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INTRODUCTION

  • Overview of Emergency Cardiac Care

    • Interim COVID-19 AHA Guidelines (Released April 2020)

  • Cardiopulmonary Resuscitation (CPR)

    • CPR Basics

    • Unresponsive Adult (Age >8 yr)

    • CPR of Child (Age 1–Onset of Puberty)

    • CPR of Unresponsive Infant (Age <1 yr)

    • Neonatal Resuscitation

  • Advanced Cardiac Life Support (ACLS)

    • Cardiac Arrest

    • Symptomatic Bradycardia and Tachycardia

    • Emergency Airway and Ventilatory Support

    • Automatic External Defibrillation, Cardioversion

    • Acute Coronary Syndromes and Myocardial Infarction

    • ACLS Algorithms

  • Stroke, Initial Management

  • Other Common Emergencies

    • Adrenal Crisis

    • Anaphylaxis

    • Asthma, Acute Attack

    • Anticholinergic Toxicity

    • Coma

    • Dental Emergencies

    • Hypercalcemia

    • Hyperglycemia

    • Hyperkalemia

    • Hypermagnesemia

    • Hypernatremia

    • Hyperphosphatemia

    • Hypertensive Crisis

    • Hyperthyroidism

    • Hypocalcemia

    • Hypoglycemia

    • Hypokalemia

    • Hypomagnesemia

    • Hyponatremia

    • Hypophosphatemia

    • Hypothyroidism

    • Medication-Induced Syndromes

    • Overdose, Opioid

    • Overdose, Benzodiazepine

    • Poisoning (Common Agents)

    • Seizures, Status Epilepticus

    • Thyroid Emergencies

  • Pediatric Emergency Care Considerations

  • Adult Emergency Cardiac Care (ECC) Medications

Chapter update by Patrick T. Gomella, MD, MPH, EMT-P, Steven A. Haist, MD, MS, and Leonard G. Gomella, MD

OVERVIEW OF EMERGENCY CARDIAC CARE

The algorithms and guidelines of the American Heart Association (AHA) and International Liaison Committee on Cardiac Resuscitation (ILCOR) are routinely updated. The latest guidelines promote the use of automatic external defibrillator (AED) by emergency medical services (EMS), police, and the general public as well as provide an emphasis on high-quality compressions (adequate rate, depth, and recoil while minimizing interruptions) and a team-based approach to resuscitation when available. With the establishment of public access defibrillator (PAD) programs and continued development of EMS protocols, it is essential that receiving providers in emergency departments be knowledgeable about current AHA guidelines regarding the use of the prehospital AEDs as well as for all in-hospital resuscitation guidelines. These recommendations can be found in the most current Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care 2015 and are reviewed in this chapter.1 In 2017 the American Heart Association (AHA) began moving to a continuous evidence evaluation process and annual Guidelines update. These annual updates allow the rigor of a comprehensive review and expert consensus in as close to real time as possible and can be found at https://eccguidelines.heart.org/circulation/cpr-ecc-guidelines/.

The most recent guidelines emphasize high-quality chest compressions and have notably changed the standard A-B-C (airway-breathing-circulation) to C-A-B (circulation-airway-breathing). This emphasis is primarily focused at lay rescuers to start the CPR sequence with compressions rather than a pulse/breathing check (lay rescuers can frequently misinterpret agonal respirations for spontaneous breathing) to limit delays in adequate chest compressions. In cases of untrained lay rescuers, compression only resuscitation has gained favor as it avoids rescue breathing, which delays chest compressions. Healthcare providers are still expected to check for pulse/breathing. If a person experiences sudden cardiac arrest and a defibrillator or an AED is available, defibrillation can be performed as soon as possible. However, if a person is found unresponsive, prompt initiation of compressions should be performed before defibrillation.

Individuals who experience cardiac arrest and receive immediate defibrillation are more likely to be successfully defibrillated ...

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