i

OXFORD MEDICAL PUBLICATIONS

A Resuscitation
Room Guide

ii
Published and forthcoming Oxford Specialist Handbooks
Oxford Specialist Handbooks in Paediatrics
Paediatric Nephrology (Rees, Webb and Brogan)
Paediatric Neurology (Forsyth and Newton eds.)
Paediatric Gastroenterology, Hepatology & Nutrition
(Beattie, Dhawan and Puntis eds.)
Oncology and Haematology (Bailey and Skinner eds.)
Oxford Specialist Handbooks in Cardiology
Echocardiology (Leeson, Mitchell and Becher eds.)
Cardiac Catheterization and Coronary Angiography
(Mitchell, Leeson, West and Banning)
Heart Failure (Gardner, McDonagh and Walker)
Pacing and Implantable ICDs
(Timperley, Leeson, Mitchell and Betts eds.)
Oxford Specialist Handbooks in Surgery
Vascular Surgery (Hands, Murphy, Sharp and Ray Chaudry)
Plastic Surgery (Giele and Cassell eds.)
Urology (Reynard, Sullivan, Turner, Feneley, Armenakas and Mark eds.)
Oxford Specialist Handbooks in Neurology
Parkinsons Disease & Movement Disorders
(Edwards, Bhatia and Quinn and Swinn)
Epilepsy (Alarcon, Nashaf, Cross and Nightingale)

iii

A Resuscitation
Room Guide
Ashis Banerjee
Consultant in Emergency Medicine,
Barnet and Chase Farm Hospitals NHS Trust,
London, UK
and

Chris Hargreaves
Consultant in Intensive Care Medicine
and Anaesthesia, Director of ICU,
The Whittington Hospital NHS Trust,
London, UK

iv

Great Clarendon Street, Oxford OX2 6DP

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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
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and recommendations are for the non-pregnant adult who is not breast-feeding.

Acknowledgements
We wish to express our thanks to our senior adviser on paediatric
matters, Dr David Mbamalu, and to Mr Vincent Kika for providing the
photographs.
The production of any book requires some support from the proposed
audience, and we are grateful to our trainees who have, over the years,
identified various clinical questions and the need for a rapid reference
text for help in dealing with them. We are indebted to the various individuals who gave up their valuable time to read through and comment on
earlier versions of the text
We wish to acknowledge the use of algorithms produced by the
Resuscitation Council (UK), the British Thoracic Society, the Intensive
Care Society and the Difficult Airway Society, and two algorithms published in the Postgraduate Medical Journal.
We have endeavoured to acknowledge all sources of information used
in preparation of the text, but would be happy to redress in subsequent
editions any inadvertent infringements in the use of information from
other sources.
We look forward to receiving any comments and criticisms, which will
always be viewed in a constructive spirit
The book would not have taken off had it not been for the vision and
support of Catherine Barnes at OUP. We sincerely thank Sara Chare at
OUP for patiently and diligently nurturing it through its various gestational
stages.
Ashis Banerjee
Chris Hargreaves

vii

Contents

Acknowledgements v
Detailed contents ix
Preface xvii
Symbols and abbreviations xix
1
2
3
4
5
6
7
8
9
10
11
12
13

Resuscitation room organization

Basic principles of resuscitation
Team approach to resuscitation
Cardiac arrest and peri-arrest management
Airway and breathing management
Circulation management
Trauma
Burns
Neurological resuscitation and management
Renal, endocrine, and metabolic management
Toxicology
Gastrointestinal and gynaecological resuscitation
Sepsis
Contact addresses
Useful websites
Index 563

1
35
45
57
95
233
355
411
423
463
499
525
539
557
561

ix

Detailed contents
Acknowledgements v
Preface xvii
Symbols and abbreviations xix
1 Resuscitation room organization

Introduction 2
Initial triage 4
Immediate priorities 6
Note keeping/documentation 8
Ongoing care 10
Is the patient adequately resuscitated? 12
Is the patient ready to leave the resuscitation room? 16
Where is the appropriate place for the patient to
go from the resuscitation room? 18
Universal precautions 20
Infection control procedures 22
Do not attempt resucitation policy 24
Safe inter-hospital transfer 26
Breaking bad news 30
Care of the dying 32
2 Basic principles of resuscitation
Airway management 36
Breathing (ventilation) 38
Circulation 40
Dysfunction of the CNS 42
Exposure, with environment control 44

35

DETAILED CONTENTS

3 Team approach to resuscitation

Introduction 46

45

The cardiac arrest team 48

Critical care outreach teams 50
Cardiac arrest protocol 52
Trauma team activation criteria 54
4 Cardiac arrest and peri-arrest management

57

Introduction 58
Causes of cardiac arrest 60
Cardiac arrest management 62
Chest compression 64
Indications for the termination of CPR 66
Drugs used in cardiac arrest 74
Antiarrhythmic drugs in peri-arrest situations 78
Defibrillation 82
Cardiac arrest in pregnancy 88
Anaphylaxis 90
5 Airway and breathing management
Introduction 96
Features of increased work of breathing 98
Patterns of altered breathing 100
Features of paediatric upper airway 102
Elective airway evaluation 104
Airway adjuncts 106
Face mask application 110
Bag and mask ventilation 112
Adult and paediatric choking 114
Respiratory system monitoring techniques 116
Pulse oximetry 118
Capnography 120

