Safety in Dermatologic Procedures: Basic and Advanced Cardiopulmonary Resuscitation

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Della Santa, J. Magliano" "autores" => array:2 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Della Santa" ] 1 => array:2 [ "nombre" => "J." 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Martin-Gorgojo" "autores" => array:2 [ 0 => array:3 [ "nombre" => "B." "apellidos" => "Lobo-Valbuena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "A." "apellidos" => "Martin-Gorgojo" "email" => array:1 [ 0 => "alejandromartingorgojo@aedv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio ITS/Dermatología, Sección Especialidades Médicas, Organismo Autónomo Madrid Salud – Ayuntamiento de Madrid, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seguridad en procedimientos dermatológicos: Reanimación cardiopulmonar básica e instrumental" ] ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0020" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 1085 "Ancho" => 886 "Tamanyo" => 73813 ] ] ] ] "textoCompleto" => "Mortality due to cardiac arrest has remained stable for more than 20 years, with survival rates on hospital discharge of 10% (although regional differences exist, with rates ranging from 1% to 25%). It is also a cause of morbidity, as it generates 4.5% of life years adjusted for disability.<a class="elsevierStyleCrossRefs" href="#bib0035">1–5</a>In 2021, the European Resuscitation Council issued a set of guidelines called Systems Saving Lives, based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science.<a class="elsevierStyleCrossRef" href="#bib0060">6</a>In this article, we discuss the cardiopulmonary resuscitation (CPR) maneuvers we can apply: Basic CPR, instrumental CPR, and advanced CPR.Basic Cardiopulmonary ResuscitationBasic CPR (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) should be initiated in any person who “is unresponsive, with absent or abnormal breathing”, and it should be remembered that slow and labored breathing (agonic breathing) must be considered a sign of cardiac arrest. In the case of an unresponsive patient with a breathing pattern that would be considered normal, the patient should be placed on their side in the safety position (regarding pregnant women, always on the left side), remembering to assess breathing continuously.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Once cardiac arrest has been detected, the emergency medical services (EMS) should be notified immediately. Even when we are the only person available to perform resuscitation, this is still the first step we must take before beginning CPR.We should begin chest compression (preferably on a firm surface):<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•as soon as possible</li><li class="elsevierStyleListItem" id="lsti0010">•on the lower half of the sternum</li><li class="elsevierStyleListItem" id="lsti0015">•compressing to a depth of at least 5cm and no more than 6cm</li><li class="elsevierStyleListItem" id="lsti0020">•at a rhythm of between 100 and 120 times per minute</li><li class="elsevierStyleListItem" id="lsti0025">•with as few interruptions as possible</li><li class="elsevierStyleListItem" id="lsti0030">•ensuring that the chest recoils fully after each compression.</li></ul>After the first 30 compressions, we should perform 2 rescue breaths (using the head-tilt, chin-lift maneuver to open the airway) and then continue with the compressions. If, for any reason, it is not possible to provide the rescue breathing, we must perform continuous chest compressions.Instrumental Cardiopulmonary ResuscitationIf an automated external defibrillator (AED) is available, once basic CPR has begun, the electrodes must be placed on the patient's chest, in the position indicated on the AED (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A), while (if more than one resuscitator is present) CPR continues. Although CPR must be maintained until the AED is connected to the patient and put into operation, defibrillation should not be delayed once the AED is ready.