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Cardio pulmonary resuscitation

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Cardio pulmonary resuscitation

  1. 1. Cardiopulmonary resuscitation Dr.V.Ravimohan What I learned in the ILS training http://www.mrcogexam.net
  2. 2. Chain of survival <ul><li>Early recognition and call for help </li></ul><ul><li>Early cardiopulmonary resuscitation (CPR) </li></ul><ul><li>Early defibrillation </li></ul><ul><li>Post resuscitation care </li></ul>
  3. 3. Early recognition <ul><li>Most in-hospital cardiac arrests are not sudden or unpredictable events </li></ul><ul><li>Hypoxia or hypotension are either not noticed by staff ,or are recognised but treated poorly. </li></ul><ul><li>2 systems </li></ul><ul><li>early warning scores </li></ul><ul><li> calling criteria </li></ul><ul><li>“ cardiac arrest team” “Medical emergency team” </li></ul>
  4. 4. Medical emergency team calling criteria Acute change in Physiology Airway Threatened Breathing All respiratory arrests Respiratory rate < 5/ min Respiratory rate >36/min Circulation All cardiac arrests Pulse rate <40/min Pulse rate > 140/min Systolic pressure <90 mmHg Neurology Sudden decrease in level of consciousness Decrease in GCS of > 2 points Repeated or prolonged seizures Other Any patient causing concern who doesn’t fit the above criteria
  5. 5. Airway obstruction <ul><li>Treatment </li></ul><ul><ul><li>Remove any obstruction unless contraindicated turn the patient to a side </li></ul></ul><ul><ul><li>Simple airway opening manoeuvres head tilt, jaw thrust or chin lift (remember to give oxygen) </li></ul></ul><ul><ul><li>Oropharyngeal airway or nasal airway </li></ul></ul><ul><ul><li>Elective tracheal intubation </li></ul></ul><ul><ul><li>Tracheostomy </li></ul></ul><ul><ul><li>Always remember to give oxygen </li></ul></ul>
  6. 6. Breathing problems <ul><li>Causes </li></ul><ul><ul><li>Poor respiratory drive-CNS depression </li></ul></ul><ul><ul><li>Poor respiratory effort-muscle weakness/nerve damage </li></ul></ul><ul><ul><li>Lung disorders </li></ul></ul>
  7. 7. Breathing problems <ul><li>Recognition </li></ul><ul><ul><li>Irritability, confusion, lethargy and depressed consciousness(from hypoxia and hypercapnia) </li></ul></ul><ul><ul><li>High respiratory effort(>30/min) </li></ul></ul><ul><ul><li>Pulse oxymetry </li></ul></ul><ul><ul><ul><li>Non invasive measure of oxygenation but not a measure of ventilation </li></ul></ul></ul><ul><ul><li>Blood gas analysis </li></ul></ul>
  8. 8. Circulation problems <ul><li>Causes </li></ul><ul><ul><li>Primary heart problems  arrythmia secondary to ischaemia </li></ul></ul><ul><ul><li>Secondary heart problems  severe anaemia, hypothermia </li></ul></ul>
  9. 9. Acute coronary syndromes <ul><li>Unstable angina </li></ul><ul><li>Non ST segment elevation MI </li></ul><ul><li>ST segment elevation MI </li></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><ul><li>O 2 high concentration </li></ul></ul></ul><ul><ul><ul><li>Aspirin 300 mg </li></ul></ul></ul><ul><ul><ul><li>Nitro-glycerine S/L </li></ul></ul></ul><ul><ul><ul><li>Morphine </li></ul></ul></ul>
  10. 10. ABCDE approach <ul><li>A-airway </li></ul><ul><li>B-breathing </li></ul><ul><li>C-circulation </li></ul><ul><li>D-disability </li></ul><ul><li>E-exposure </li></ul>
  11. 11. Airway Obstruction <ul><li>Airway obstruction-”sea-saw” respirations </li></ul><ul><ul><li>complete </li></ul></ul><ul><ul><ul><li>no breath sounds at the mouth or nose </li></ul></ul></ul><ul><ul><li>Incomplete </li></ul></ul><ul><ul><ul><li>noisy </li></ul></ul></ul><ul><li>clear the airway </li></ul><ul><li>Give O 2 10 l/min </li></ul>
  12. 12. Breathing <ul><li>General signs of respiratory distress </li></ul><ul><ul><li>Use of accessory muscles of respiration </li></ul></ul><ul><ul><li>Sweating </li></ul></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><li>Respiratory rate </li></ul><ul><li>Pulse oxymeter </li></ul><ul><li>Trachea </li></ul><ul><li>Percuss </li></ul><ul><li>Listen </li></ul>
  13. 13. Circulation <ul><li>Colour & temperature of limbs </li></ul><ul><li>Capillary fill time </li></ul><ul><ul><li>Finger tip held at the heart level </li></ul></ul><ul><ul><li>Normal fill time is less than 2 seconds </li></ul></ul><ul><li>Pulse volume </li></ul><ul><li>low – poor cardiac output </li></ul><ul><li>high(bounding)-sepsis </li></ul><ul><li>B.P </li></ul><ul><li>low diastolic blood pressure </li></ul><ul><li>arterial vasodilatation  anaphylaxis or sepsis </li></ul><ul><li>narrow pulse pressure-(normal 35-45 mmHg) </li></ul><ul><li>arterial vasoconstriction  hypovolaemia/cardiogenic shock </li></ul>