95

DETAILED CONTENTS

Oxygen therapy 126

Oxygen delivery devices 128
Arterial blood gases 132
Tracheal intubation 136
Confirmation of tracheal tube placement 140
Laryngeal mask airway 144
Airway trolley contents 146
Aids to intubation 148
Cricothyroidotomy 150
Tracheostomy 154
Rapid sequence intubation 156
Rapid onset sedativehypnotics 160
Neuromuscular relaxants 164
Management after uneventful intubation 168
Failed intubation 170
Anticipated difficult intubation 172
Mechanical ventilation 176
Transport ventilator 182
Ventilatory modes 184
Non-invasive ventilation 188
Setting up non-invasive ventilation 192
Components of an anaesthetic machine 196
Chest X-ray 198
Dyspnoea 202
Asthma 204
Acute exacerbation of COPD 208
Stridor 212
Upper airway infections 214
Community-acquired pneumonia 216
Pleural effusion 222
Pneumothorax 224

xi

xii

DETAILED CONTENTS

Haemoptysis 230
Drowning 232
6 Circulation management
Methods for cardiovascular system monitoring 234
Indications for cardiovascular support 236
Shock 238
Venous access 242
Venipuncture techniques 248
Intraosseous access 250
Central venous access 252
Saphenous vein cut-down 258
Central venous pressure measurement 260
Pulmonary artery catheter 262
Arterial line 264
Intravenous infusions 268
Inotropic agents 270
Blood transfusion 272
Blood products 274
Requesting blood for transfusion 276
Giving blood 278
Coagulation profile 280
Sickle cell crisis 282
Electrocardiography 286
Normal 12-lead ECG 288
ST segment elevation 294
Evaluation of cardiac arrhythmia 298
Narrow complex tachycardia 300
Broad complex tachycardia 302
Atrial fibrillation 304
Atrial flutter 306

233

DETAILED CONTENTS

Anti-arrhythmic drugs 308

Specific anti-arrhythmic agents 310
Atrioventricular block 312
Indications for pacing 314
External pacing 316
Temporary transvenous pacing 318
Permanent pacemaker problems 320
Acute coronary syndromes 324
Cardiogenic shock 332
Myocarditis 334
Heart failure 336
Aortic dissection 340
Abdominal aortic aneurysm 342
Pulmonary embolism 346
Hypertensive emergencies 350
Cardiac tamponade 352
7 Trauma
Trauma resuscitation 356
Primary survey 358
Cervical spine control 360
Secondary survey 362
Useful details about injury circumstances 364
Indications for tracheal intubation 366
Potential causes of shock after trauma 368
Head injury 370
Spinal injury 378
Spinal cord injury 384
Penetrating neck injury 388
Chest trauma 390
Cardiac trauma 396

355

xiii

xiv

DETAILED CONTENTS

Place of CPAP, NIV, and ventilation in

chest injury 398
Aortic injury 400
Signs of peripheral arterial injury 402
Evaluation in abdominal trauma 404
Pelvic trauma 408
8 Burns

411

Evaluation 412
Evaluation of body surface area involvement 414
Replacement formulae for fluid replacement
after burns 416
Burn depth assessment 418
Referral to burns unit 420
9 Neurological resuscitation and management

423

Checklist for acute alteration in mental state 424

Coma 426
Brainstem death and organ donation 430
Convulsive status epilepticus 432
Stroke 438
Subarachnoid haemorrhage 442
Meningitis 446
Acute weakness 450
GuillainBarre syndrome 452
Myasthenia gravis 454
Sedatives 456
Analgesia 458
10 Renal, endocrine and metabolic management
Oliguria 464
Acute renal failure 466

463

DETAILED CONTENTS

Renal support 468

Water balance 472
Sodium disorders 474
Potassium disorders 478
Hypercalcaemic crisis 480
Hypoglycaemia 482
Diabetic ketoacidosis 484
Addisonian Crisis (acute adrenocortical failure) 488
Hypothermia 490
Frostbite 492
Heat stroke 494
Rhabdomyolysis 496
11 Toxicology

499

Introduction to poisoning 500

Specific antidotes 502
Toxidromes (toxicological syndromes) 504
Beta blocker 506
Cocaine 508
Digitalis 510
Ecstasy 512
Paracetamol 514
Salicylate 516
Tricyclic antidepressant 520
Carbon monoxide 522
12 Gastrointestinal and gynaecological resuscitation 525
Caustic burns of the oesophagus 526
Upper gastrointestinal bleeding 528
Acute liver failure 532
Acute pancreatitis 534
Early pregnancy complications 538

xv

xvi

DETAILED CONTENTS

13 Sepsis
SIRS criteria 540
Septic shock 542
Goal-directed approach to septic shock 544
The ill patient with fever and skin rash 546
Toxic shock syndrome 548
Necrotizing soft tissue infections 550
Malaria 552
Meningococcal septicaemia 554
Contact addresses 557
Useful websites 561
Index 563
Detailed contents

