0
CPR FOR ADULTS
1
2
Plan
4
 Definition/Aim of Cardiopulmonary Resuscitation (CPR)
 Treatment of VF / Pulseless VT
 Treatment of non-VF/VT r...
Cardiopulmonary Resuscitation
(CPR) - Definition
5
Emergent medical applications that are performed for a living
whose res...
6
To provide adequate amount of oxygenated blood
for vital organs
Cardiopulmonary Resuscitation
(CPR) - Aim
7
Cardiopulmonary Arrest (CPR)
8
Causes:
 Airway obstruction
 Respiratory distress
 Cardiac abnormalities
ACUTE MYOCARDIA...
9
CPR – ILCOR (International Liaison Committee On Resuscitation)
 American Heart Association (AHA)
 European Resuscitati...
10
CPR
 Basic Life Support
 Advanced Life Support
 Prolonged Life Support
11
CPR
 Basic Life Support
 Advanced Life Support
 Prolonged Life Support
12
CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/Pulseless VT)
Non-shockable
(PEA/Asystole)
1 ...
13
CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/Pulseless VT)
Non-shockable
(PEA/Asystole)
1 ...
14
Open Airway
Look for signs of life
…. to confirm cardiac arrest
 Patient response
 Open airway
 Check for normal bre...
15
CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/Pulseless VT)
Non-shockable
(PEA/Asystole)
1 ...
16
Open Airway
Look for signs of life
Call
Resuscitation
Team
Cardiac arrest confirmed
CPR 30:2
Until defibrillator /
moni...
17
Chest Compression
 30:2
 Compressions
 Centre of chest
 5-6 cm depth
 100-120 min-1
 Uninterrupted
compressions w...
18
CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/Pulseless VT)
Non-shockable
(PEA/Asystole)
1 ...
19
Adult ALS
Algorithm
Open Airway
Look for signs of life
Call
Resuscitation
Team
CPR 30:2
Until defibrillator/monitor att...
20
Adult ALS
Algorithm
Open Airway
Look for signs of life
Call
Resuscitation
Team
CPR 30:2
Until defibrillator/monitor att...
21
Shockable (VF)
 Irregular waveform
 No recognisable QRS
complexes
 Random frequency and
amplitude
 Uncoordinated el...
Monomorphic VT
 broad complex rhythm
 rapid rate
 constant QRS morphology
Polymorphic VT
 torsade de pointes
Shockab...
Precordial Thump
 Rapid treatment of a
witnessed and monitored
VF/VT cardiac arrest
 Used if defibrillator not
immediate...
1st shock
 150 - 200 J biphasic
 360 J monophasic
Assess
Rhythm
Shockable
(VF/Pulseless VT)
1 Shock
150-360 J biphasic
o...
Defibrillation Energies
 Vary with manufacturer
 Check local equipment
 If unsure, deliver 200 J (do not delay shock)
Deliver 2nd shock
Deliver 3rd shock
CPR for 2 min
If VF/VT persists
CPR for 2 min
Deliver 4th shock
Adrenalin, 1mg iV
Amio...
After delivery of shock
Continue CPR for another 2 min
 stop CPR only if patient shows signs of life
After 2 min, assess...
Asystole
Pulseless Electrical
Activity (PEA)
Assess
Rhythm
Non-shockable
(PEA/Asystole)
Immediately resume
CPR 30:2
for 2 ...
 Absent ventricular (QRS) activity
 Atrial activity (P waves) may persist
 Rarely a straight line trace
 Treat fine VF...
Asystole
During CPR:
 check leads are attached
 adrenaline 1 mg IV every 3 – 5 min
 Clinical features of cardiac arrest
 ECG normally associated with an output
Non-shockable
(PEA)
Pulseless Electrical Activity
(PEA)
 Exclude/treat reversible causes
 Adrenaline 1 mg IV every 3-5 min
During CPR:
 Correct reversible causes
 Check electrode position and contact
 Attempt / verify:
- IV access
- Airway an...
Potential reversible causes:
 Hypoxia
 Hypovolaemia
 Hypo/hyperkalaemia & metabolic disorders
 Hypothermia
 Tension p...
Airway and Ventilation
 Secure airway:
 tracheal tube
 supraglottic airway device
 e.g. LMA
 Once airway secured, if ...
Intravenous Access
 Peripheral versus central veins
Intraosseous Access
TRACHEAL ACCESS
x
Drugs
 Adrenaline
 Amiodarone
 Magnesium
 Thrombolytics
 Sodium bicarbonate
O2
Adrenaline
Actions:
 agonist arterial vasoconstriction
 systemic vascular resistance
 cerebral and coronary blood flow
...
