Cardiopulmonary Resuscitation Mechanisms of Cardiopulmonary Arrest Cardiopulmonary arrest

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Cardiopulmonary Resuscitation Mechanisms of Cardiopulmonary Arrest Cardiopulmonary arrest results from either primary cardiac or

Cardiopulmonary Resuscitation Mechanisms of Cardiopulmonary Arrest Cardiopulmonary arrest results from either primary cardiac or respiratory arrest. Cardiac arrest may be: Primary: _due to dysrhythmia or severe myocardial failure Secondary: _due to hypoxaemia(respiratory arrest), electrolyte imbalance, etc There are three fundamental (rhythms)of cardiac arrest: Ventricular fibrillation(VF), or pulseless ventricular tachy cardia(VT) Asystole, or extreme bradycardia Electromechanical dissociation(EMD)

Factors Affecting Survival _The rhythm is VF or VT _The arrest is witnessed _Defibrillation

Factors Affecting Survival _The rhythm is VF or VT _The arrest is witnessed _Defibrillation and advanced life support are given early Basic life support All medical, nursing and other hospital staff, as well as the general public, should be able to perform basic life support Important points: _Check that there is no danger to yourself or to the casuality before starting resuscitation. _If the casuality is unresponsive , first shout for help, then check airway, breathing and circulation _Airway foreign bodies may be removed under diret vision or by finger sweeps, back blows or the heimlich manoeuver. _If breathing and pulse are absent, get help before starting CPR. Survival is very unlikely without advanced life support and defibrillation.

-The ratio of chest compressions to ventilation should be 15: 2 with one rescuer,

-The ratio of chest compressions to ventilation should be 15: 2 with one rescuer, and 5: 1 with two rescuers. _Ventilation can be performed either mouth to mouth or by using airway adjuncts. _Be aware of the possibility of neck trauma before considering extending the neck in order to open the airway. _Lifting the jaw anteriorly(jaw thrust)may be required to open the airway. _The technique of expired air resuscitation cannot be learnt from a book but only from a properly training session supervised

For an adult or an older child who has reached puberty: Move or remove

For an adult or an older child who has reached puberty: Move or remove all clothing covering the chest. You need to be able to see the chest move. Kneel next to the person , locate the lower third of sternum, avoid the xiphisternum. . Put the heel of one hand on the center of the person's chest between the nipples. Positioning your hands for chest compressions: Use both hands to give compressions. Stack your other hand on top of the one that you just put in position. Lace the fingers of both hands together, and raise your fingers so they do not touch the chest. Straighten your arms, lock your elbows, and center your shoulders directly over your hands.

Positioning your arms and body for doing chest compressions: Press down in a steady

Positioning your arms and body for doing chest compressions: Press down in a steady rhythm, using your body weight. The force from each thrust should go straight down onto the chest, pressing it down 1. 5 in. (3. 8 cm) to 2 in. (5 cm). . Be sure to let the chest re-expand at the end of each compression.

Is the patient Responsive? no 1. Check for injuries 2. Reassess at regular Intervals

Is the patient Responsive? no 1. Check for injuries 2. Reassess at regular Intervals yes 3. Get help if needed call for he. Ip Assess breathing And circulation reathing. B Pulse present? 1. Turn to recovery Position 2. Phone for help Not breathing. Pulse present 1. Give 10 breaths 2. Phone for help 3. Continue expired Air resuscitation Not breathing No Pulse 1. Phone for help 2. Perform CPR

Advanced Life Support n All persons who may be called upon perform ALS should

Advanced Life Support n All persons who may be called upon perform ALS should be familiar with these algorithms. Regular refresher courses are recommended. n

Asystol e Precordial thump VE excluded NO Yes D. C. shock 200 J D.

Asystol e Precordial thump VE excluded NO Yes D. C. shock 200 J D. C. shock 360 J access Intubate/i. v. Adrenaline 1 mg i. v. CPR 10 sequences of 5: 1 Atropine 3 mg i. v. (give only once) Electrical Activity? NO Yas 1. Continue CPR between shocks 2. If no I. V. access consider adrenaline(2 mg via tracheal tube). 3. Give adrenaline (1 mg )during each loop, give atropine only in The first loop. 4. After 3 loops consider adrenaline(5 mg)i. v. , calcium, alkalinizing agent.