539

xvii

Preface
The resuscitation room is the hub of intense and focused activity within
the emergency department. In most departments, the demands on resuscitation room usage have been steadily increasing, especially linked with
the increasing presentation of acutely unwell medical patients to the
emergency department.
A wide range of health care professionals contribute to care in this
situation. Effective team working hence assumes great importance when
working in this environment. The composition and working of teams is
thus discussed early in the course of the text.
This book concentrates on important aspects of resuscitation room
organization, and emphasizes clinical aspects of management that are of
particular importance in this situation. Given the size of the book, it is
inevitable that there are alternative views regarding management that may
not have been considered or mentioned. Furthermore, the frontiers of
evidence-based medicine are rapidly advancing, leading to the potential
non-inclusion of some very recent advances. The authors would welcome
any suggestions and comments with regard to improving the content of
future editions. They, however, sincerely hope that the large majority of
users will find it to be a useful adjunct to their clinical practice.
AB
CH

xix

Symbols and abbreviations

+ve
ve

ACE
ACS
ACTH
AED
AF
aPTT
ARDS
AV
bd
BiPAP
BP
BSA
BTS
CAP
CK
CPAP
CPR
CSF
cm
CMV
CNS
COPD
CPAP
CPP
CPR
CRP
CSF
CT
CTPA
CVP
CXR

positive
negative
with/without
degree
angiotensin-converting enzyme
acute coronary syndrome
adrenocorticotrophic hormone
automated external defibrillator
atrial fibrillation
activated partial thromboplastin time
acute respiratory distress syndrome
atrioventricular
bi diem (twice daily)
bilevel positive airway pressure
blood pressure
body surface area
British Thoracic Society
community-acquired pneumonia
creatine kinase
continuous positive airway pressure
cardiopulmonary resuscitation
cerebrospinal fluid
centimetre
continuous mandatory ventilation
central nervous system
chronic obstructive pulmonary disease
continuous positive airway pressure
cerebral perfusion pressure
cardiopulmonary resuscitation
C-reactive protein
cerebrospinal fluid
computed tomography
computed tomographic pulmonary angiography
central venous pressure
chest X-ray

xx

SYMBOLS AND ABBREVIATIONS

DKA
DVT
ECF
ECG
ED
EEG
ELISA
EPAP
ERCP
ESR
ETT
EVAR
FBC
FFP
g
GCS
GTN
h
HCG
HOCM
Hct
ICF
ICP
ICU
IM
INR
IPAP
IV
kg
LBBB
LFT
LMA
L
LV
LMA
LVH
MAP
mcg
MET
mg

diabetic ketoacidosis
deep vein thrombosis
extracellular fluid
electrocardiograph
emergency department
electroencephalograph
enzyme-linked immunosorbent assay
expiratory positive airway pressure
endoscopic retrograde cholangio-pancreatography
erythrocyte sedimentation rate
endotracheal tube
endovascular aortic repair
full blood count
frozen fresh plasma
gram
Glasgow Coma Score
glyceryl trinitrate
hour
human chorionic gonadotrophin
hypertrophic obstructive cardiomyopathy
haematocrit
intracellular fluid
intracranial pressure
intensive care unit
intramuscular
international normalized ratio
inspiratory positive airway pressure
intravenous
kilogram
left bundle branch block
liver function test
laryngeal mask airway
litre
left ventricle
laryngeal mask airway
left ventricle hypertrophy
mean arterial pressure
microgram
Medical Emergency Team
milligram

SYMBOLS AND ABBREVIATIONS

min
mL
MRI
MRSA
MSU
NAC
NIV
NSAID
ODP
PCI
PCR
PCWP
PE
PEA
PEEP
PEFR
PO
PSV
PT
PTT
qds
RA
RBBB
RBC
RSI
RV
RVH
s
SA
SAH
SC
SD
SIADH
SIMV
SIRS
SLE
STEMI
tds
TIA
TSS

minute
millilitre
magnetic resonance imaging
methicillin-resistant Staphylococcus aureus
midstream urine
N-acetylcysteine
non-invasive ventilation
non-steroidal anti-inflammatory drug
operating department practitioner
percutaneous coronary intervention
polymerase chain reaction
pulmonary capillary wedge pressure
pulmonary embolism
pulseless electrical activity
positive end-expiratory pressure
peak expiratory flow rate
per os (by mouth)
pressure support ventilation
prothrombin time
partial thromboplastin time
quater die sumendus (4 times a day)
rheumatoid arthritis
right bundle branch block
red blood cell
rapid sequence intubation
right ventricle
right ventricle hypertrophy
second
sinoatrial
subarachnoid haemorrhage
subcutaneous
solvent detergent
syndrome of inappropriate antidiuretic hormone secretion
synchronized intermittent mandatory ventilation
systemic inflammatory response syndrome
systemic lupus erythematosus
ST elevation myocardial infarction
ter die sumendus (3 times a day)
transient ischaemic attack
toxic shock syndrome

xxi

xxii

SYMBOLS AND ABBREVIATIONS

TT
U&E
VBG
VF
VPC
VT
vWF
WBC
WPW

thrombin time
urea and electrolytes
venous blood gas
ventricular fibrillation
ventricular premature complex
ventricular tachycardia
von Willebrand factor
white blood cell
WolffParkinsonWhite

