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Nuevas recomendaciones RCP 2010

Nuevas recomendaciones RCP 2010






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  • Protocolos nuevos para tiempos nuevos ? ., 2005 Criterio: ABC., actualización 2010 Criterio :CAB.,Indicador de insuficientes estudios tipo EVIDENCIA, RECOMENDACION O BUENA PRACTICA., es decir LA RCP no es parte de la medicina BASADA EN EVIDENCIA ? Las Instituciones el Sector Salud deben hacerse presentes al igual que lo están haciendo con Las GPC, GRR y GRD.
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  • Por cada minuto de retraso en realizar la desfibrilación disminuye la supervivencia un 10-12%. Mejor hacer compresiones torácicas que nada. La RCP previa a la desfibrilación disminuye la mortalidad de un 10-12% a un 3-4%.
  • Hay que optimizar la cadena de supervivencia(Estudios realizados en Japón disminuía la mortalidad del 15 al 30%)? Disminuir los tiempos de respuesta a todos los niveles.
  • Cerca del 40% de los paros con respiración agónica no se reconoce como normal y el reconocimiento de los jadeos aumenta la supervivencia.
  • SOS-KANTO Background Mouth-to-mouth ventilation is a barrier to bystanders doing cardiopulmonary resuscitation (CPR), but few clinical studies have investigated the efficacy of bystander resuscitation by chest compressions without mouth-to-mouth ventilation (cardiac-only resuscitation). Methods We did a prospective, multicentre, observational study of patients who had out-of-hospital cardiac arrest. On arrival at the scene, paramedics assessed the technique of bystander resuscitation. The primary endpoint was favourable neurological outcome 30 days after cardiac arrest. Findings 4068 adult patients who had out-of-hospital cardiac arrest witnessed by bystanders were included; 439 (11%) received cardiac-only resuscitation from bystanders, 712 (18%) conventional CPR, and 2917 (72%) received no bystander CPR. Any resuscitation attempt was associated with a higher proportion having favourable neurological outcomes than no resuscitation (5·0% vs 2·2%, p<0·0001). Cardiac-only resuscitation resulted in a higher proportion of patients with favourable neurological outcomes than conventional CPR in patients with apnoea (6·2% vs 3·1%; p=0·0195), with shockable rhythm (19·4% vs 11·2%, p=0·041), and with resuscitation that started within 4 min of arrest (10·1% vs 5·1%, p=0·0221). However, there was no evidence for any benefit from the addition of mouth-to-mouth ventilation in any subgroup. The adjusted odds ratio for a favourable neurological outcome after cardiac-only resuscitation was 2·2 (95% CI 1·2—4·2) in patients who received any resuscitation from bystanders. Interpretation Cardiac-only resuscitation by bystanders is the preferable approach to resuscitation for adult patients with witnessed out-of-hospital cardiac arrest, especially those with apnoea, shockable rhythm, or short periods of untreated arrest.
  • Methods From January 1, 2005, through December 31, 2007, we conducted a prospective, population-based, observational study involving consecutive patients across Japan who had an out-of-hospital cardiac arrest and in whom resuscitation was attempted by emergency responders. We evaluated the effect of nationwide dissemination of public-access AEDs on the rate of survival after an out-of-hospital cardiac arrest. The primary outcome measure was the 1-month rate of survival with minimal neurologic impairment. A multivariate logistic-regression analysis was performed to assess factors associated with a good neurologic outcome. Full Text of Methods... Results A total of 312,319 adults who had an out-of-hospital cardiac arrest were included in the study; 12,631 of these patients had ventricular fibrillation and had an arrest that was of cardiac origin and that was witnessed by bystanders. In 462 of these patients (3.7%), shocks were administered by laypersons with the use of public-access AEDs, and the proportion increased, from 1.2% to 6.2%, as the number of public-access AEDs increased (P<0.001). The mean time to shock was reduced from 3.7 to 2.2 minutes, and the annual number of patients per 10 million population who survived with minimal neurologic impairment increased from 2.4 to 8.9 as the number of public-access AEDs increased from fewer than 1 per square kilometer of inhabited area to 4 or more. Full Text of Results... Conclusions Nationwide dissemination of public-access AEDs in Japan resulted in earlier administration of shocks by laypersons and in an increase in the 1-month rate of survival with minimal neurologic impairment after an out-of-hospital cardiac arrest.
  • Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Breitkreutz R , Price S , Steiger HV , Seeger FH , Ilper H , Ackermann H , Rudolph M , Uddin S , Weigand MA , Müller E , Walcher F ; Emergency Ultrasound Working Group of the Johann Wolfgang Goethe-University Hospital, Frankfurt am Main . Department of Anaesthesiology, Intensive Care and Pain Therapy University of the Saarland, Medical Faculty, D-66421 Homburg (Saar), Germany. raoul.breitkreutz@gmail.com Abstract PURPOSE OF THE STUDY: Focused ultrasound is increasingly used in the emergency setting, with an ALS-compliant focused echocardiography algorithm proposed as an adjunct in peri-resuscitation care (FEEL). The purpose of this study was to evaluate the feasibility of FEEL in pre-hospital resuscitation, the incidence of potentially treatable conditions detected, and the influence on patient management. PATIENTS, MATERIALS AND METHODS: A prospective observational study in a pre-hospital emergency setting in patients actively undergoing cardio-pulmonary resuscitation or in a shock state. The FEEL protocol was applied by trained emergency doctors, following which a standardised report sheet was completed, including echo findings and any echo-directed change in management. These reports were then analysed independently. RESULTS: A total of 230 patients were included, with 204 undergoing a FEEL examination during ongoing cardiac arrest (100) and in a shock state (104). Images of diagnostic quality were obtained in 96%. In 35% of those with an ECG diagnosis of asystole, and 58% of those with PEA, coordinated cardiac motion was detected, and associated with increased survival. Echocardiographic findings altered management in 78% of cases. CONCLUSIONS: Application of ALS-compliant echocardiography in pre-hospital care is feasible, and alters diagnosis and management in a significant number of patients. Further research into its effect on patient outcomes is warranted

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