Adrenaline
Indications:
 During cardiac arrest
 VF/VT – give after 3rd shock
 Non VF/VT – give immediately
 Repeat eve...
Amiodarone
Actions:
 Lengthens duration of action potential
 Prolongs QT interval
 Mild negative inotrope - may cause
h...
Amiodarone
Indications:
 Shock refractory VF/VT
 300 mg IV
 Give after 3rd shock
 If unavailable give lidocaine 1.5mg/...
Atropine
Actions:
 Blocks effects of vagus nerve
 Increases sinus node automaticity
 Increases atrioventricular conduct...
Atropine
Indications:
 Peri-arrest
 Symptomatic sinus, atrial or nodal bradycardia
 500 mcg IV increments to 3 mg
Magnesium
 Hypomagnesaemia often co-exists with
hypokalaemia
Actions:
 Depresses neurological and myocardial
function
 ...
Magnesium
Indications:
 VF / VT with hypomagnesaemia
 Torsade de pointes
 Atrial fibrillation
 Digoxin toxicity
 Dose...
Thrombolytic Drugs
Actions:
 Dissolves thrombus
 Improves cerebral blood flow
 Has a role in coronary thrombosis and
pu...
Thrombolytic Drugs
Indications:
 Cardiac arrest caused by suspected pulmonary
embolus
 Can take up to 60 min to have eff...
Sodium Bicarbonate
Actions:
 Alkalinising agent (increases pH)
 But can:
 increase carbon dioxide load
 inhibit releas...
Sodium Bicarbonate
Indications:
 Life-threatening hyperkalaemia
 Tricyclic overdose
 Severe metabolic acidosis (pH < 7....
Summary
• ALS algorhythm provides a standardised approach to
cardiac arrest treatment
• Shockable rhythms (VF/pulseless VT...
LAST WORDS
Drugs role in cardiac arrest becomes after
effective chest compression, effective ventilation
with high oxygen ...
53
THANK
YOU…
Dr. Sule AKIN
54
THANK
YOU…
Dr. Sule AKIN
Cpr for adults
Upcoming SlideShare
Loading in...5
×

Cpr for adults

499

Published on

Cpr for adults

0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
499
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
17
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Transcript of "Cpr for adults"

  1. 1. CPR FOR ADULTS 1
  2. 2. 2
  3. 3. Plan 4  Definition/Aim of Cardiopulmonary Resuscitation (CPR)  Treatment of VF / Pulseless VT  Treatment of non-VF/VT rhythm  Potential reversible causes of cardiac arrest  Airway, IV Access, Drugs
  4. 4. Cardiopulmonary Resuscitation (CPR) - Definition 5 Emergent medical applications that are performed for a living whose respiratory and circulation functions have been stopped in an immediate and unexpected status
  5. 5. 6 To provide adequate amount of oxygenated blood for vital organs Cardiopulmonary Resuscitation (CPR) - Aim
  6. 6. 7
  7. 7. Cardiopulmonary Arrest (CPR) 8 Causes:  Airway obstruction  Respiratory distress  Cardiac abnormalities ACUTE MYOCARDIAL INFARCTON
  8. 8. 9 CPR – ILCOR (International Liaison Committee On Resuscitation)  American Heart Association (AHA)  European Resuscitation Council (ERC)  Heart and Stroke Foundation of Canada (HSFC)  Australian Resuscitation Council (ARC)  Resuscitation Councils of Southern Africa (RCSA)  Council of Latin America for Resuscitation (CLAR)
  9. 9. 10 CPR  Basic Life Support  Advanced Life Support  Prolonged Life Support
  10. 10. 11 CPR  Basic Life Support  Advanced Life Support  Prolonged Life Support
  11. 11. 12 CPR 30:2 Until defibrillator/monitor attached Assess Rhythm Shockable (VF/Pulseless VT) Non-shockable (PEA/Asystole) 1 Shock 150-360 J biphasic or 360 J monophasic Open Airway Look for signs of life Immediately resume CPR 30:2 for 2 min Call Resuscitation Team During CPR: • Correct reversible causes • Check electrode position and contact • Attempt / verify: IV access airway and oxygen • Give uninterrupted compressions when airway secure • Give adrenaline every 3-5 min • Consider: amiodarone, atropine, magnesium Immediately resume CPR 30:2 for 2 min Adult ALS Algorithm
