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AIRWAY AND BREATHING MANAGEMENT CONTINUED...
PROBLEM
BENEFIT & CONSIDERATIONS
AIRWAY RISK FOR CASUALTY CARE CERTIFICATE HOLDERS
COMMENTS
Adult cardiac arrest/medical unwitnessed or CPR ongoing >15 minutes
Risk likely to outweigh benefit.
• MREW teams attend approx 10 cardiac arrests per year. • Use current MREW Covid-19 CPR guideline.
• Extremely likely to have very poor outcome. • Usually has a cardiac (heart- related) cause. • Success dependent on early defibrillation and prompt chest compressions within first few minutes after collapse. • If team is present at ‘collapse’ or within first few minutes, outcome initially more hopeful. • Cause likely to be cardiac (heart-related). • Early defibrillation and chest compressions remain the best means of treating the reversible cause. • Respiratory cause but very poor outcome unless recently submerged and rescued within 10 minutes. After 25 minutes’ submersion, very poor outcomes. • There can be a protective effect of hypothermia in ice cold water. • Outcome very poor once arrest has occurred. Mountain accidents cause blunt trauma. • Rapid intervention is not usually available for a reversible cause in remote situations. Blood loss is the cause of arrest in 50%. Although other reversible causes may be present in 15%, these cannot be corrected by Casualty Care Certificate interventions.
Adult cardiac arrest/medical witnessed
• AEDs are used by MREW teams approx 8 times a year. • Use current MREW Covid-19 CPR guideline. • See below for risk assessment and interventions if A & B interventions considered.
Risk likely to outweigh benefit. Consider A & B if defibrillation not successful in first three shocks.
Adult cardiac arrest/trauma
Risk is likely to outweigh benefit.
• Defibrillation will not treat the cause of a traumatic cardiac arrest.
• Gloves
Paediatric arrest/ drowning
Benefit increased BUT requires assessment of situation.
• MREW teams attend approx 3 drownings (of all ages) per year. • Emotional dilemma present in all child cardiac arrest. Assess the risk: 1: Children do have the potential to infect adults BUT this might be less likely to do so. 2: Cause of arrest is lack of oxygen and airway intervention with ventilation is more likely to reverse the cause than with some other causes. 3: Time under water: improved survival if child is rescued within 10 minutes. Very poor outcomes after 25 minutes under water. 4: Improved outcome if CPR started immediately. Ideally, decision by experienced HCP. Resuscitation requires Level 3 PPE available and suitably skilled provider — is this available? • If you accept the risk, use a bag-valve- mask (well-fitting mask and filter) + oxygen, rather than a face shield or pocket mask.
• Bystander immediate CPR/ventilation critical.
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MOUNTAIN RESCUE MAGAZINE WINTER 2021
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