  14. 14. Disability <ul><li>AVPU </li></ul><ul><ul><li>A-Alert </li></ul></ul><ul><ul><li>V-responds to vocal stimuli </li></ul></ul><ul><ul><li>P-responds to painful stimuli </li></ul></ul><ul><ul><li>U-unresponsive to all stimuli </li></ul></ul><ul><ul><ul><li>Measure blood glucose to exclude hypoglycaemia </li></ul></ul></ul><ul><ul><ul><li>This is simpler than Glasgow coma scale </li></ul></ul></ul>
  15. 15. Exposure <ul><li>Exposure to examine the patient properly </li></ul><ul><ul><li>Minimise heat loss </li></ul></ul><ul><ul><li>Respect dignity </li></ul></ul>
  16. 16. “ collapsed patients” <ul><li>Ensure personal safety </li></ul><ul><li>Check for patient response </li></ul><ul><ul><li>“ are you alright?” </li></ul></ul><ul><ul><ul><li>If patient responds  ABCDE approach” </li></ul></ul></ul><ul><ul><ul><li>If patient doesn’t respond  call for help </li></ul></ul></ul><ul><li>Airway </li></ul><ul><li>Breathing-”look” “feel” “hear” for not more than 10 secs </li></ul>
  17. 17. Pulse <ul><li>Checking for pulse-can be difficult even for the trained staff </li></ul><ul><li>If unsure about the pulse don’t start delaying CPR </li></ul><ul><ul><ul><li>If there is pulse </li></ul></ul></ul><ul><ul><ul><ul><li>Still call for help </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Give O 2 Ventilate lungs check for circulation ever 10 seconds </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Attach monitoring </li></ul></ul></ul></ul><ul><ul><ul><ul><li>IV access </li></ul></ul></ul></ul>
  18. 18. If there is no pulse or signs of life <ul><li>Call for help </li></ul><ul><li>30 chest compression:2 ventilation </li></ul><ul><li>100 compressions/min compression depth 4-5 cm </li></ul><ul><li>Once the defibrillator arrives apply electrodes to patient and analyse rhythm </li></ul><ul><li>Minimise interruptions to chest compressions </li></ul>
  19. 19. Advanced life support cardiac rhythm <ul><li>2 groups of cardiac rhythm </li></ul><ul><ul><li>Shock able rhythm </li></ul></ul><ul><ul><ul><li>Ventricular fibrillation </li></ul></ul></ul><ul><ul><ul><li>Pulse less ventricular tachycardia </li></ul></ul></ul><ul><ul><li>Non shock able rhythm </li></ul></ul><ul><ul><ul><li>Asytole </li></ul></ul></ul><ul><ul><ul><li>Pulse less electrical activity </li></ul></ul></ul>
  20. 20. Shock able Rhythm
  21. 21. 3 possibilities
  22. 22. VT/VF persists
  23. 23. VF/VT still persists
  24. 26. Some tips <ul><li>Lidocaine 100mg IV is an alternative for amidarone but isn’t an option if amidarone is already given </li></ul><ul><li>If there is doubt about whether a rhythm is Asystole or very fine AF </li></ul><ul><ul><ul><li>don’t defibrillate </li></ul></ul></ul><ul><ul><ul><li>Very fine VF is unlikely to respond to shock </li></ul></ul></ul>
  25. 27. Precordial Thump <ul><li>May be useful in VF/VT cardiac arrest which was witnessed and monitored sudden collapse </li></ul><ul><li>Ulnar edge of a tightly clenched fist </li></ul><ul><li>From height of about 20 cm </li></ul><ul><li>Thumb is most likely to be successful in converting VT to sinus rhythm </li></ul>
  26. 28. PULSELESS ELECTRICAL ACTIVITY <ul><li>Definition: organised electrical activity in the absence of any palpable pulses. </li></ul>
  27. 29. Treatment for PEA
  28. 31. If VT/VF persists <ul><li>Follow shock able side of algorithm </li></ul>
  29. 33. Treatment for asystole and slow PEA(rate <60 min -1 )
  30. 34. During CPR
  31. 35. Reversible causes 4H 4T Hypoxia Tension pneumothorax Hypovolaemia Tamponade,cardiac Hypo/Hyperkalaemia/metabolic Toxins Hypothermia Thrombosis
  32. 36. 4 H Hypoxia 100% oxygen Ensure adequate chest rise & bilateral breath sounds Hypovolaemia Crystalloid/Colloid Surgery Hyperkalaemia 12 ECG may help in the diagnosis Check for hypoglycaemia Hypothermia
  33. 37. 4T Tension pneumothorax May be a complication of inserting central venous catheter Signs: decreased air entry decreased expansion hyperresonance percussion on affected side Do: needle thoracocentesis Tamponade cardiac Cardiac arrest after penetrating chest trauma 2 reasons:A.hypovolaemia B.cardiac tamponade Do: needle pericardiocentesis or resuscitative thoracotomy Toxins Thrombosis Consider thrombolytic therapy
  34. 38. CPR in a pregnant patient <ul><li>Left lateral tilt(15-30 degrees) of patient </li></ul><ul><li>Periarrest caesarean section should begin within 4 minutes </li></ul><ul><li>Sterile preparation is not necessary </li></ul><ul><li>Moving the patient to operating theatre isn’t necessary </li></ul>

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