  12. 12. 13 CPR 30:2 Until defibrillator/monitor attached Assess Rhythm Shockable (VF/Pulseless VT) Non-shockable (PEA/Asystole) 1 Shock 150-360 J biphasic or 360 J monophasic Open Airway Look for signs of life Immediately resume CPR 30:2 for 2 min Call Resuscitation Team During CPR: • Correct reversible causes • Check electrode position and contact • Attempt / verify: IV access airway and oxygen • Give uninterrupted compressions when airway secure • Give adrenaline every 3-5 min • Consider: amiodarone, magnesium Immediately resume CPR 30:2 for 2 min Adult ALS Algorithm
  13. 13. 14 Open Airway Look for signs of life …. to confirm cardiac arrest  Patient response  Open airway  Check for normal breathing (caution agonal breathing)  Check circulation  Monitoring
  14. 14. 15 CPR 30:2 Until defibrillator/monitor attached Assess Rhythm Shockable (VF/Pulseless VT) Non-shockable (PEA/Asystole) 1 Shock 150-360 J biphasic or 360 J monophasic Open Airway Look for signs of life Immediately resume CPR 30:2 for 2 min Call Resuscitation Team During CPR: • Correct reversible causes • Check electrode position and contact • Attempt / verify: IV access airway and oxygen • Give uninterrupted compressions when airway secure • Give adrenaline every 3-5 min • Consider: amiodarone, magnesium Immediately resume CPR 30:2 for 2 min Adult ALS Algorithm
  15. 15. 16 Open Airway Look for signs of life Call Resuscitation Team Cardiac arrest confirmed CPR 30:2 Until defibrillator / monitor attached
  16. 16. 17 Chest Compression  30:2  Compressions  Centre of chest  5-6 cm depth  100-120 min-1  Uninterrupted compressions when airway secured  Avoid  Provider fatigue  Interruptions
  17. 17. 18 CPR 30:2 Until defibrillator/monitor attached Assess Rhythm Shockable (VF/Pulseless VT) Non-shockable (PEA/Asystole) 1 Shock 150-360 J biphasic or 360 J monophasic Open Airway Look for signs of life Immediately resume CPR 30:2 for 2 min Call Resuscitation Team During CPR: • Correct reversible causes • Check electrode position and contact • Attempt / verify: IV access airway and oxygen • Give uninterrupted compressions when airway secure • Give adrenaline every 3-5 min • Consider: amiodarone, atropine, magnesium Immediately resume CPR 30:2 for 2 min Adult ALS Algorithm
  18. 18. 19 Adult ALS Algorithm Open Airway Look for signs of life Call Resuscitation Team CPR 30:2 Until defibrillator/monitor attached Assess Rhythm Shockable (VF/Pulseless VT) Non-shockable (PEA/Asystole)
  19. 19. 20 Adult ALS Algorithm Open Airway Look for signs of life Call Resuscitation Team CPR 30:2 Until defibrillator/monitor attached Assess Rhythm Shockable (VF/Pulseless VT) Non-shockable (PEA/Asystole) CARDİAC ARREST RHYTHMS 1. Ventricular Fibrillation (VF) 2. Pulseless Ventricular Tachicardia (VF) 3. Asystole 4. Pulseless Electrical Activity (PEA)
  20. 20. 21 Shockable (VF)  Irregular waveform  No recognisable QRS complexes  Random frequency and amplitude  Uncoordinated electrical activity  Coarse /fine  Exclude artifact  movement  electrical interference
  21. 21. Monomorphic VT  broad complex rhythm  rapid rate  constant QRS morphology Polymorphic VT  torsade de pointes Shockable (VT)
  22. 22. Precordial Thump  Rapid treatment of a witnessed and monitored VF/VT cardiac arrest  Used if defibrillator not immediately available ?