563

Index
A
Aa gradient 124, 133
ABCDE approach 6
abciximab 330
abdominal aortic aneurysm
3424
abdominal trauma 4046
acidaemia 132
acidosis 132, 134
activated partial thromboplastin time 280
acute chest syndrome
282
acute coronary syndromes
32430
Addisonian crisis 488,
4889
adenosine 7881, 310
admission wards 18
adrenal crisis 488
adrenaline (epinephrine)
73, 271
anaphylaxis 90, 91
cardiac arrest 74
adrenocortical failure
4889
adrenocortical insufficiency
488
adrenocorticotrophic
hormone (ACTH) 488
advance directives 24
advanced life support
adults 69
paediatrics 71
agitation 364
air leak 398
airway
adjuncts 1068
assessment and control
96
clearing 367
Cormack and Lehane
classification 104,
105
Difficult Airway Society
148, 175
elective evaluation 1045,
105
emergency management
96
foreign bodies 11415
immediate priority 6
inadequate air exchange
978

laryngoscopic view 104,

105
Mallampati score 104,
105
management 367
nasopharyngeal 108
oropharyngeal (Guedel)
106, 107, 110
paediatric 102
patency 37
predicators of difficult
airway 104
airway trolley 146
albumin 268
alfentanil 161, 459
alkalaemia 132
alkalosis 132, 134
Allens test 264
alteplase 330, 439
alveolararterial oxygen
gradient 124, 133
alveolar gas equation 124
alveolar hypoventilation
121
Ambu bag 11213
aminophylline 204, 205
amiodarone 75, 7881, 310
AMPLE history 157
anaemia 14
anaesthetic machines
1946, 195
analgesia 45861, 458, 459,
461
adjuncts 460
non-opioids 458
opioids 459
paediatrics 460
anaphylactoid reactions 90
anaphylaxis 903, 91, 92,
93
angioplasty 327
anion gap 133
anoxia tolerance 126
anterior cord syndrome
386
anti-arrhythmic drugs
7881, 308, 31011
anticholinergic poisoning
502
anticholinergic syndrome
504
anticoagulation 280
anti-emetics 460, 461
antimuscarinic syndrome
504

anxiolytics 460
aortic aneurysm 3424
aortic dissection 3401
aortic injury 4001
apneustic breathing 100
arrhythmias 298
anti-arrhythmic drugs
7881, 308, 31011
arsenic poisoning 502
arterial blood gases 1324
arterial blood pressure
234
arterial cannulae 245
arterial hypotension 2367
arterial ischaemia 402
arterial line 2646
aseptic precautions 22
aspirin 458
overdose 51618
asthma 121, 2047
ataxic breathing 100
atracurium 164, 166, 168
atrial fibrillation 3045
atrial flutter 306
atrial tachycardia 300
atrioventricular block 312
atropine 75, 7881, 164
and glycopyrrolate 165
automated external
defibrillators 85, 87
AV nodal re-entrant
tachycardia 300

B
bacterial meningitis 4478
bag and mask ventilation
11213, 113
Bair Hugger 490
basal requirements 266
base excess 133
basic life support
adults 68
paediatrics 70
Bazetts formula 291
Becks triad 352
benzodiazepines 456
poisoning 502, 505
beta blockers, toxicity 502,
506
bicarbonate (HCO3) 133
bilevel positive airway
pressure (BIPAP) 185
bladder injury 408

564

INDEX
bleeding, management 280
bleeding time 280
blood volume, normal 266
blood loss 40, 272
blood pressure 12, 234,
237
blood products 274
blood transfusion 2723,
272
ABO-incompatible 278
giving blood 278
Jehovahs witnesses 272
massive 278
requesting blood 276
bodily fluids/substances 20
body-cooling unit 494
bradycardia algorithm 79
brain injury, primary and
secondary 370
brainstem death 4301
breaking bad news 30
breathing
altered patterns 100
apneustic 100
assessing adequacy 38
ataxic 100
CheyneStokes 100
cluster 100
immediate priority 6
noisy 978
paradoxical 1489
work of 98, 1489
brittle asthma 204
broad complex tachycardia
298, 3023
BrownSequard syndrome
385
Brudzinski sign 446
bupivacaine 461
burns 41120
body surface area 41415
caustic burns of
oesophagus 526
depth 418
electrical 420
evaluation 41112
fluid replacement 414,
416
inhalation injury 411
referral to burns unit
420
tracheal intubation 412
BURP 148, 172
burr hole 3767

C
C1odontoid measurement
379
calcium
cardiac arrest 76
data 479

calcium antagonist
overdose 502
Canadian CT head rule
3723
capillary refill 12
capnography 1205
carbohydrate sources
482
carbon dioxide, PaCO2
133
carbon monoxide poisoning
119, 518, 5223
carboxyhaemoglobin 518
cardiac arrest 5793
adenosine 7881
adrenaline 74
amiodarone 75, 7881
atropine 75, 7881
automated external
defibrillators 85, 87
calcium 76
causes 60
chest compressions 64
defibrillation 827
digoxin 7881
drugs 746, 7881
effective CPR 65
epinephrine 74
esmolol 7881
experimental closed chest
CPR methods 645
flecainide 7881
lidocaine 75, 7881
magnesium sulphate 75
management 62
pre-cordial thump 64
pregnancy 88
procainamide 7881
reversible causes 81
rhythms 65
sodium bicarbonate 75
terminating CPR 66
vasopressin 75
verapamil 7881
cardiac arrest team 48, 52,
62
cardiac arrhythmias 298
anti-arrhythmic drugs
7881, 308, 31011
cardiac markers 326
cardiac pacing, see pacing
and pacemakers
cardiac tamponade 352,
396
cardiac transplantation,
ECG 288
cardiac trauma 396
cardiac troponins 326
cardiogenic shock 239, 332,
368
cardiopulmonary
resuscitation (CPR)
see under cardiac arrest