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>When turned on, the AED will provide verbal and/or visual indications. When the heart rhythm is being analyzed, it is essential to ensure that nobody is in contact with the patient.If defibrillation is indicated, we can continue with the CPR maneuvers while the device is being readied. Nobody must be touching the patient at the moment of defibrillation (which requires activation by pressing the button).If the heart rhythm does not require defibrillation and immediately after the AED has discharged, CPR maneuvers must be restarted immediately, as indicated by the AED. After 2min of CPR, the AED will request another pause to analyze the heart rhythm and determine whether defibrillation is required or not.If an oxygen source and self-inflating bag (commonly known by its initials AMBU, for air mask bag unit) connected to a face mask is available, respiration should be carried out using that device connected to the oxygen supply with the rotameter set at 15 liters per minute (maximum oxygen) and, if possible, with a reservoir bag (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Instrumental CPR with a self-inflating bag can be complicated if only one resuscitator is present. If personnel are available, it is recommended that one resuscitator seal the mask with two hands and the other, who is performing the chest compressions, squeeze the bag during the pause for ventilation.Individualized guidelines have been drawn up for patients with suspected or confirmed acute respiratory syndrome due to SARS-CoV-2. Those recommendations can be consulted at <a href="http://www.erc.edu/covid">www.erc.edu/covid</a>. In this case, airway management and breathing assessment is different from the steps described above:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0035">•Visual assessment of breathing, without opening the airway or approaching the patient's nose or mouth.</li><li class="elsevierStyleListItem" id="lsti0040">•Before starting CPR, cover the patient's nose and mouth with a surgical mask or cloth and perform CPR maneuvers while protected with an FFP2/3 mask and/or personal protection equipment (if available).</li><li class="elsevierStyleListItem" id="lsti0045">•In the case of CPR in a patient with COVID-19, continuous chest compressions without breathing are indicated, unless a self-inflating bag and mask are available, through which 100% oxygen can be administered (with the placement of a special antiviral filter valve, if available).</li></ul>The decision algorithm for instrumental CPR and pharmacologic CPR (explained in the following section) is summarized in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Pharmacologic Cardiopulmonary ResuscitationFinally, if vascular access is available (ideally, intravenous, although intraosseous access may be considered if intravenous access is not possible), administration of 1mg of adrenaline should be considered, as per the following indications:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0050">•As soon as possible in adult patients in CPR with a heart rhythm that is not shockable.</li><li class="elsevierStyleListItem" id="lsti0055">•After the third defibrillation shock in adult patients in CPR with a shockable rhythm.</li><li class="elsevierStyleListItem" id="lsti0060">•Every 3–5min (repeated administration of 1mg of adrenaline) while CPR maneuvers last.</li></ul>ConclusionsThese guidelines, based on the latest guidelines published in 2021, stress several points that we will summarize below:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0065">•Encourage the early recognition of patients suffering from cardiac arrest.</li><li class="elsevierStyleListItem" id="lsti0070">•Achieve high quality chest compressions with minimal interruption.</li><li class="elsevierStyleListItem" id="lsti0075">•Ensure early defibrillation.</li><li class="elsevierStyleListItem" id="lsti0080">•Administer adrenaline as soon as possible when the cardiac arrest rhythm is not shockable, and after 3 attempts at defibrillation if the cardiac arrest rhythm is shockable.</li></ul>Conflicts of InterestThe authors declare that they have no conflicts of interest with regard to the content of this article." