterology updates include extensive revisions of key chapters on liver failure and acute pancreatitis and new material on a wide range of matters, ranging from the common to the rare: including surgical treatments for colonic diverticular disease, antibody tests for immune disorders, and a revised treatment algorithm for small bowel bacterial overgrowth.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2012
DOI:
10.1093/med/9780199204854.001.1

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Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Cardiac arrest

Chapter:
Cardiac arrest
Author(s):

Jasmeet Soar,

Jerry P. Nolan,

David A. Gabbott

DOI:
10.1093/med/9780199204854.003.1701_update_001

November 28, 2012: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Update:

Technique of cardiopulmonary resuscitation (CPR)—modified recommendation for chest compressions.

Airway and ventilation—waveform capnography should be used to confirm correct placement of a tracheal tube and also provides an indication of the quality of CPR.

Treatment of shockable rhythms and of asystole—algorithms updated.

A monitored and witnessed VF/VT cardiac arrestto be treated by cardioversion before chest compressions are commenced in some situations.

Updated on 30 November 2011. The previous version of this content can be found here.

Cardiovascular disease is the most common cause of sudden cardiac arrest, which causes over 60% of adult coronary heart disease deaths. In Europe, the annual incidence of out-of-hospital cardiopulmonary arrests treated by emergency medical systems is 38 per 100 000.

Survival from cardiac arrest depends on a sequence of interventions—the Chain of Survival—comprising (1) early recognition and call for help, (2) early cardiopulmonary resuscitation (CPR), (3) early defibrillation, and (4) postresuscitation care. The division between basic life support and advanced life support (ALS) is arbitrary—the resuscitation process is a continuum.

Starting CPR

Initial resuscitation

Advanced life support

Continue CPR and proceed to:

Postresuscitation care

The quality of postresuscitation care determines the patient’s final outcome if resuscitation is successful. Consider therapeutic hypothermia and early percutaneous coronary intervention (PCI) in comatose survivors of cardiac arrest to improve neurological outcome and survival.

Do not attempt resuscitation (DNAR)

Do not attempt (cardiopulmonary) resuscitation decisions should be used to prevent CPR in patients who will not benefit from it or do not wish to have it. The most senior doctor available should enter a DNAR decision and the reasons for it in the medical records, the decision should be communicated effectively to all members of the team involved in the patient’s care, and it should be reviewed regularly in the light of changes in the patient’s condition.

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