cardiovascular monitoring
234, 237
cardiovascular support
2367
cardioversion 304
carotid pulse 238
cauda equina compression
385
cellulitis 550
central cord syndrome 385
central nervous system
dysfunction 42
central neurogenic
hyperventilation 100
central venous access 252,
254
chest X-ray 201
femoral 252, 255
immediate 242
internal jugular 252, 253
subclavian 252, 256
tunnelled long-term lines
252
central venous pressure
2601
cerebral oedema 373, 485
cerebral perfusion pressure
6, 376
cerebrospinal fluid (CSF)
antibiotic passage 448
recognition 373
cervical collars 360
cervical shock syndrome
538
cervical spine 36, 360, 378,
37982
chest compressions 64
chest drain 226, 229
chest trauma 3905, 398
chest wall evaluation 393
chest X-ray 198201
alveolar disease 199
chest trauma 393
diffuse lung disease 199
diffuse pulmonary
opacities 201
interstitial disease 199
interventional procedures
201
pleural fluid 199
pneumothorax 199
portable 199
pulmonary oedema 339
supine 199
CheyneStokes breathing
100
children, see paediatrics
chin lift 36
chlorphenamine 90
choking 11415
cholinergic syndrome 504
chronic obstructive pulmonary disease (COPD)

INDEX1
acute exacerbation
20810
capnography 121
indications for
hospitalization 209
non-invasive ventilation 7,
209
oxygen therapy 7, 126,
127, 210
severity 210
chronic type 2 respiratory
failure, oxygen therapy
127
circulating volume
monitoring 237
circulation 40
goals 12
immediate priority 6
optimizing 10
cisatracurium 164
clinical waste 20
clivo-odontoid relationship
379
clotting factors 274
cluster breathing 100
coagulation 14, 2802, 281
cocaine 5089
coffee ground vomit 528
colloids 268
coma 4268
community-acquired
pneumonia 21620
compartment syndrome
403
computed tomography
(CT)
abdominal trauma 405
bacterial meningitis 447
Canadian CT head rule
3723
head injury 3723, 3734,
374
spinal injury 385
subarachnoid
haemorrhage 442
congestive heart failure
3367
consciousness 12, 370
conscious sedation 4567
continuous mandatory
ventilation (CMV) 184,
185
continuous positive airway
pressure (CPAP) 185,
190, 210, 398
conus medullaris 385
convulsive status epilepticus
4327
cooling, after cardiac arrest
14
cooling methods 494
Cormack and Lehane
classification 104, 105

coronary care units 18

coroners 323
creatine kinase (CK) 326,
496
CK-MB 326
creatinine, renal failure 467
cricoid pressure 157
cricothyroidotomy 1502,
151
critical care 18
critical care outreach teams
50
critical illness 19
croup 214
cryoprecipitate 274, 281
crystalloids 268
Cullens sign 534
cyanide poisoning 502
cycling accidents 54

D
D-dimer 280
defibrillation 827
dehydration 472
dextrans 268
dextrose 268
diabetic ketoacidosis
4846
diamorphine 459
intranasal 460, 461
diaphragm rupture 395
diastolic heart failure 336,
337
diazepam 432, 456
Difficult Airway Society
148, 175
digitalis 510
digoxin 7881, 310
poisoning 502
disability assessment 6
disseminated intravascular
coagulation 278
dobutamine 271
documentation 8
do not attempt
resuscitation 24
dopexamine 271
double lumen tube 398
Downs syndrome 36
drowning 232
drug administration
routes 74
dying 323
dyspnoea 127, 202

E
ecstasy 512
ectopic pregnancy 538
electrical burns 420

electrocardiography (ECG)
bundle branch block
294
cardiac transplantation
288
digitalis 510
fascicular block 294
giant T wave inversion
291
hyperkalaemia 478
hypothermia 490, 491
implanted pacemakers
321
isoelectric baseline 292
J point 291
juvenile T pattern 291
J wave 289
leads 286
monitoring role 234
normal 12-lead 28892
Osborn wave 289
PR interval 289
pseudo-ST depression
296
pulmonary embolism
348
P waves 288
QRS complex 289
QT interval 291, 292
Q waves 290
sick sinus syndrome 289
sinus rhythm 288
ST depression 296
ST segment elevation
2946
ST segment monitoring
292
T waves 291
U wave 292
electronic monitoring
systems 8
endobronchial drug
administration 74, 76
End of Life Care Pathway
32
endotracheal tubes (see
also tracheal intubation)
137, 138, 139, 201, 398
endovascular aortic repair
343
entonox 460
epiglottitis 214
epinephrine (adrenaline)
73, 271
anaphylaxis 90, 91
cardiac arrest 74
EpiPen 90
erythematous rash 546
Eschmann tracheal tube
introducer 136
esmolol 7881
ethylene glycol poisoning
502

565

566

INDEX
etomidate 160
euvolaemic hypernatraemia
476
euvolaemic hyponatraemia
474, 475
Evans formula 416
examination 6
exhaust fumes 522
expiratory positive airway
pressure (EPAP) 185
exposure 6, 44
extradural haematoma
373, 374

F
face masks 110
facet joints 379
falciparum malaria 5523
Fastrach intubating LMA
144
FAST scan 405
femoral pulse 238
femoral vein catheterization
252, 255
fentanyl 161, 164, 459
fever 546
fibrin degradation products
280
fibrinogen assay 280
flail chest 393
flecainide 7881, 311
flumazenil 456
fluoride poisoning 502
Foxs sign 534
fresh frozen plasma 274,
280
frostbite 492

