Resuscitation guidelines what is new


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Resuscitation guidelines what is new

  1. 1. Resuscitation Guidelines 2010 - What’s new? C.N.E conducted at ATLAS HOSPITAL, Muscat Compiled by: Dr.Rajesh.T.Eapen Anaesthesiologist Atlas Hospital, Ruwi 25, 2012 Friday, May
  2. 2. Friday, May 25, 2012
  3. 3. Emergency Response Friday, May 25, 2012
  4. 4. LEARN CPRYou can do it!2010 AHA Guidelines: The ABCs of CPRRearranged to "CAB" Friday, May 25, 2012
  5. 5. CAB – for life• CPR is a technique used to save anyone from breathing and circulatory failure.• CPR consists of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS). Friday, May 25, 2012
  6. 6. Friday, May 25, 2012
  7. 7. Emphasis onHigh-Quality CPR 2010 Guidelines“To provide effective chest compressions, pushhard and push fast. … compress the adult chestat a rate of at least 100 compressions perminute with a compression depth of at least 2inches/5 cm. … allow complete recoil of thechest after each compression, to allow the heartto fill completely before the next compression.… minimize the frequency and duration ofinterruptions in compressions to maximize thenumber of compressions delivered per minute.(Berg, et al. Circulation. 2010;122;S685-S705) Friday, May 25, 2012
  8. 8. Highlights• This is a re-emphasis from 2005.• For effective compressions: – Push fast – Push hard – Allow chest to fully recoil – Minimize any interruptions• Applies to both lay and healthcare providers. Friday, May 25, 2012
  9. 9. Rationale For Change• High-quality chest compressions within CPR continues to be a critical focal point.• Well-performed compressions increase the likelihood of survival. Friday, May 25, 2012
  10. 10. Compression Hand Position 2010 Guidelines“The rescuer should place the heel of one handon the center (middle) of the victim‟s chest(which is the lower half of the sternum) and theheel of the other hand on top of the first so thatthe hands are overlapped and parallel.”(Berg, et al. Circulation. 2010;122;S685-S705) Friday, May 25, 2012
  11. 11. Highlights• Hands in center of the chest.• Lower half of breastbone• Second hand on top of the first.• Not on lowest part of breastbone.• Applies to both lay and healthcare providers. Friday, May 25, 2012
  12. 12. Rationale For Change• Use of the nipple line as a landmark for hand placement was found to be unreliable. Friday, May 25, 2012
  13. 13. Compression Rate 2010 Guidelines“It is reasonable for laypersons and healthcareproviders to compress the adult chest at arate of at least 100 compressions per minutewith a compression depth of at least 2 inches(5 cm.)”(Berg, et al. Circulation. 2010;122;S685-S705) Friday, May 25, 2012
  14. 14. Highlights• “At least” 100 times per minute.• It is okay to be a little faster.• Applies to both lay and healthcare providers. Friday, May 25, 2012
  15. 15. Rationale For Change• It has been found that higher survival rates are associated with an increase in the number of compressions provided per minute. Friday, May 25, 2012
  16. 16. Compression Depth 2010 Guidelines“It is reasonable for laypersons and healthcareproviders to compress the adult chest at a rate ofat least 100 compressions per minute with acompression depth of at least 2 inches/5 cm.”(Berg, et al. Circulation. 2010;122;S685-S705) Friday, May 25, 2012
  17. 17. Highlights• “At least” 2 inches on an adult.• It is okay to compress a little deeper.• Not enough information to define upper limit.• Applies to both lay and healthcare providers. Friday, May 25, 2012
  18. 18. Rationale For Change• Research indicates the tendency for CPR providers to not compress deep enough, even with the emphasis to "push hard." Friday, May 25, 2012
  19. 19. Breathing Assessment 2010 Guidelines“After activation of the emergency response system, all rescuers shouldimmediately begin CPR for adult victims who are unresponsive with nobreathing or no normal breathing (only gasping).”(Berg, et al. Circulation. 2010;122;S685-S705) Friday, May 25, 2012
  20. 20. Highlights• No more look, listen, and feel.• Quick “look” for no breathing or no normal breathing.• Agonal breaths remain a concern.• Applies to both lay and healthcare providers. Friday, May 25, 2012
