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93 53 54 54 55 Fig. 13 Anaphylactic reactions: treatment algorithm for children by first medical responders. Reproduced with permission by the Resuscitation Council (UK). 96 Introduction • Early airway assessment and control are essential components of the respiratory management of all acutely ill patientsâ for whom oxygenation is always a crucial priority • Apart from witnessed primary cardiac arrestâ where defibrillation takes precedenceâ ensuring a patent airway and delivering oxygen into the lungs is the immediate aim, fundamental to successful patient care by preventing hypoxaemia • The clear airway may be threatened by many widely different disease processes and at different levels from the front of the face down to the bronchi • Tracheal intubation is the definitive way of securing the airway to by-pass any obstruction, permit positive pressure ventilation and regulate gas exchange with high oxygen concentrations if needed.

104 Elective airway evaluation Mouth opening Mouth opening should be 6-8cm (3-4 finger breadths). The thyromental distance should be 6-8cm (3-4 finger breadths). This is the straight line distance between the thyroid notch and the lower border of the mentum (chin) with the head extended. Mallampati score This is evaluated while sitting up with head in neutral position and maximal opening of mouth with maximal tongue protrusion. Visible pharyngeal structures are used in the process of scoring. The scoring system does carry the disadvantage of noticeable interobserver variability.

A further 150mg bolus is given for recurrent/refractory VT/VF, followed by an infusion of 900mg over 24h if return of spontaneous circulation occurs. Magnesium sulphate • 8mmol or 2g(4mL of 50% magnesium sulphate) over 1-2min; can be repeated after 10-15min • 1mL 50% magnesium sulphate = 2mmol = 500mg. 10mmol/kg). • Two concentrations exist in ampoule form: ♦ 20mL of 20% (= 16mmol = 4g) ♦ 2mL of 50% (= 4mmol = 2g) • 4, 5 and 10mL pre-filled syringes of 50% solution are also available. g. potassium-losing diuretic therapy) • Torsade de pointes on the ECG • Digoxin toxicity.

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