26 - Emergency medicine: cardiac arrest management, severe burns, near-drowning and multiple trauma

Summary

This chapter explores four important practical topics in emergency medicine. The management of cardiac arrest, drowning, burns and multiple trauma all require specific knowledge and skills in order to achieve best outcomes. We have provided an overview of the general principles of management of these four clinical scenarios and identified a number of specific questions regarding novel or emerging therapies. In attempting to answer these questions we reviewed the evidence and further identified what is known and what requires further study. Whilst there is some good-quality evidence to support practice in the areas of cardiac arrest, traumatic brain injury and some aspects of fluid resuscitation in trauma, there is little evidence to guide clinicians in the choice of burns dressings, management of near drowning and differing strategies in trauma fluid resuscitation. Opportunities for further research are highlighted.

Cardiac arrest management

The patient in cardiac arrest is the most important time-critical emergency that the anaesthetist will face. The earliest possible initiation of basic and advanced life support offers the best chance of patient survival.

In 1997 the International Liaison Committee On Resuscitation (ILCOR) published The Universal ALS Algorithm. The updated version is shown in Figure 26.1. It was designed to be simple, concise and easy to memorise.