Cardiopulmonary resuscitation & management

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Cardiopulmonary resuscitation & management

  1. 1. CARDIOPULMONARY RESUSCITATION & MANAGEMENT Advisor: dr.Nicolaas P.S, Sp. An 1
  2. 2. Time is critical • > 300,000 people experience sudden cardiac death in prehospital settings each year. • If resuscitation begins within a few minutes, many of these individuals have a chance for survival. epidemiologi 2
  3. 3. Time is Critical! • To begin resuscitation within a few minutes: • Patient’s collapse witnessed • EMS immediately activated • CPR started immediately • Defibrillation within minutes 3
  4. 4. Review of the Circulatory System What is the function of the circulatory system? 4
  5. 5. The Circulatory System Delivers O2 and nutrients Removes CO2 and wastes 5
  6. 6. Why is the function of the circulatory system critical to our survival? 6
  7. 7. Lack of O2 accumulatio n of wastes quickly lead • to death 7
  8. 8. 8
  9. 9. Major Arteries 9
  10. 10. Heart Physiology • LV contracts – sends wave of blood • Pressure wave felt as pulse • No contraction = No blood flow = cardiac arrest 10
  11. 11. Time is Critical! • Brain damage begins in 4–6 min • Brain damage irreversible in 8–10 min Circulation must be restored within 4– 6 minutes. 11
  12. 12. CPR • Provides minimal amount of circulation/oxygenation until cause of cardiac arrest corrected • External chest compressions circulate blood • Artificial ventilations provide O2 to lungs 12
  13. 13. HISTORY 2010 : New Guidelines on CPR (AHA) 13
  14. 14. Causes of Cardiac Arrest • Heart disease • Respiratory arrest • Medical emergencies • Drowning and suffocation • Congenital heart defects • Trauma 14
  15. 15. AMERICAN HEART ASSOCIATION CHANGES IN THE 2010 GUIDELINES AFFECTING ALL RESCUERS AMERICAN HEART ASSOCIATION 15
  16. 16. AMERICAN HEART ASSOCIATION: 2010 GUIDELINES Health Care Provider*  “PUSH HARD AND PUSH FAST”  At least 100 COMPRESSIONS / MINUTE*  Allow the chest to recoil -- equal compression and relaxation times  <10 seconds for pulse checks or rescue breaths  Compression Depth*  Adults 2”  Child/Infant 1/3 depth of chest 1.5" infant 2" child  Avoid excessive ventilations 16
  17. 17.  A-B-C changed to C-A-B*  Critical element is chest compressions  Delay in A-B  Avoidance of A & B  Early defib  If alone--call and retrieve AED  Exception asphyxial arrest AMERICAN HEART ASSOCIATION: 2010 GUIDELINES 17
  18. 18. New Sequence 18
  19. 19. • Cricoid pressure not recommended • Advanced airway = 1 every 6-8 seconds • Adult: 1 every 5-6 Peds: 1 every 3 • With advanced airway- no pause AMERICAN HEART ASSOCIATION: 2010 GUIDELINES 19
  20. 20. AMERICAN HEART ASSOCIATION: 2010 GUIDELINES AHA ECC Adult Chain of Survival - New 20
  21. 21. Simplified Universal BLS algorithm AMERICAN HEART ASSOCIATION: 2010 GUIDELINES 21
  22. 22. Causes of Cardiac Arrest • Heart disease • Respiratory arrest • Medical emergencies • Drowning and suffocation • Congenital heart defects • Trauma 22
  23. 23. CPR Compression : ventilation remains 30 : 2 Duration of 2 breaths = 5 seconds 23
  24. 24. CPR – 1 Rescuer • If there is no pulse, find your landmarks, lower half of the sternum, between the nipples
  25. 25. CPR – 1 Rescuer • Begin chest compressions
  26. 26. CPR – 1 Rescuer • Perform 30 chest compressions • Push hard • Push fast • Allow the chest to recoil after each compression
  27. 27. CPR – 1 Rescuer • Administer two ventilations then return to compressions
  28. 28. CPR – 2 Rescuer 1 2 3 4
  29. 29. CPR - Children • Use heel of one hand • Keep airway open with other hand • 30 compressions:2 ventilations if alone (2 rescuers use 15:2)
  30. 30. CPR - Infant • Give chest thrusts and puffs of air • 30 compressions:2 ventilations if alone • 15 compressions: 2 ventilations with 2 rescuers
  31. 31. Copyright © 2004 Elsevier (USA). All Rights Reserved Defibrillation •Ventricular fibrillation a common cause of arrest •Can only correct with defibrillation
  32. 32. Copyright © 2004 Elsevier (USA). All Rights Reserved • Chance of success decreases with time • AEDs save lives! Defibrillation
  33. 33. AEDs • Safe, accurate & lightweight • Easy to operate 33
  34. 34. PAD • AEDs in public places • Training the public in CPR/AED 34
  35. 35. AED
  36. 36. Assess • Check your patient
  37. 37. Power • Turn the power on
  38. 38. Patient • Apply pads to patient
  39. 39. Analyze • Stay clear while patient’s heart rhythm analyzed
  40. 40. Clear • Head to toe and toe to head: everyone is clear!
  41. 41. Shock • Defibrillate
  42. 42. Patient • Standard is set of 1 shock • Immediately restart CPR for 2 minutes then check pulse
  43. 43. ADULT CARDIAC ARREST ALGORITHM 43
  44. 44. 44
  45. 45. 45
  46. 46. 46
  47. 47. 47
  48. 48. 48
  49. 49. 49
  50. 50. 50
  51. 51. 51
  52. 52. Summary • Continual beating, or contracting, of the heart is necessary to keep blood circulating throughout the body. • Brain damage begins in 4 to 6 minutes of cardiac arrest. • There are many causes of sudden cardiac death, but the most common is ventricular fibrillation. 52
  53. 53. Summary • Survival from cardiac arrest depends on the sequence (chain) of survival. • Rescuers are critically important in maintaining the sequence (chain) of survival. 53
  54. 54. Thank you 54

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