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6 acls

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6 acls

  1. 1. Cardiopulmonary Resuscitation (Basic and Advanced Cardiac Life Support) David Maldonado MD Mayo Clinic Rochester, MN, USA
  2. 2. Agenda • Cardiac Arrest • Basic Life Support • Advanced Cardiac Life Support for Pulseless Arrest • Ventricular Fibrillation (VF) • Pulseless Ventricular Tachycardia (VT) • Asystole • Pulseless Electrical Activity (PEA) • Algorithms
  3. 3. Cardiac Arrest • Sudden loss of heart function • With or without prior history of heart disease • May lead to death within minutes • In U.S. up to 750,000 cardiac arrests with attempted resuscitation every year • 225,000 deaths
  4. 4. Causes of Cardiac Arrest • Most commonly coronary artery disease • Electrical impulses become too rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) • Also from profound bradycardia, respiratory arrest/choking/drowning, electrocution, trauma and other causes • May also occur without any known cause Americanheart.org
  5. 5. • Brain death begins within 4-6 minutes • Cardiac arrest can be reversed within minutes • Chances of survival decrease 7-10% every minute without CPR or defibrillation (not including cold-water drowning) • Early & effective CPR and early & appropriate defibrillation are keys to management Americanheart.org
  6. 6. Cardiopulmonary Resuscitation (CPR) Basic Life Support (BLS) • Chest Compressions and Rescue Breathing for person felt to be in cardiac arrest • To provide blood flow to brain and heart • Maintain end-organ perfusion during arrest • May still likely require defibrillation or definitive treatment of ACLS (anti-arrhythmic medications, fluid resuscitation, electrolyte restoration, etc.)
  7. 7. BLS Healthcare Provider Algorithm No movement or response Open AIRWAY, check BREATHING If not breathing, give 2 BREATHS that make chest rise • Give 1 breath every 5 to 6 seconds • Recheck pulse every 2 minutes If no response, check pulse: Definite pulse Give cycles of 30 COMPRESSIONS and 2 BREATHS Push hard and fast (100/min) and release completely Minimize interruptions in compression No pulse AED/defibrillator ARRIVES Check rhythm Shockable rhythm? Give 1 shock Resume CPR immediately for 5 cycles Resume CPR immediately For 5 cycles Check rhythm every 5 cycles; continue until ALS Providers take over or victim starts to move Shockable (VF/VT) Non Shockable Adapted from Circulation;112 (24 Supplement): IV-19. (2005)
  8. 8. ABCD’s of BLS Step 1: Airway • Head-tilt, Chin-lift maneuver • Open airway
  9. 9. Step 2: Breathing Look, listen, and feel • Look for chest rise • Listen for normal breath sounds • Feel air flow with cheek or hand • If not detected within 10 seconds, give 2 rescue breaths, then proceed to next step • Each breath for 1 second • Visible chest rise • Bag-mask, mouth-to-mask, mouth-to- mouth
  10. 10. Smurd.com
  11. 11. Step 3: Circulation Check Pulse • Pulse present: give 1 breath every 5-6 seconds • Pulse absent: deliver effective chest compressions • “Push hard and fast” • 100 compressions/minute • 4-5 cm depth • Complete chest recoil • 30 compressions : 2 breaths = 1 cycle
  12. 12. Chest Compression Technique Smurd.com
  13. 13. 100 compressions/minute Abella et al. Circulation. 2005;111:428-434.
  14. 14. Compression Depth 4-5 cm Edelson et al. Resuscitation. 2006; 71:136-145.
  15. 15. Step 4: Defibrillation Advanced Cardiac Life Support (ACLS) • Oxygen, monitor/defibrillator, IV • Assess rhythm • Shockable rhythm • Ventricular fibrillation • Pulseless Ventricular Tachycardia • Non-shockable rhythm • Asystole • Pulseless Electrical Activity
  16. 16. Shockable Rhythms VF and pulseless VT
  17. 17. • Deliver single shock (360 J Monophasic or 200 J Biphasic) • Immediate 5 cycles of CPR • Assess rhythm – Still shockable rhythm? • Repeat defibrillation, 5 cycles of CPR, and either epinephrine 1mg every 3-5 minutes or Vasopression 40 Units IV x 1 • Assess rhythm – Still shockable rhythm? • Repeat defibrillation, 5 cycles of CPR, and consider antiarrhythmics • Amiodarone 300mg IV push or • Lidocaine 1-1.5mg/kg
  18. 18. Non-Shockable Rhythms Asystole and PEA
  19. 19. • Immediate 5 cycles of CPR • Epinephrine 1mg IV every 3-5 minutes or Vasopressin 40 Units IV x 1 • Atropine 1mg IV for asystole or slow PEA • Reassess rhythm – Still non-shockable? • Repeat pattern and consider differential
  20. 20. Differential/Management 6 H’s and 5 T’s • Hypovolemia Fluid resuscitation • Hypoxia Supplemental O2 • Hydrogen (Acidosis) Treat cause, ?bicarbonate • Hypo-/Hyperkalemia Correct imbalance • Hypoglycemia Check/replace glucose • Hypothermia Rewarming • Toxins Toxin-specific Rx • Tamponade Pericardiocentesis • Tension Pneumothorax Needle decompress • Thrombosis (MI or PE) MI/PE Rx • Trauma Surgical evaluation
  21. 21. Post-resuscitative Care • Supportive, multi-organ care • ?Hypothermia, ?Glucose control • Predictors of poor outcome at 24 hrs • Absent corneal reflex • Absent pupillary response • Absent withdrawl response to pain

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