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1763791" "titulo" => "Graphical abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:3 [ "identificador" => "xres1763793" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec1550952" "titulo" => "Keywords" ] 3 => array:3 [ "identificador" => "xres1763792" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0015" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1550953" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Basic Cardiopulmonary Resuscitation" ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Instrumental Cardiopulmonary Resuscitation" ] 7 => array:2 [ "identificador" => "sec0015" "titulo" => "Pharmacologic Cardiopulmonary Resuscitation" ] 8 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of Interest" ] 10 => array:2 [ "identificador" => "xack623181" "titulo" => "Acknowledgments" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-03-02" "fechaAceptado" => "2022-03-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1550952" "palabras" => array:4 [ 0 => "Dermatologic surgery/Adverse Events" 1 => "Dermatologic surgery/Complications" 2 => "Cardiopulmonary resuscitation" 3 => "Life support care" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1550953" "palabras" => array:4 [ 0 => "Procedimientos quirúrgicos dermatológicos/efectos adversos" 1 => "Procedimientos quirúrgicos dermatológicos/complicaciones" 2 => "Reanimación cardiopulmonar" 3 => "Cuidados de soporte vital" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "This article in the series on safety in dermatologic procedures covers the delivery of basic cardiopulmonary resuscitation (using no devices), instrumental resuscitation (using an automated external defibrillator), and pharmacological resuscitation (using adrenaline). We provide a brief overview of the updated 2021 European Resuscitation Council guidelines and offer an algorithm and visual aids to support recommended practices." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "En el presente artículo de la serie «Seguridad en procedimientos dermatológicos» se aborda la reanimación cardiopulmonar básica (sin empleo de ningún dispositivo), instrumentalizada (usando un desfibrilador externo automático) y farmacológica (haciendo uso de adrenalina). Se plantean las recomendaciones actualizadas en 2021 del Consejo Europeo de Resucitación de forma resumida, con material gráfico que las sistematiza de forma estructurada." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2346 "Ancho" => 1093 "Tamanyo" => 220771 ] ] "descripcion" => array:1 [ "en" => "Basic CPR decision algorithm." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2662 "Ancho" => 2178 "Tamanyo" => 297007 ] ] "descripcion" => array:1 [ "en" => "A) Diagram for placing AED electrodes. B) Description of the parts of the self-inflating bag. Abbreviation: Lpm indicates liters per minute." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1416 "Ancho" => 2178 "Tamanyo" => 247679 ] ] "descripcion" => array:1 [ "en" => "Decision algorithm for instrumental and pharmacologic CPR. Abbreviations: ADRENA indicates adrenaline; EMD, electromechanical dissociation; VF, ventricular fibrillation; MIN, minutes; VT, ventricular tachycardia." ] ] 3 => array:5 [ "identificador" => "fig0020" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 1085 "Ancho" => 886 "Tamanyo" => 73813 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Out-of-hospital cardiac arrest: a systematic review of current risk scores to predict survival" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y.X. Gue" 1 => "K. Adatia" 2 => "R. Kanji" 3 => "T. Potpara" 4 => "G.Y.H. Lip" 5 => "D.A. 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Lott" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2021.02.003" "Revista" => array:6 [ "tituloSerie" => "Resuscitation" "fecha" => "2021" "volumen" => "161" "paginaInicial" => "1" "paginaFinal" => "60" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33773824" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack623181" "titulo" => "Acknowledgments" "texto" => "The authors would like to thank Dr. José Luis Azpiazu for his excellent presentation at the group of conferences on safety in dermatologic procedures. The authors would also like to thank all the members of the dermatology forum Dermachat." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011300000008/v1_202208290519/S0001731022006147/v1_202208290519/en/main.assets" "Apartado" => array:4 [ "identificador" => "6142" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Dermatología práctica" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011300000008/v1_202208290519/S0001731022006147/v1_202208290519/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022006147?idApp=UINPBA000044"]