  21. 21. End-tidal CO2• The use of end-tidal CO2 (ETCO2) monitoring is a valuable adjunct for healthcare professionals.• When patients have no spontaneous circulation, the ETCO2 is generally ≤ 10 mm Hg.• When spontaneous circulation returns, ETCO2 levels are expected to abruptly increase to at least 35-40 mm Hg.• By monitoring these levels, interruptions in compressions for pulse checks become unnecessary. Friday, May 25, 2012
  22. 22. Rationale for Change• Simplifying the breathing assessment is intended to help laypersons respond more quickly with chest compressions and CPR.• There is a high likelihood of agonal, or irregular, gasping breaths to occur early in cardiac arrest and confuse rescuers. Friday, May 25, 2012
  23. 23. CPR Sequence - Lay 2010 GuidelinesFor an unresponsive person, activate EMS,then assess breathing. If the person is notbreathing or not breathing normally, begin CPRwith 30 compressions followed by opening theairway and giving 2 rescue breaths. Repeatcycles of 30:2 (CAB method).(Summary from Berg, et al. Circulation.2010;122;S685-S705) Friday, May 25, 2012
  24. 24. Highlights• Initial assessment steps: – Assess responsiveness – Activate EMS – Assess breathing – Perform CPR• CAB – begin CPR cycles with compressions, followed by airway and breathing.• Guideline applies to adults, children, and infants. Friday, May 25, 2012
  25. 25. Rationale For Change• The science indicates the importance of not delaying chest compressions to perform rescue breaths.• Early chest compression can immediately circulate oxygen that is still in the bloodstream. Friday, May 25, 2012
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  28. 28. CHAINOF SURVIVAL Friday, May 25, 2012
  29. 29. Chain of Survival 2010 Guidelines“These actions are termed the links in the„Chain of Survival.‟ For adults they include: Immediate recognition of cardiac arrest andactivation of the emergency response system Early CPR that emphasizes chestcompressions Rapid defibrillation if indicated Effective advanced life support Integrated post– cardiac arrest care.”(Travers, et al. Circulation. 2010;122;S676-S684) Friday, May 25, 2012
  30. 30. Highlights• Addition of fifth link in chain. – Integrated post-cardiac arrest care.• Applies to both lay and healthcare providers. Friday, May 25, 2012
  31. 31. Rationale For Change• Links in the “Chain of Survival” indicate the individual actions that must be strong in order for a person to survive a sudden cardiac arrest.• The addition of the fifth link, integrated post- cardiac arrest care, further emphasizes the additional dependence on longer-term care for long-term survival. Friday, May 25, 2012
  32. 32. Cricoid Pressure 2010 Guidelines“The routine use of cricoid pressure in adultcardiac arrest is not recommended.”(Berg, et al. Circulation. 2010;122;S685-S705) Friday, May 25, 2012
  33. 33. Highlights• Cricoid may impede ventilation.• Difficult to teach.• May prevent advanced airway placement.• Aspiration may still occur. Friday, May 25, 2012
  34. 34. Rationale For Change• Regardless of expertise, rescuers cannot effectively apply cricoid pressure. Friday, May 25, 2012
  35. 35. Team Approach 2010 Guidelines“The intent of the algorithm is to present the steps of BLS in a logical andconcise manner that is easy for all types of rescuers to learn, remember andperform. These actions have traditionally been presented as a sequence ofdistinct steps to help a single rescuer prioritize actions. However, manyworkplaces and most EMS and in-hospital resuscitations involve teams ofproviders who should perform several actions simultaneously (e.g.: onerescuer activates the emergency response system while another begins chestcompressions, and a third either provides ventilations or retrieves the bag-mask for rescue breathing, and a fourth retrieves and sets up a defibrillator).”(Berg, et al. Circulation. 2010;122;S685-S705) Friday, May 25, 2012
  36. 36. Highlights• Tasks can be performed simultaneously.• Integrate additional rescuers as they arrive.• Designate team leader with multiple rescuers. Friday, May 25, 2012
  37. 37. Rationale For Change• Some resuscitations start with a lone rescuer and builds to more, whereas other resuscitations begin with several willing rescuers.• Training should focus on building a team and performing tasks simultaneously. Friday, May 25, 2012
  38. 38. Major change in drugs!! • Atropine is no longer recommended for routine use in managing and treating pulseless electrical activity or asystole. Friday, May 25, 2012 .