VF Precodial thump 1 D. C. shock 200 J 2 D. C. shock 200

VF Precodial thump 1 D. C. shock 200 J 2 D. C. shock 200 J 3 D. C. shock 360 J Lntubate/. i. v. accass Adrenaline 1 mg CPR 10 sequences of 5: 1 4 D. C. shock 360 J 5 D. C. shock 360 J 6 D. C. shock 360 J 1. Continue CPR between shocks. 2. The interval between D. C. shocks 3 and 4 should not be more Than 2 min 3. Give adrenaline (1 mg )i. v. during each loop. 4. If no i. v. access consider adrenaline (2 mg) via tracheal tube. 5. After 3 loops consider alkalinizing agent, anti arhythmic(e. g. Bretylium, amiodarone)

Electromechanical dissociation Hypovolaemia Tensinon pneumothorax Cardiac tamponade Pulmonary embolism Electrolyte imbalance Hypothermia Drug verdose

Electromechanical dissociation Hypovolaemia Tensinon pneumothorax Cardiac tamponade Pulmonary embolism Electrolyte imbalance Hypothermia Drug verdose Lntubate/i. v. access Adrenaline 1 mg CPR 10 sequences of 5; 1 1. If no i. v. access, consider adrenaline(2 mg Tracheal tube. 2. After 3 loops consider : Adrenaline(5 mg )i. v. Calcium chloride Alkalinizing agent Pressor agents

Important points n * A precordial thump may convert VF or VT to Sinus

Important points n * A precordial thump may convert VF or VT to Sinus rhythm, or stimulate a contraction in asystole. *Defibrrilation is the only cure for VF or VT , but must be given as soon as possible. *Adrenaline is given to improve cerebral and coronary blood flow, not to terminate VF or asystole. *Sodium bicarbonate is no longer recommended at an early stage , as it may worsen intracellular acidosis. It is given in early stage only if the acidosis is the cause of VF or asystole. Up to 50 mmol i. v. may be given for severe metabolic acidosis later in the process of resuscitation, preferably guided by arterial blood gases. *EMDis usually secondary, and CPR is unlikely to be successful unless the cause is treated, e. g. calcium may be useful in hypocalcaemia, hyperkalaemia, or after use of

*Bretylium, ligocain, or amiodarone may be considered in refractory VF. CPR must be continued

*Bretylium, ligocain, or amiodarone may be considered in refractory VF. CPR must be continued for a further 20 – 30 min if bretylium is given, as its effect is delyed. *Drugs are best given through a central line. Central line insertion during CPR is hazarous if done by the inexperienced. If intravenous access is not possible, the endotracheal route ia an alternative for adrenaline, atropine, lignocaine, using 2 – 3 times the i. v. dose.

Postresuscitation care The patient should be nursed in an ITU. The following points should

Postresuscitation care The patient should be nursed in an ITU. The following points should be considered: History: *Previous medical history. *Events preceding the arrest *Cause of the arrest. *Examination Respiratory(endotracheal tube position, pneumothorax, fractured ribs or sternum Cardiovascular(pulse, BP, adequacy of perfusion, jugular venous pressure, urine out put. Neurological(glasgow coma score, pupil size and reactivity , neurological deficit) Investigations *arterial blood gases , chest X-ray, 12 lead ECG, Urea and electrolytes, and cosidering the invasive haemodynamic monitoring. Treatment _Oxygen, according to arterial blood gases , , Continued

Paediatric Resuscitation The principles of CPR in children are very similar to those in

Paediatric Resuscitation The principles of CPR in children are very similar to those in adult, but the following differences apply: _Asystole or severe bradycardia are the commonest causes. They may be secondary to hypoxaemia or circulatory failure, and may be cured by BLS and oxygenation. _Cardiac arrest may be due to airway obstruction(foreign bodies, epiglottitis or croup), near drowning, asthma , trauma , or severe infections _The Heimlich manoevre, finger sweeps, and incisional cricothyrotomy are contraindication in younger children. Back blows , chest thrusts and needle cricothyrotomy are alternative. _External cardiac massages: The compressionrate should be 100 – 120 in infants, and 80 – 100 in older children. Remember to use less force. _Defibrillation: The initial charge is 2 j/kg , increasing to 4 j /kg if necessary. _Drug doses: Adrenaline 0. 1 ml/kg of 1: 10000 Atropine 0. 02 mg/kg(minimum 0. 1 mg , maximum 0. 6 mg) Calcium 0. 1 ml/ kg of 10% calcium chloride. Lignocaine 0. 1 ml/ kg of 1% lignocaine Sodium bicarbonate 1 mmol/kg.

CARDIOPULMONARY RESUSCITATION Dr-Basim Sudani F. I. B. M. S , D. A. I. C.

CARDIOPULMONARY RESUSCITATION Dr-Basim Sudani F. I. B. M. S , D. A. I. C. , M. B. Ch. B. THANK YOU