Cpr 1

610 views

Published on

Published in: Health & Medicine, Business
  • Be the first to comment

  • Be the first to like this

Cpr 1

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

×