  23. 23. 1st shock  150 - 200 J biphasic  360 J monophasic Assess Rhythm Shockable (VF/Pulseless VT) 1 Shock 150-360 J biphasic or 360 J monophasic Immediately resume CPR 30:2 for 2 min
  24. 24. Defibrillation Energies  Vary with manufacturer  Check local equipment  If unsure, deliver 200 J (do not delay shock)
  25. 25. Deliver 2nd shock Deliver 3rd shock CPR for 2 min If VF/VT persists CPR for 2 min Deliver 4th shock Adrenalin, 1mg iV Amiodaron, 300 mg 2nd and subsequent shocks  Max. (270-360J) biphasic  360 J monophasic Minimise delays between CPR and shocks (< 10 s)
  26. 26. After delivery of shock Continue CPR for another 2 min  stop CPR only if patient shows signs of life After 2 min, assess rhythm: If organised electrical activity, check for signs of life:  if ROSC start post resuscitation care  if no ROSC go to non VF/VT algorithm If asystole, go to non VF/VT algorithm
  27. 27. Asystole Pulseless Electrical Activity (PEA) Assess Rhythm Non-shockable (PEA/Asystole) Immediately resume CPR 30:2 for 2 min
  28. 28.  Absent ventricular (QRS) activity  Atrial activity (P waves) may persist  Rarely a straight line trace  Treat fine VF as asystole Non-shockable (Asystole)
  29. 29. Asystole During CPR:  check leads are attached  adrenaline 1 mg IV every 3 – 5 min
  30. 30.  Clinical features of cardiac arrest  ECG normally associated with an output Non-shockable (PEA)
  31. 31. Pulseless Electrical Activity (PEA)  Exclude/treat reversible causes  Adrenaline 1 mg IV every 3-5 min
  32. 32. During CPR:  Correct reversible causes  Check electrode position and contact  Attempt / verify: - IV access - Airway and oxygen  Give uninterrupted compressions when airway secure  Give adrenaline every 3-5 min  Consider: amiodarone, magnesium
  33. 33. Potential reversible causes:  Hypoxia  Hypovolaemia  Hypo/hyperkalaemia & metabolic disorders  Hypothermia  Tension pneumothorax  Tamponade, cardiac  Toxins  Thrombosis (coronary or pulmonary) 4H 4T
  34. 34. Airway and Ventilation  Secure airway:  tracheal tube  supraglottic airway device  e.g. LMA  Once airway secured, if possible, do not interrupt chest compressions for ventilation  Avoid hyperventilation
  35. 35. Intravenous Access  Peripheral versus central veins
  36. 36. Intraosseous Access TRACHEAL ACCESS x
  37. 37. Drugs  Adrenaline  Amiodarone  Magnesium  Thrombolytics  Sodium bicarbonate O2
  38. 38. Adrenaline Actions:  agonist arterial vasoconstriction  systemic vascular resistance  cerebral and coronary blood flow  agonist  heart rate  force of contraction  myocardial O2 demand (may increase ischaemia)
  39. 39. Adrenaline Indications:  During cardiac arrest  VF/VT – give after 3rd shock  Non VF/VT – give immediately  Repeat every 3-5 min  1 mg IV  Cautious use after ROSC
  40. 40. Amiodarone Actions:  Lengthens duration of action potential  Prolongs QT interval  Mild negative inotrope - may cause hypotension
  41. 41. Amiodarone Indications:  Shock refractory VF/VT  300 mg IV  Give after 3rd shock  If unavailable give lidocaine 1.5mg/kg IV
  42. 42. Atropine Actions:  Blocks effects of vagus nerve  Increases sinus node automaticity  Increases atrioventricular conduction
  43. 43. Atropine Indications:  Peri-arrest  Symptomatic sinus, atrial or nodal bradycardia  500 mcg IV increments to 3 mg
  44. 44. Magnesium  Hypomagnesaemia often co-exists with hypokalaemia Actions:  Depresses neurological and myocardial function  A physiological calcium blocker
  45. 45. Magnesium Indications:  VF / VT with hypomagnesaemia  Torsade de pointes  Atrial fibrillation  Digoxin toxicity  Dose:  cardiac arrest 2 g (8 mmol) IV bolus  peri-arrest 2 g (8 mmol) IV over 10 min
  46. 46. Thrombolytic Drugs Actions:  Dissolves thrombus  Improves cerebral blood flow  Has a role in coronary thrombosis and pulmonary embolism
  47. 47. Thrombolytic Drugs Indications:  Cardiac arrest caused by suspected pulmonary embolus  Can take up to 60 min to have effect  Dose:  Tenecteplase 500-600 mcg kg-1 IV over 10 sec  Alteplase (rt-PA) 10 mg IV over 1-2 min followed by IV infusion of 90 mg over 2 h
  48. 48. Sodium Bicarbonate Actions:  Alkalinising agent (increases pH)  But can:  increase carbon dioxide load  inhibit release of oxygen to tissues  impair myocardial contractility  cause hypernatraemia
  49. 49. Sodium Bicarbonate Indications:  Life-threatening hyperkalaemia  Tricyclic overdose  Severe metabolic acidosis (pH < 7.1)  Dose:  50 ml 8.4% sodium bicarbonate IV
  50. 50. Summary • ALS algorhythm provides a standardised approach to cardiac arrest treatment • Shockable rhythms (VF/pulseless VT) • Non-shockable rhythms (Asystole, PEA) • Reversible reasons of cardiac arrest (4H,4T)
  51. 51. LAST WORDS Drugs role in cardiac arrest becomes after effective chest compression, effective ventilation with high oxygen concentration and defibrillation
  52. 52. 53 THANK YOU… Dr. Sule AKIN
  53. 53. 54 THANK YOU… Dr. Sule AKIN
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×