Asystole, Cardiology Case

Posted by e-Medical PPT Friday, April 19, 2013
A 54 years old women transferred by her colleagues in a unconcious state in ER. There was no any clear history about past , and BP is not detectable and pusle is not pulpable , breathing is there , Pupil is not dilated and simultaneously with a glance general survey a ‘One” lead ECG shows this ECG strip 1) what is best Diagnosis by ECG ? 2)What is your management for her ?

When can CPR be withheld? Virtually all hospitals have policies which describe circumstances under which CPR can be withheld. Two general situations arise which justify withholding CPR: when CPR is judged to be of no medical benefit (also known as "medical futility"and when the patient with intact decision making capacity (or when lacking such capacity, someone designated to make decisions for them) clearly indicates that he / she does not want CPR, should the need arise.

When is CPR "futile"? CPR is “Futile” when it offers the patient no clinical benefit. When CPR offers no benefit, you as a physician are ethically justified in withholding resuscitation. Clearly it is important to define what it means to "be of benefit." The distinction between merely providing measurable effects (e.g. normalizing the serum potassium) and providing benefits is helpful in this deliberation.

When is CPR not of benefit? One approach to defining benefit examines the probability of an intervention leading to a desirable outcome. CPR has been prospectively evaluated in a wide variety of clinical situations. Knowledge of the probability of success with CPR could be used to determine its futility. For instance, CPR has been shown to be have a 0% probability of success in the following clinical circumstances: Septic shock Acute stroke Metastatic cancer Severe pneumonia
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