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By Hargreaves

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Extra resources for A Resuscitation Room Guide Banerjee

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Reduction of trans-thoracic impedance • Larger paddle diameter: 10-13cm in adults • Conductive electrode paste or gel pads • Pressure on paddles (8kg) improves paddle-skin contact • Delivery of shock during the expiratory phase. Air is a poor electrical conductor. Hence the impedance is slightly reduced when the lung volume is lower. • Repeated counter-shocks with a short interval in between: stacked shocks have, however, been abandoned in the Resuscitation 2005 Guidelines as they interrupt chest compression.

4 Insertion of an oropharyngeal airway. 108 Nasopharyngeal airway • Soft tube made of rubber or pliable plastic with a bevel and a flange at the opposite ends (flange prevents overinsertion) • Sizes: 6-8mm internal diameter (adult female: 6-7mm; adult male: 7-8mm). The desired length is from the tragus of ear to the tip of the nose. • These airways are of a fixed length. Selection of the appropriate diameter airway will usually also give the right length. Shortened ETTs can be used in children as small size nasopharyngeal tubes are not available • In the patient with a clamped jaw or when insertion of an oropharyngeal airway has failed, nasopharyngeal airway insertion can rapidly provide a clear airway and access for suctioning to the pharynx.

The scoring system does carry the disadvantage of noticeable interobserver variability. • Class 1: soft palate, uvula, fauces and anterior and posterior tonsillar pillars seen • Class 2: as above, but view of the tonsillar pillars is prevented by tongue • Class 3: only soft palate and base of uvula seen • Class 4: soft palate not seen at all; only hard palate visible. Cormack and Lehane classification 57 58 • Laryngoscopic view • Grade I: all or most of the glottis visible • Grade II: only the posterior part of the glottis visible • Grade III: whole of the glottis not visible • Grade IV: epiglottis not visible.

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