  39. 39. BLS TRAINING CLASSES Friday, May 25, 2012
  40. 40. Reasons for this change• Most survivors of adult cardiac arrest have an initial rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT)• Best treated initially with chest compressions and early defibrillation rather than airway management. Friday, May 25, 2012
  41. 41. Reasons for this• changedelay of Airway management often results in a initiation of good chest compressions.• Airway management no longer recommended until after the first cycle of chest compressions -- 30 compressions in 18 seconds.• The 30 compressions are now recommended to precede the 2 ventilations, which previous guidelines had recommended at the start of resuscitation. Friday, May 25, 2012
  42. 42. • Only a minority of cardiac arrest victims receive bystander CPR.• Significant obstacle to bystanders performing CPR is their fear of doing mouth-to-mouth breathing. By changing the initial focus of resuscitation to chest compressions rather than airway maneuvers, more patients will receive important bystander intervention, even if it is limited to chest compressions. Friday, May 25, 2012
  43. 43. Change…..• Hands-only CPR (compressions only -- no ventilations) is recommended for the untrained lay rescuers to obviate their fears of mouth-to-mouth ventilations and to prevent delays/interruptions in compressions. Friday, May 25, 2012
  44. 44. Change…..• Pulse checks by lay rescuers should not be attempted because of the frequency of false- positive findings.• Recommended that lay rescuers should just assume that an adult who suddenly collapses, is unresponsive and not breathing normally (e.g. gasping) has had a cardiac arrest, activate the emergency response system, and begin compressions. Friday, May 25, 2012
  45. 45. Change…..• If pulse checks are performed, healthcare providers should take no longer than 10 seconds to determine if pulses are present.• If no pulse is found within 10 seconds, compressions should resume immediately. Friday, May 25, 2012
  46. 46. Electrical therapies• Patients with VF or pulseless VT should receive chest compressions until a defibrillator is ready. Defibrillation should then be performed immediately.• Transcutaneous pacing of patients who are in asystole has not been found to be effective and is no longer recommended. Friday, May 25, 2012
  47. 47. ACLS Changes….. The recommendations for airway management have undergone 2 major changes:(1) the use of quantitative waveform capnography for confirmation and monitoring of endotracheal tube placement is now a class I recommendation in adults;(2) the routine use of cricoid pressure during airway management is no longer recommended. Friday, May 25, 2012
  48. 48. Changes in recommendations for dysrhythmia management• For symptomatic or unstable bradydysrhythmias, intravenous infusion of chronotropic agents (e.g. dopamine, epinephrine) is now recommended when atropine fails; Friday, May 25, 2012
  49. 49. Post-cardiac arrest care.• Induced hypothermia is generally recommended for adult survivors of cardiac arrest who remain unconscious, regardless of presenting rhythm.• Hypothermia should be initiated as soon as possible after return of spontaneous circulation with a target temperature of 32°C-34°C. Friday, May 25, 2012
  50. 50. ACLS Changes…..• Urgent cardiac catheterization and percutaneous coronary intervention are recommended for cardiac arrest survivors who demonstrate ECG evidence of ST- segment elevation acute myocardial infarction regardless of neurologic status. Friday, May 25, 2012
  51. 51. Post-arrest care changes….• Hemodynamic optimization to maintain vital organ perfusion, avoidance of hyperventilation, and maintenance of euglycemia are also critical elements in post-arrest care. Friday, May 25, 2012
  52. 52. Now let us have a look at a videoon the Resuscitation guidelines2010: Friday, May 25, 2012
  53. 53. Friday, May 25, 2012
  54. 54. ANY QUESTIONS? Friday, May 25, 2012
  55. 55. Thank You ! Friday, May 25, 2012