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Practical Dermatology

Safety in Dermatologic Procedures: Basic and Advanced Cardiopulmonary Resuscitation

Seguridad en procedimientos dermatológicos: Reanimación cardiopulmonar básica e instrumental

B. Lobo-Valbuenaa, A. Martin-Gorgojob,

Corresponding author

alejandromartingorgojo@aedv.es

Corresponding author.

a Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain

b Servicio ITS/Dermatología, Sección Especialidades Médicas, Organismo Autónomo Madrid Salud – Ayuntamiento de Madrid, Madrid, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Mortality due to cardiac arrest has remained stable for more than 20 years&#44; with survival rates on hospital discharge of 10&#37; &#40;although regional differences exist&#44; with rates ranging from 1&#37; to 25&#37;&#41;&#46; It is also a cause of morbidity&#44; as it generates 4&#46;5&#37; of life years adjusted for disability&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In 2021&#44; the European Resuscitation Council issued a set of guidelines called <span class="elsevierStyleItalic">Systems Saving Lives</span>&#44; based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this article&#44; we discuss the cardiopulmonary resuscitation &#40;CPR&#41; maneuvers we can apply&#58; Basic CPR&#44; instrumental CPR&#44; and advanced CPR&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Basic Cardiopulmonary Resuscitation</span><p id="par0020" class="elsevierStylePara elsevierViewall">Basic CPR &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; should be initiated in any person who &#8220;is unresponsive&#44; with absent or abnormal breathing&#8221;&#44; and it should be remembered that slow and labored breathing &#40;agonic breathing&#41; must be considered a sign of cardiac arrest&#46; In the case of an unresponsive patient with a breathing pattern that would be considered normal&#44; the patient should be placed on their side in the safety position &#40;regarding pregnant women&#44; always on the left side&#41;&#44; remembering to assess breathing continuously&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Once cardiac arrest has been detected&#44; the emergency medical services &#40;EMS&#41; should be notified immediately&#46; Even when we are the only person available to perform resuscitation&#44; this is still the first step we must take before beginning CPR&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We should begin chest compression &#40;preferably on a firm surface&#41;&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0035" class="elsevierStylePara elsevierViewall">as soon as possible</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0040" class="elsevierStylePara elsevierViewall">on the lower half of the sternum</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0045" class="elsevierStylePara elsevierViewall">compressing to a depth of at least 5<span class="elsevierStyleHsp" style=""></span>cm and no more than 6<span class="elsevierStyleHsp" style=""></span>cm</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">at a rhythm of between 100 and 120 times per minute</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">with as few interruptions as possible</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">ensuring that the chest recoils fully after each compression&#46;</p></li></ul></p><p id="par0065" class="elsevierStylePara elsevierViewall">After the first 30 compressions&#44; we should perform 2 rescue breaths &#40;using the head-tilt&#44; chin-lift maneuver to open the airway&#41; and then continue with the compressions&#46; If&#44; for any reason&#44; it is not possible to provide the rescue breathing&#44; we must perform continuous chest compressions&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Instrumental Cardiopulmonary Resuscitation</span><p id="par0070" class="elsevierStylePara elsevierViewall">If an automated external defibrillator &#40;AED&#41; is available&#44; once basic CPR has begun&#44; the electrodes must be placed on the patient&#39;s chest&#44; in the position indicated on the AED &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#44; while &#40;if more than one resuscitator is present&#41; CPR continues&#46; Although CPR must be maintained until the AED is connected to the patient and put into operation&#44; defibrillation should not be delayed once the AED is ready&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">When turned on&#44; the AED will provide verbal and&#47;or visual indications&#46; When the heart rhythm is being analyzed&#44; it is essential to ensure that nobody is in contact with the patient&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">If defibrillation is indicated&#44; we can continue with the CPR maneuvers while the device is being readied&#46; Nobody must be touching the patient at the moment of defibrillation &#40;which requires activation by pressing the button&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">If the heart rhythm does not require defibrillation and immediately after the AED has discharged&#44; CPR maneuvers must be restarted immediately&#44; as indicated by the AED&#46; After 2<span class="elsevierStyleHsp" style=""></span>min of CPR&#44; the AED will request another pause to analyze the heart rhythm and determine whether defibrillation is required or not&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">If an oxygen source and self-inflating bag &#40;commonly known by its initials AMBU&#44; for air mask bag unit&#41; connected to a face mask is available&#44; respiration should be carried out using that device connected to the oxygen supply with the rotameter set at 15 liters per minute &#40;maximum oxygen&#41; and&#44; if possible&#44; with a reservoir bag &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; Instrumental