Free Term Paper About Advanced Life Support
ADVANCED LIFE SUPPORT AIRWAYS
Advanced life support as we understand is the next step to basic life support which is aimed at securing the circulation and the respiratory airways a step ahead than the basic life support in an effort to revive a sinking patient. The need of advanced life support arises when the basic life support measures have been administered and further steps are required to ensure that the patient is safe from any further dangers that may be life threatening to him. The steps involved in the Advanced life support procedures comprises of both cardiac and respiratory measures. The procedures involved requires very skilled and efficient physicians and nurses with adequate experience, any unskilled act may be life threatening. In this paper we will discuss the respiratory measures in details which are required to secure the airways of the patients.
Endotracheal Intubation: This is the method of inserting a tube into the trachea or the windpipe through the mouth or nose. This method helps in clearing the airways for better respiration. It is also helpful for the physician in cases when some foreign body is stuck in the throat resulting in airway obstruction. The procedure will help the physician to get a clearer view of the airway and therefore he will be able to remove the cause of hindrance, if any (Surgeryencyclopedia.com, 2015).
Rapid Sequence Intubation: This is the method of choice when the patient is not fasting or is not apnoeic. This is used in patients who have a higher risk of vomiting or aspiration on being intubated. Mostly used as an emergency measure, it leads to immediate unconsciousness and paralysis of the respiratory tract thus facilitating intubation. The initial medications include a sedating agent like etomidate followed by a paralytic drug like rocuronium (Lafferty, 2015).
Cricothyrotomy: In this method an incision is made on the cricothyroid membrane through the skin. It helps in establishing a patent airway. This method is considered to be the last resort in cases of airway obstruction. The need for the procedure arises only when there is a contradiction for nasotracheal or orotracheal intubation (Khan, 2015).
Needle Cricothyotomy: This is similar to the Cricothyrotomy, the basic difference lies in the fact that this procedure is done with a needle rather than a scalpel. This method is used when a very limited patency of the airway is required as it involves a very area. It is usually done as a combined procedure with Percutaneous Translaryngeal Ventilation (Mace & Khan, 2008).
Oxygen support: 100% or highly concentrated oxygen should be given to the patient as soon as available.
Bag valve mask: This is used as a measure till another way of securing the way is established. In patients where endotracheal intubation or any other such procedure is contraindicated, this method could prove to be life saving for the patient. As an emergency method this could be the only resort in some patients. In paediatric cases this is the mostly adapted technique as a prehospital management procedure (Bosson, 2015). Although very effective, but it may prove to be very risky too if done by untrained hands.
Laryngeal mask airway: This is a better choice as compared to the bag valve mask as it requires lesser expertise in handling; also it shows its efficiency by resulting in lesser numbers of aspiration incidences or regurgitations. It does not require a direct visualization of the chords or any other invasive methods, thus requiring lesser training and involving lesser complications than others (Neumar et al., 2010).
Supraglottic Mask: It has a similar function like the laryngeal mask and also does not require a direct visualization of the chords.
Oxygen Powered Resuscitator: These are valves which control the supply of oxygen at a particular pressure with the help of regulators, either manually or automatically (Wikipedia, 2015).
Mechanical Ventilators: These are used until the patient is capable enough to breath himself without any external aid. They are connected to the trachea through endotracheal intubation for assisted breathing.
Exhaled carbon dioxide detectors: These are used to ensure the correct positioning of the endotracheal tubes. They show a high degree of sensitivity and specificity when used for detecting the carbon dioxide that has been expired by the patient.
Esophageal Detector devices: They help in determining if the endotracheal tube has reached the esophagus as a result of faulty technique used. If the result is positive, that is, the tube has actually reached the esophagus then the device will induce a suction pressure in the lumen will lead to its collapse or it may pull out some tissues off the esophagus to ensure its closure (Neumar et al., 2010).
Adrenaline: It leads to vasoconstriction immediately after administration following a cardiac arrest, thus facilitating adequate flow of blood to the vital organs. It is advised to be given as IV/IO, the dosage is 1mg every 3-5min followed by 20ml flush. If IV/IO is difficult to administer then it can be given through ETT from 2 to 2.5gram.
Atropine: It facilitates the conduction of the AV node, should be given IV 0.5mg every 3-5minutes to a maximum of 3mg.
Adenosine: It is effective in narrowing stable narrow complex PSVT. Dose to be administered is 6mg of adenosine rapidly infused in the antecubital vein followed by 20ml saline flush. If found to be unsuccessful, then this can be followed up by 2 doses of 12mg each, every 1-2 minutes.