G
gas delivery, colour codes
195
gas exchange 1214
gastrointestinal bleeding
52831
gelatins 268
gelofusine 268
general wards 18
Glasgow Coma Scale 12,
3702
Glasgow meningococcal
septicaemia prognostic
score 555
glucagon 506
glucocorticoid deficiency
488
glucose, oral 482
glyceryl trinitrate infusion
325
Grey Turners sign 534

Guedel airway 106, 107,

110
GuillainBarre syndrome
452, 4523
gum elastic bougie 136,
148, 172

H
haemaccel 268
haematemesis 528
haemodynamic support
239
Haemophilus influenzae
type b 214
haemoptysis 2301
haemorrhage 6
class I IV 238
hand hygiene 22
Hartmanns solution 268
head injury 3707
burr hole 3767
categorization 372
consciousness 370
CT scan 3724
intracranial pressure 376,
377
neurosurgical referral 376
pupils 374
tracheal intubation 375
head tilt 36
heart failure 336, 337
heart rate 12, 237
heart transplantation, ECG
288
heat stroke 494
Heimlich manoeuvre 114
heliox 130, 204
helmet removal 379
hepatitis B and C 20
hepatorenal syndrome
470
high dependency 18
high flow masks 128
house fire smoke 420
human albumin 268
hydroxyethyl starches
268
hyperamylasaemia 535
hyperbaric oxygen 523
hypercalcaemic crisis 480
hyperglycaemic non-ketotic
coma 486
hyperkalaemia 14, 478,
479
hypernatraemia 476
hypertensive emergencies
3503, 351
hypertonic hyponatraemia
474
hypervolaemic
hypernatraemia 476

hypervolaemic
hyponatraemia 474, 475
hypnotics 1602
overdose 505
hypoglycaemia 4823
hypokalaemia 478
hyponatraemia 4745
hypotension 240, 265, 352
hypothermia 4901
induced after resuscitation
14
hypotonic hyponatraemia
474
hypovolaemia 239, 266,
368
hypovolaemic hypernatraemia 476
hypovolaemic hyponatraemia 474, 475
hypoxaemia 120, 1212,
125, 177
hypoxia 120, 126

I
ibuprofen 458
ibutilide 311
indomethacin 458
induction programmes
23
infection control 22
influenza virus types
A and B 214
inotropic agents 270,
2701
inspiratory positive airway
pressure (IPAP) 185
insulins 481
intensive care 18
inter-hospital transfer 16,
19, 268
intermittent positive
pressure ventilation
184, 185
internal jugular vein catheterization 252, 253
international normalized
ratio (INR) 280
inter-vertebral disc spaces
380
intracranial pressure 3767
intraosseous access 74,
246, 250
intravenous infusions 268
intubation, see tracheal
intubation
ipratropium 204, 205
iron poisoning 502
isoprenaline 271
isosorbide dinitrate infusion
325
isotonic hyponatraemia 474

INDEX1

J
jaw thrust 36
Jehovahs witnesses 272
junctional tachycardia 300

K
Kernig sign 446
ketamine 161, 456
ketorolac 458
Kussmauls breathing 202

L
lactate 12
Laerdal bag 11213
laparotomy 405
laryngeal foreign body 215
laryngeal mask airway
1445
laryngoscopes 136, 137
laryngotracheobronchitis
214
lead poisoning 502
left heart failure 336, 337
left ventricular aneurysm
295
Legionnaires disease 217
lidocaine 75, 7881, 164,
311, 461
limb fractures 403
liver failure 5323
Liverpool Care Pathway 32
local anaesthetics 461
log roll 239
lorazepam 432, 456
lower motor neuron 450
low flow masks 128
lumbar puncture 446
Lund and Browder chart
414, 415

M
Macklers triad 526
maculo-papular rash 546
Magills forceps 147
magnesium sulphate 75,
204
malaria 5523
Mallampati score 104, 105
MARS BAR score 549
mast cell tryptase 90
McCoys laryngoscope 148,
172
mean arterial pressure
234
mechanical ventilation
17680

alarms 179
algorithm 180
asthma 205
basic principles 177
bilevel positive airway
pressure (BIPAP) 185
chest injury 398
connecting patient 179
continuous mandatory
ventilation (CMV)
184, 185
continuous positive
airway pressure
(CPAP) 185
inappropriate 176
indications 177
initial settings 178
inspiratory:expiratory
(I:E) ratio 185
intermittent positive
pressure ventilation
184, 185
modes 1847
patient trigger 185
portable 1823
positive end-expiratory
pressure (PEEP)
185, 187
pressure control
ventilation 184
pressure support
ventilation (PSV) 184,
185
protective lung ventilation
185
safety checks 178
setting up 178
spontaneous breathing
modes 185
synchronized intermittent
mandatory ventilation
(SIMV) 184, 185
transport 1823
volume control ventilation
184
Medical Emergency Team
(MET) 48
Medic Alert 90
melaena 528
meningitis 4468
meningococcal septicaemia
5545
mental state 424
mercury poisoning 502
MERIT Study 48
metabolic acidosis 132, 134
metabolic alkalosis 132,
134
methanol poisoning 502
midazolam 161, 166, 168,
456
mineralocorticoid
deficiency 488

miscarriage 538
mixed caudaconus lesions
385
Mobitz block type I/II 312
morphine 166, 459
motor vehicle accidents 54,
364
mouth opening 104
MRSA 22
Muir and Barclay formula
416
multilumen venous catheter
kits 261
Murphy eye 137
muscarinic syndrome 504
muscle disorders 450
myasthenia gravis 454
myocardial infarction 295
myocardial necrosis,
markers 326
myocarditis 334
myoglobin 326
myoglobinuria 496
myonecrosis 550

