Cpr for adults
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Cpr for adults

Cpr for adults

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    Cpr for adults Cpr for adults Presentation Transcript

    • CPR FOR ADULTS 1
    • 2
    • 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
    • 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
    • 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 MYOCARDIAL INFARCTON
    • 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)
    • 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 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
    • 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
    • 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
    • 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
    • 16 Open Airway Look for signs of life Call Resuscitation Team Cardiac arrest confirmed CPR 30:2 Until defibrillator / monitor attached
    • 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
    • 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
    • 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)
    • 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)
    • 21 Shockable (VF)  Irregular waveform  No recognisable QRS complexes  Random frequency and amplitude  Uncoordinated electrical activity  Coarse /fine  Exclude artifact  movement  electrical interference
    • Monomorphic VT  broad complex rhythm  rapid rate  constant QRS morphology Polymorphic VT  torsade de pointes Shockable (VT)
    • Precordial Thump  Rapid treatment of a witnessed and monitored VF/VT cardiac arrest  Used if defibrillator not immediately available ?
    • 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
    • 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 Amiodaron, 300 mg 2nd and subsequent shocks  Max. (270-360J) biphasic  360 J monophasic Minimise delays between CPR and shocks (< 10 s)
    • 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
    • Asystole Pulseless Electrical Activity (PEA) Assess Rhythm Non-shockable (PEA/Asystole) Immediately resume CPR 30:2 for 2 min
    •  Absent ventricular (QRS) activity  Atrial activity (P waves) may persist  Rarely a straight line trace  Treat fine VF as asystole Non-shockable (Asystole)
    • 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 and oxygen  Give uninterrupted compressions when airway secure  Give adrenaline every 3-5 min  Consider: amiodarone, magnesium
    • Potential reversible causes:  Hypoxia  Hypovolaemia  Hypo/hyperkalaemia & metabolic disorders  Hypothermia  Tension pneumothorax  Tamponade, cardiac  Toxins  Thrombosis (coronary or pulmonary) 4H 4T
    • 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
    • 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  agonist  heart rate  force of contraction  myocardial O2 demand (may increase ischaemia)
    • 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
    • Amiodarone Actions:  Lengthens duration of action potential  Prolongs QT interval  Mild negative inotrope - may cause hypotension
    • Amiodarone Indications:  Shock refractory VF/VT  300 mg IV  Give after 3rd shock  If unavailable give lidocaine 1.5mg/kg IV
    • Atropine Actions:  Blocks effects of vagus nerve  Increases sinus node automaticity  Increases atrioventricular conduction
    • 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  A physiological calcium blocker
    • 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
    • Thrombolytic Drugs Actions:  Dissolves thrombus  Improves cerebral blood flow  Has a role in coronary thrombosis and pulmonary embolism
    • 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
    • Sodium Bicarbonate Actions:  Alkalinising agent (increases pH)  But can:  increase carbon dioxide load  inhibit release of oxygen to tissues  impair myocardial contractility  cause hypernatraemia
    • Sodium Bicarbonate Indications:  Life-threatening hyperkalaemia  Tricyclic overdose  Severe metabolic acidosis (pH < 7.1)  Dose:  50 ml 8.4% sodium bicarbonate IV
    • 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)
    • LAST WORDS Drugs role in cardiac arrest becomes after effective chest compression, effective ventilation with high oxygen concentration and defibrillation
    • 53 THANK YOU… Dr. Sule AKIN
    • 54 THANK YOU… Dr. Sule AKIN