RESUSCITATION - The Basics

Introduction

Resuscitation centers around the preservation of adequate respiratory and circulatory function compatible with life. To this can be added maintenance of appropriate brain and thermoregulatory function.
Resuscitation principles are the same regardless of the condition
Any patient who is moderately unwell should be considered a candidate for further resuscitation
Neither advanced skills or training in anaesthesia or intensive care are a necessary pre-requisite to begin resuscitating a patient
Rarely should definitive treatment come before resuscitation (e.g. minimal fluid resuscitation for ruptured AAA or penetrating truncal trauma)
Many deaths have occurred because of failure to appreciate the need to begin treatment or inadequate efforts of treatment

Airway	Stridor Snoring/Gurgling Tracheal tug
Breathing	Central cyanosis Tachypnoea Apnoea/Bradypnoea
Circulation	Tachycardia Hypotension Poor capillary refill Urine output < 40 ml/hr
Disability	Drowsiness/Coma
Exposure	T > 40C T < 35C

EUC	K > 6.5 Bicarbonate < 21 Creatinine > 250
FBC	WCC > 30000 or < 4000 in setting of infection
ABG	Metabolic acidosis pH < 7.35 Bicarb < 21 pCO2 > 50 pO2 < 60

Airway	Airway obstruction/aspiration in comatose patient
Breathing	Hypoxia
Circulation	Unrecognized septic shock in infection Unappreciated haemorrhage in thoraco-abdominal-pelvic trauma Occult haemorrhage from GI bleeding, ruptured AAA or ectopic pregnancy

Airway	Chin lift/Jaw thrust
Breathing	100% oxygen by non-rebreather mask
Circulation	2 x >16G IV cannula Empiric IV fluid bolus 10-20ml/kg Early blood matching for haemorrhage Insertion of IDC and keep U/O > 1-2ml/kg

Airway	Not putting someone with a potentially threatened airway into a highly monitored environment
Breathing	Ignoring falling SaO2 or allowing it to stay below 90%
Circulation	Not addressing tachycardia or hypotension IMMEDIATELY Not taking serious infection or bleeding seriously Treating oliguria empirically with frusemide