N
N-acetylcysteine (NAC)
514
nalbuphine 459
naloxone 458, 4589
naproxen 458
narrow complex tachycardia 298, 300
nasal cannulae 129, 130
nasal catheter 128
nasal prongs 128, 129
nasopharyngeal airway 108
National Poisons Information Service 500
NCEPOD 48, 343
neck
penetrating injury 388
stiffness 446
necrotizing fasciitis 550
needle cricothyroidotomy
1502
needle disposal 20
needle thoracentesis 226
neonatal life support 72
neostigmine 165
neurological status 6
neuromuscular junction
450
neuromuscular relaxants
1646
nitrate infusion 325
nitrous oxide 460
non-invasive ventilation 7,
18890
asthma 204
chest injury 398

567

568

INDEX
non-invasive ventilation
(Contd)
COPD 7, 209
indications 189
masks 189
modes 188
pulmonary oedema 7
selection guidelines 190
setting up 192, 196
when to use 195
non-rebreathing masks 129,
130
norepinephrine
(noradrenaline) 271
note keeping 8

O
oesophagealtracheal
combitube 148
oesophagus
barogenic rupture 526
bleeding varices 529
caustic burns 526
foreign body 215
oliguria 2367, 464
ongoing care 10
opioids
analgesia 459
overdose 458, 502, 505
organ donation 4301
organophosphate poisoning
502
oropharyngeal airway 107,
108, 110
orthodromic AV re-entrant
tachycardia 300
outreach 50
over-the-needle catheters
245
oxygenhaemoglobin
dissociation curve 123
oxygen partial pressure
122, 124, 133
oxygen saturation 122,
124
oxygen therapy 1267
asthma 204
COPD 7, 126, 127, 210
delivery devices 12830
hyperbaric 523

P
pacing and pacemakers
external 316
indications 314
permanent pacemaker
problems 3202
temporary transvenous
31819

paediatrics
advanced life support 71
analgesia 460
anaphylaxis 93
asthma 205
basic life support 70
burns, surface area
involved 414
cervical spine 3801
chest compressions 64
choking 11415
endotracheal tube size 138
meningeal irritation 446
newborn life support 72
oropharyngeal airway 110
peripheral venous access
244, 245
respiratory rate 98
upper airway 102
pancreatitis 5346
pancuronium 164, 166
PAO2PaO2 gradient 124,
133
paracetamol 458
liver failure 533
overdose 502, 51415
paradoxical breathing
1489
parainfluenza virus types I
and II 214
paraquat poisoning 127, 502
Parkland formula 416
partial rebreathing masks
129, 130
Parvolex 514
Patient at Risk Team 48
peak inspiratory pressure
185
pedestrian accidents 54
PEEP 185, 187
pelvic fracture 408
penetrating injury
chest 391
neck 388
percutaneous coronary
intervention 327
pericardial effusion 353
pericardiocentesis 353
pericarditis 295
pericardium 353
peripheral arterial injury
4023, 403
peripheral venous access
243, 244, 245
peripheral venous blood
gases 134
peripheral venous drug
administration 74
peritoneal lavage 406
petechial rash 546
pethidine 459
pH 132, 133, 134
placement of patients 1819

Plasmodium falciparum
malaria 5523
platelet concentrates 274,
281
platelet count 280, 281
pleural effusion 2224
Pneumocystis carinii
pneumonia 220
pneumonia 21620
pneumothorax 199, 2249,
3935
poisoning 11
positive end-expiratory
pressure (PEEP) 185,
187
posterior cord syndrome
386
postural hypotension 234,
528
potassium disorders 4789
Powers ratio 380
pre-cordial thump 64
pregnancy
cardiac arrest 88
complications 538
pressure control ventilation
184
pressure support ventilation
(PSV) 184, 185
prilocaine 461
primary brain injury 370
Prinzmetals angina 295
priorities 4, 67
procainamide 7881
Procurator Fiscal 33
propofol 160, 168
protective lung ventilation
185
prothrombin time 280
pseudo-hyperkalaemia 14
pulmonary arterial pressure
261
pulmonary artery catheter
2623
pulmonary contusion 3935
pulmonary embolism 346,
347, 349
pulmonary laceration 394
pulmonary oedema 7,
3379
pulse 238
pulse oximetry 11819
pulsus paradoxus 352
pupils
coma 427
head injury 374
purpuric rash 546
pyridostigmine 165