Amiodarone: It is useful in both stable and unstable tachyarrythmias, however the dosage differs in the two conditions. In stable tachyarrythmias 300mg of Amiodarone is infused IV for 20-60 minutes. Whereas, in the unstable form it is given 300mg IV every 10 minutes. For maintenance infusion, 900mg is administered over a period of 24 hours.
Calcium: Calcium is used only in cases of pulseless electrical activity like hyperkalemia, hypo or hypercalcemia etc. the treatment should commence with an initial dose of 10ml of 10% calcium chloride, which may be repeated if required.
Lignocaine: It is an alternative to Amiodarone in cases of cardiac arrest due to VT/VF. In cardiac arrest the initial dose should be 1-1.5mg/kg of body weight of the patient given IV or IO.
Dopamine: This should be used in patients showing signs and symptoms of shock and presenting with bradycardia. The dosage is 2-20micogram/kg/minute.
Magnesium: Its use is indicated in digitalis toxicity leading to ventricular arrhythmias or in cardiac arrest cases with Torsades de pointes or hypomagnesemia. The dosage in cardiac arrest due to torsades de pointes or hypomagnesemia is 1-2gm in 10ml of D5% over 50-60 minutes, followed by 0.5-1g/hour. However the dosage differs in torsades de pointes with pulse or AMI with hypomagnesemia; it then becomes 1-2gm with 50ml of D5% over 5-60 minutes followed by 0.5-1g/hour.
Vasopressin: It is used as an alternative to Adrenaline in cases of refractory VF or pulseless VT, PEA or asystole. Dosage to be administered is 40 units IV/IO.
Sodium bicarbonate: Useful in cases of known pre existing hyperkalemia, bicarbonate responsive acidosis like aspirin overdose, diabetic ketoacidosis or tricyclic antidepressants or cocaine. The dosage should be 1mEq/kg IV bolus (Advanced Life Support training manual, 2012).
SCOPE OF PRACTICE
As a paramedic the scope is wide. Although the rules and regulations vary from state to state. An advanced paramedic is eligible to provide the advance life support care and can be deployed in an advanced life support ambulance. Their work ranges from interpretation of heart rhythms, management of the airways, defibrillation techniques to drug administration. Not only in the hospital setting, they have an important role to perform in the community too, they may be called up in emergency situations. They are also required to assist the police or the firemen in cases of massive disasters where they can be the life savers of the hundreds of people in trouble fighting for their lives. They can also be employed as a flight medic to handle critical cases occurring in the flights while in air (jibc.ca., 2015). They are a great support for the mankind, saving thousands of lives every second, all over the world.
Advanced Life Support training manual. (2012) (1st ed.). Malaysia. Retrieved from http://www.moh.gov.my/images/gallery/Garispanduan/Life_Support.pdf
Bosson, N. (2015). Bag-Valve-Mask Ventilation. Emedicine.medscape.com. Retrieved 14 January 2015, from http://emedicine.medscape.com/article/80184-overview
Jibc.ca,. (2015). Advanced Care Paramedic | Justice Institute of British Columbia. Retrieved 14 January 2015, from http://www.jibc.ca/programs-courses/careers/advanced-care-paramedic
Khan, H. (2015). Cricothyroidotomy. Emedicine.medscape.com. Retrieved 14 January 2015, from http://emedicine.medscape.com/article/1830008-overview
Lafferty, K. (2015). Rapid Sequence Intubation. Emedicine.medscape.com. Retrieved 14 January 2015, from http://emedicine.medscape.com/article/80222-overview
Mace, S., & Khan, N. (2008). Needle Cricothyrotomy. Emergency Medicine Clinics Of North America,26(4), 1085-1101. doi:10.1016/j.emc.2008.09.004
MedlinePlus,. (2011). Endotracheal Intubation. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/imagepages/9295.htm
Neumar, R., Otto, C., Link, M., Kronick, S., Shuster, M., & Callaway, C. et al. (2010). Part 8: Adult Advanced Cardiovascular Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation,122(18_suppl_3), S729-S767. doi:10.1161/circulationaha.110.970988
Surgeryencyclopedia.com,. (2015). Endotracheal Intubation - procedure, tube, pain, complications, Definition, Purpose, Description, Preparation, Risks, Normal results, Alternatives. Retrieved 14 January 2015, from http://www.surgeryencyclopedia.com/Ce-Fi/Endotracheal-Intubation.html
Wikipedia,. (2015). Resuscitator. Retrieved 14 January 2015, from http://en.wikipedia.org/wiki/Resuscitator
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