Cardiopulmonary Cerebral Resuscitation CPR Prof M H Mumtaz
Cardio-pulmonary Cerebral Resuscitation (CPR) Prof. M. H. Mumtaz
PHASES I III Basic Life Prolonged Life Support (BLS) (ABC) Support (PLS) (GHI) II Advanced Life Support (ALS) (DEF)
BLS If Unconscious ? A. AIRWAY F Tilt Head. F Lift Neck. F Support Chin.
BLS If not breathing ? B. BREATHE F Lung – – Inflation. Mouth to Nose. Mouth to Tube. Bag-wash.
BLS C. CIRCULATE One Operator Two Operators
Cause Sympathetic F Nervous System. Parasympathetic F Myocardium.
Phase Two Advanced Life Support (Restoration of Spontaneous Circulation) D. DRUGS & FLUIDS F Adrenaline. F Alkali. F Fluids.
E. EKG Ventricular Fibrillation Asystole Bizarre Complexe
F. FIBRILLATION TREATMENT F Ext Defibrillation. F Lignocain.
Biochemical Changes
Biochemical Changes H-CO 3 + H+ H 2 CO 3 CO 2 + H 2 O ECF K+ ICF H+ Lungs Kidney
Correction Bicarbonate Therapy: (CO 2 Producing) H-CO 3 + H+ H 2 CO 3 F F CO 2 + H 2 O Carbonate Therapy: (Non CO 2 Producing) – Routine Indications u Base Deficit u PH u HCO 3 > 10 Meq/L < 7. 20 < 14 Mmol/L Meq HCO 3 = Base Deficit X wt. (kg) X. 3
Correction F Problems – A. Alkalosis. - K+ - O 2 Dissociation - Left Shift. - Depression of Myocard. – B. Sodium Over Load. F Oxygenation Ventilation.
Total Oxygen at Arrest 1500 -1600 mls
Critical Survival Time
Requirement Drugs F Atropine. F Adrenaline. F Calcium. F Glucagon. F Isoprenalin. F Dopamine. F Debutamine. F Lignocaine. Equipment F Trained Doctor. F Laryngoscope. F Tube (ETT). F Ambu Resuscitation. F Defibrillator with Oscilloscope.
Emergency-Fluid Resuscitation
Primary volume therapy “Fill from inside out” Vessel ISS ICS out inside
A New Concept Small Volume Hyperosmolar Saline Colloid Resuscitation 4 ml/kg - 7. 2 -7. 5% Na. Cl/Colloid
Shock Small-volume hyperosmolar resuscitation endothelial cell d erythrocyte interstitium Flow d interstitium
Physiological & Basic Mechanisms F F F Plasma osmolality= 285 -295 mosmol/kg. 7. 2% Na. Cl = 2400 mosmol/kg. End bolus infusion = 460 mosmol/kg. (4 ml/kg). – Ttransmembrane osmotic gradient. – ¯ – Endogenous fluid mobilization. (most pronounced in capillary districts) – ¯ – Plasma volume. – ¯ Hydraulic resistance. – Tissue perfusion.
- Slides: 21