Q
quinine 552

INDEX1

radial pulse 238

Ranson criteria 535
rapid sequence induction
1568, 164, 165, 204
rashes 546
rebreathing masks 129,
130
recombinant activated
factor VII 274
record keeping 8
red cell products 274
remifentanil 459
renal failure 46670
renal replacement therapy
468
renal trauma 406
reservoir bags 129, 130
respiration 12
respiratory acidosis 132,
134
respiratory alkalosis 132,
134
respiratory rate 1214,
98
respiratory syncytial virus
214
respiratory system
monitoring 116
restlessness 364
resuscitation
adequate 1214
basic principles 3544
goals 12
in-hospital 67
team approach 4555
resuscitation room 23
moving patients from 16,
1819
reteplase 330
retro-peritoneal
haemorrhage 534
retro-pharyngeal space
379
retro-tracheal space 379
revised trauma score 362,
363
rewarming 490
rhabdomyolysis 496
rib fractures 393
right heart failure 336,
337
right heart pressures/flows
263
right ventricular infarction
327
road traffic accidents 54,
364
Rockall prognostic score
530
rocuronium 164, 166

salbutamol 204, 205

salicylate poisoning 51618
saline, normal 268
saline manometer 260
saphenous vein cut-down
258
scalp lacerations 372
SCIWORA 3801
scribe 8
secondary brain injury
370
sedatives 1602, 4567
overdose 505
Seldinger technique 242,
248
SengstakenBlakemore
tube 529
sepsis 13
sepsis syndrome 540
septic shock 540, 542, 544
sharps 20
shock 23840, 368, 3923
shunt 124
sickle cell crisis 2824
sick sinus syndrome 289
sinus tachycardia 300
SIRS criteria 540
SITS-MOST 439
skin perfusion 12, 234
skin rashes 546
skull
basal fracture 3734
traction 386
SLUDGE 504
smoke 420
smoke inhalation 420
sodium bicarbonate 75
sodium disorders 4746
soft tissue infections 5501
spinal cord injury 384
spinal injury 37882
spino-laminar line 379
spinous line 379
stab wounds 391
staff induction 23
status epilepticus 4327
ST elevation myocardial
infarction (STEMI) 327,
328
steroids
equivalent dosages 489
spinal injury 386
streptokinase 330
stridor 212
stroke 43840
subarachnoid blood 373
subarachnoid haemorrhage
4424
subclavian vein catheterization 252, 256

subdiaphragmatic
abdominal thrust 114
subdural haematoma 373,
374
suprapubic catheterization
464
suxamethonium 164, 165
Swischuks line 380
sympatholytic syndrome
505
sympathomimetic
syndrome 504
synchronized intermittent
mandatory ventilation
(SIMV) 184, 185
systemic inflammatory
response syndrome
(SIRS) criteria 540
systolic heart failure 336,
337

T
tachyarrhythmia 303
tachycardia 80, 298, 300,
3023
targeted treatment 10
team approach 4455
temperature control 14
tenecteplase 330
tension pneumothorax 141
terbutaline 205
thallium poisoning 502
thiopentone 1601
thoracotomy 391, 393
three-column theory 381
thrombin time 280
thrombolysis 330, 439
TIMI risk score 328
tissue oxygenation 119
tissue perfusion 2367
TOXBASE 500
toxicological syndromes
5045
toxicology 11
toxic shock syndrome
5489
toxidromes 5045
tracheal intubation 96,
1369, 142, 143
aids 1489, 172
anticipated difficult
1725, 175
blind 144
burns 412
BURP 148, 172
cant intubate, cant
ventilate 170, 174
chest X-ray 201
confirmation of tube
placement 1403

569

570

INDEX
tracheal intubation (Contd)
correct tube length
1401
Difficult Airway Society
guidelines 148, 175
dislodgement 141
drug administration 74,
76
endotracheal tubes 137,
138, 139, 201, 398
failed 148, 170
fibreoptic 148
gas induction of
anaesthesia 172, 173
gum elastic bougie 136,
148, 172
head injury 375
hypotension 142
hypoxia 142
illuminated stylet 172
indications in trauma
366
light wand 172
McCoys laryngoscope
148, 172
oesophagealtracheal
combitube 148
retrograde 172
securing tube 141
stiff lungs 142
surgical tracheostomy
174
tracheal tube introducer
or stylet 136, 172
uneventful, management
after 168
tracheal suction 142
tracheostomy 154, 174,
201
tramadol 459
transfer 16, 19, 268
translocational hyponatraemia 474
transport
documentation 28
key checks 16

transport ventilator
1823
trauma 355410
cervical spine control
360
injury circumstances
364
primary survey 358
restlessness and agitation
364
resuscitation team
3567
scoring system 362, 363
secondary survey 3623
shock 368
tracheal intubation 366
trauma team 545
triage 45
triangle of safety 226
tricyclic antidepressants
520
triple manoeuvre 36
troponins 326
true hyponatraemia 474
tube thoracostomy 226,
229
tubular necrosis 467
tunnelled long-term lines
252

U
universal precautions 20
unstable acute coronary
syndrome 325
unstable angina, TIMI risk
score 328
upper airway infection
21415
upper gastrointestinal
bleeding 52831
upper motor neuron 450
urethral injury 408
urinary bladder 408
urine output 12, 239

V
vasopressin 75
vasospasm 295
vecuronium 164, 166, 168
venipuncture 248
venous access 2426
venous blood gases 134
venous cannulation 242,
245
ventilation, bag and mask
11213: see also
mechanical ventilation
ventilationperfusion
mismatch 121
Venturi masks 128, 130
verapamil 7881
vertebral column 382
vesiculo-bullous rash 546
volume control ventilation
184
V/Q scan 3478

W
Wackenheims clivus
baseline 379
Wallaces Rule of Nines
414
warfarin overdose 502
warming methods 490
water balance 472
water requirement 266
weakness 4501
Wells score 347
Wenckebach phenomenon
312
WolffParkinsonWhite
syndrome 289, 294
work of breathing 98

Y
Yankauer sucker 142