Cardiopulmonary Resuscitation Dr Hajijafari anesthesiologist KUMS Introduction to

Cardiopulmonary Resuscitation Dr Hajijafari anesthesiologist KUMS

Introduction to CPR BLS ACLS

Time is Critical! • > 300, 000 people experience sudden cardiac death in prehospital settings each year. • If resuscitation begins within a few minutes, many of these individuals have a chance for survival.

Time is Critical! To begin resuscitation within a few minutes: • Diagnosis • EMS immediately activated • CPR started immediately • Defibrillation within minutes

What is the function of the circulatory system?

The Circulatory System • Delivers O 2 and nutrients • Removes CO 2 and wastes

Time is Critical! • Brain damage begins in 4– 6 min • Brain damage irreversible in 8– 10 min Circulation must be restored within 4– 6 minutes.

CPR • Combines external chest compressions with artificial ventilation: – Provides 30% (or less) of normal circulation – Only effective for short period of time

Causes of Cardiac Arrest

Causes of Cardiac Arrest • • • Heart disease Respiratory arrest Medical emergencies Drowning and suffocation Congenital heart defects Trauma

The cause of cardiac arrest is important BUT do not delay CPR to obtain history

ABC change to CAB

CPR – 1 Rescuer • Assess responsiveness • Summon EMS • Position the patient

CPR – 1 Rescuer • Check for a pulse (≤ 10 seconds)

CPR – 1 Rescuer • If there is no pulse, find your landmarks, lower half of the sternum, between the nipples

CPR – 1 Rescuer • Begin chest compressions

CPR – 1 Rescuer • Perform 30 chest compressions • Push hard • Push fast • Allow the chest to recoil after each compression

CPR – 1 Rescuer • Administer two ventilations then return to compressions

CPR – 1 Rescuer • Check for a pulse (≤ 10 seconds) • Normal pulse

• Open the airway • If there is no breathing, give two breaths, each lasting 1 second

CPR – 2 Rescuer 1 2 3 4

CPR - Children • Use heel of one hand • Keep airway open with other hand • 30 compressions: 2 ventilations if alone (2 rescuers use 15: 2)

CPR - Infant • ABC • 30 compressions: 2 ventilations if alone • 15 compressions: 2 ventilations with 2 rescuers

Sequence of Survival

Chain of Survival for Adult

Sequence of Survival Also known as Chain of Survival • Recognition and Early Access • Early CPR • Defibrillation • Early Advanced Care

Recognition and Early Access • Depends on public education • EMS must be immediately notified • 9 -1 -1 dispatchers can provide CPR instructions

Early CPR • Must begin within 4 -6 minutes of collapse • Public training is necessary • Rescuers have a critical role

Defibrillation • Ventricular fibrillation a common cause of arrest • Can only correct with defibrillation Copyright © 2004 Elsevier (USA). All Rights Reserved

Ventricular Fibrillation • The most common cause of sudden cardiac death – disorganized heart activity – Heart muscle cannot pump blood

Ventricular Fibrillation • Requires immediate defibrillation • CPR lengthens window of survival

Early Advanced Care • Medication • Advanced airway management • Post-resuscitation care

AED

AEDs • Safe, accurate & lightweight • Easy to operate

AED • AEDs in public places • Training the public in CPR/AED

AED

Universal Steps Power ↓ Patient ↓ Analyze ↓ Shock

Power • Turn the power on

Patient • Apply pads to patient

Analyze • Stay clear while patient’s heart rhythm analyzed

Clear

Shock • Defibrillate

Patient • Standard is set of 1 shock • Immediately restart CPR for 2 minutes then check pulse

Summary of BLS • Continual beating, or contracting, of the heart is necessary to keep blood circulating throughout the body. • Brain damage begins in 4 to 6 minutes of cardiac arrest. • There are many causes of sudden cardiac death, but the most common is ventricular fibrillation.

• ACLS

• • IV Access Airway management Medication and defibrilation Post CPR

ADULT CARDIAC ARREST ALGORITHM

MANAGEMENT OF SYMPTOMATIC BRADYCARDIA & TACHYCARDIA

BRADYARRHYTHMIA

TACHYARRHYTHMIA

CARDIOVERSION ↓ DRUGS & DOSAGE →

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