CPR with a self-inflating bag can be complicated if only one resuscitator is present&#46; If personnel are available&#44; it is recommended that one resuscitator seal the mask with two hands and the other&#44; who is performing the chest compressions&#44; squeeze the bag during the pause for ventilation&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Individualized guidelines have been drawn up for patients with suspected or confirmed acute respiratory syndrome due to SARS-CoV-2&#46; Those recommendations can be consulted at <a href="http://www.erc.edu/covid">www&#46;erc&#46;edu&#47;covid</a>&#46; In this case&#44; airway management and breathing assessment is different from the steps described above&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Visual assessment of breathing&#44; without opening the airway or approaching the patient&#39;s nose or mouth&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Before starting CPR&#44; cover the patient&#39;s nose and mouth with a surgical mask or cloth and perform CPR maneuvers while protected with an FFP2&#47;3 mask and&#47;or personal protection equipment &#40;if available&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0110" class="elsevierStylePara elsevierViewall">In the case of CPR in a patient with COVID-19&#44; continuous chest compressions without breathing are indicated&#44; unless a self-inflating bag and mask are available&#44; through which 100&#37; oxygen can be administered &#40;with the placement of a special antiviral filter valve&#44; if available&#41;&#46;</p></li></ul></p><p id="par0115" class="elsevierStylePara elsevierViewall">The decision algorithm for instrumental CPR and pharmacologic CPR &#40;explained in the following section&#41; is summarized in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pharmacologic Cardiopulmonary Resuscitation</span><p id="par0120" class="elsevierStylePara elsevierViewall">Finally&#44; if vascular access is available &#40;ideally&#44; intravenous&#44; although intraosseous access may be considered if intravenous access is not possible&#41;&#44; administration of 1<span class="elsevierStyleHsp" style=""></span>mg of adrenaline should be considered&#44; as per the following indications&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0125" class="elsevierStylePara elsevierViewall">As soon as possible in adult patients in CPR with a heart rhythm that is not shockable&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0130" class="elsevierStylePara elsevierViewall">After the third defibrillation shock in adult patients in CPR with a shockable rhythm&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Every 3&#8211;5<span class="elsevierStyleHsp" style=""></span>min &#40;repeated administration of 1<span class="elsevierStyleHsp" style=""></span>mg of adrenaline&#41; while CPR maneuvers last&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="par0140" class="elsevierStylePara elsevierViewall">These guidelines&#44; based on the latest guidelines published in 2021&#44; stress several points that we will summarize below&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8226;</span><p id="par0145" class="elsevierStylePara elsevierViewall">Encourage the early recognition of patients suffering from cardiac arrest&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Achieve high quality chest compressions with minimal interruption&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Ensure early defibrillation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8226;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Administer adrenaline as soon as possible when the cardiac arrest rhythm is not shockable&#44; and after 3 attempts at defibrillation if the cardiac arrest rhythm is shockable&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of Interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest with regard to the content of this article&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This article in the series on safety in dermatologic procedures covers the delivery of basic cardiopulmonary resuscitation &#40;using no devices&#41;&#44; instrumental resuscitation &#40;using an automated external defibrillator&#41;&#44; and pharmacological resuscitation &#40;using adrenaline&#41;&#46; We provide a brief overview of the updated 2021 European Resuscitation Council guidelines and offer an algorithm and visual aids to support recommended practices&#46;</p></span>"
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        "texto" => "<p id="par0170" class="elsevierStylePara elsevierViewall">The authors would like to thank Dr&#46; Jos&#233; Luis Azpiazu for his excellent presentation at the group of conferences on safety in dermatologic procedures&#46; The authors would also like to thank all the members of the dermatology forum <span class="elsevierStyleItalic">Dermachat</span>&#46;</p>"
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Article information

ISSN: 00017310
Original language: English

DOI:10.1016/j.ad.2022.07.008

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Year/Month	Html	Pdf	Total

2024 November	12	16	28
2024 October	107	52	159
2024 September	116	48	164
2024 August	140	62	202
2024 July	100	49	149
2024 June	102	54	156
2024 May	81	57	138
2024 April	80	60	140
2024 March	70	81	151
2024 February	56	57	113
2024 January	46	30	76
2023 December	55	26	81
2023 November	70	55	125
2023 October	68	50	118
2023 September	59	41	100
2023 August	64	34	98
2023 July	86	45	131
2023 June	71	31	102
2023 May	69	30	99
2023 April	68	19	87
2023 March	80	32	112
2023 February	51	31	82
2023 January	71	54	125
2022 December	83	36	119
2022 November	74	43	117
2022 October	85	43	128
2022 September	158	91	249
2022 August	129	56	185
2022 July	60	48	108

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