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  • 1. D-r Elena Georgieva
  • 2.
    • CPR and emergency cardiac care should be considered any time an individual cannot adequately oxygenate or perfuse vital organs.
  • 3. ABCDs of CPR
    • A – airway.
    • B – breathing.
    • C – circulation.
    • D – defibrillation.
  • 4. Algorithm
    • Check responsiveness.
    • Activate emergency response system.
    • Call for defibrillator.
    • Primary ABCD survey.
    • Secondary ABCD survey.
  • 5. Airway – open the airway.
    • Head – tilt, chin – lift: if there is no evidence of cervical spine instability.
    • Jaw thrust.
    • Vomitus or a foreign body – should be swept out with a hooked index finger or by Heimlich maneuver.
  • 6. Breathing
    • Mouth-to-mouth.
    • Mouth-to-nose.
    • Mouth-to-stoma.
    • Mouth-to-barrier device.
    • Mouth-to-mask.
    • By using a bag-mask device.
  • 7. Apnea
    • Lack of chest movement.
    • Absence of breath sounds.
    • Lack of airflow.
  • 8. Breathing
    • Initially 2 breaths slowly administered (2s).
    • 10-12 breaths per minute.
    • Observing the chest rising and falling.
    • Rescuer’s exhaled air – oxygen concentration 16-17%, significant CO2 (low cardiac output and intrapulmonary shunting). Preferable to use a supplemental oxygen 100%.
    • Small tidal volume – 700-1000 ml or 400-600 ml if suppl. oxygen is used.
  • 9. Tracheal intubation
    • As soon as practical.
    • Not for more than 30s.
    • Cricoid pressure.
  • 10. Circulation
    • External chest compressions.
    • Intravenous drug administration.
    • Defibrillation when appropriate.
  • 11. External chest compressions
    • Depression of the sternum – 4-5cm.
    • Equal compression and release times.
    • Compression rate – 100/min.
  • 12. Defibrillation
    • The chance of successful defibrillation of a patient in ventricular fibrillation decreases 7-10% per minute.
    • Patients who have cardiac arrest should be defibrillated at the earliest possible moment -shock should be delivered within 3 min of arrest.
    • Biphasic waveforms – achieve the same degree of success but with less energy (less myocardial damage).
  • 13. Defibrillation
    • AEDs – automated external defibrillators.
    • 200-200-360J.
  • 14. Open-chest cardiac massage
    • Penetrating or blunt chest trauma.
    • Penetrating abdominal trauma.
    • Severe chest deformity.
    • Pericardial tamponade.
    • Pulmonary embolism.
  • 15. Drug administration
    • Through a TT.
    • Intravenous access.
    • Intraosseous access.
  • 16. Through a TT
    • Lidocaine, epinephrine, atropine, vasopressin (but not sodium bicarbonate).
    • Dosage: 2-2,5 times higher than recommended for intravenous use, diluted in 10ml of normal saline or distilled water.
  • 17. Intravenous access
    • Central line – preferable.
    • Antecubital or external jugular vein.
    • Peripheral i.v. sites: delay of 1-2 min between drug administration and delivery to the heart (reduced periferal blood flow during resuscitation) – i.v. flash (20ml) and elevation of the extremity for 10-20s.
  • 18. Intraosseous access
    • In the tibia or in the distal radius and ulna in children.
    • Slightly delayed onset of action compared with i.v. or tracheal administration.
    • Complications: osteomyelitis, compartment syndrome, bone marrow or fat embolism.
    • Avoided in patients with right-to-left shunts, pulmonary hypertension, severe pulmonary insufficiency.
  • 19. Secondary ABCD survey
    • Airway: place airway device as soon as possible.
    • Breathing: confirm and secure airway device; confirm effective oxygenation and ventilation.
    • Circulation: establish i.v. access; identify rhythm (monitor); administer drugs appropriate for rhythm and condition.
    • Differential diagnosis: search for and treat identified reversible causes.
  • 20. Drugs
    • Calcium chloride 10%: 2-4mg/kg every 10 min if documented hypocalcemia, hyperkalemia, hypermagnesemia.
    • Sodium bicarbonate: 0,5-1mEq/kg only in situations as preexisting metabolic acidosis or hyperkalemia; elevates plasma pH.
    • Atropine: 0,5-1mg repeated every 3-5 min to a total dose of 3mg; indications: symptomatic bradycardia, AV-block.
    • Epinephrine: 1mg i.v. every 3-5 min as necessary.
  • 21.
    • Lidocaine: 1-1,5mg/kg every 5-10 min to a total dose of 3mg/kg.
    • Vasopressin: 40UI i.v., single dose, one time only; 10-20 min half-life.
    • Amiodarone: 150mg over 10 min, followed by 1mg/min for 6 hours, then 0,5mg/min, with supplementary infusion of 150mg as necessary up to 2g.
  • 22. Changes in recommendations: 2005,2010
    • Use only head-tilt, chin-lift.
    • Check unresponsiveness – do not take more than 10s.
    • 30:2.
    • CAB (ABC is for babies).
    • Compressions come first before you worry about the airway.
  • 23.
    • Push a little harder.
    • Push a little faster.
    • Don’t stop pushing: every interruption in chest compressions interrupt a blood flow to the brain. It takes several compressions to get blood moving again. Push until the AED is in place and ready to analyse the heart.
    • One shock – 2 min CPR – start again with compressions.
  • 24.
    • Thank you!
  • 25.  

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