Cpr 2010

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CPR based on 2010 guidelines

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Cpr 2010

  1. 1. CARDIOPULMONARY RESUSCITATION SANIL VARGHESE
  2. 2. HISTORICAL REVIEW • In the 19th century, Doctor H. R. Silvester described a method “The Silvester Method”. • Holger Neilson technique was in the United States in 1911. • In the 20th century at Johns Hopkins University where the technique of CPR was originally developed. The first effort at testing the technique was performed on a dog by Redding, Safar and JW Perason. Soon afterward, the technique was used to save the life of a child. • Peter Safar wrote the book ABC of resuscitation in 1957.
  3. 3. CPR For Health Care Providers • Adult • Child • Infant
  4. 4. Terminology • BLS / BCLS • ALS / ACLS • Arrest, Cardiac Arrest, Code, Code Blue • Respiratory Arrest • Ventilations
  5. 5. Diagnosis of cardiac arrest Blood pressure measurement  Taking the pulse on peripheral arteries  Auscultation of cardiac tones Loss of time !!! Symptoms of cardiac arrest absence of pulse on carotid arteries – a pathognomonic symptom 3 3 respiration arrest – may be in 30 seconds after cardiac arrest 3 enlargement of pupils – may be in 90 seconds after 5 cardiac arrest
  6. 6. 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  Avoid excessive ventilations 1.5" infant 2" child
  7. 7. AMERICAN HEART ASSOCIATION: 2010 GUIDELINES  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
  8. 8. AMERICAN HEART ASSOCIATION: 2010 GUIDELINES • 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
  9. 9. AMERICAN HEART ASSOCIATION: 2010 GUIDELINES AHA ECC Adult Chain of Survival - New
  10. 10. AMERICAN HEART ASSOCIATION:2010 GUIDELINES Simplified Universal BLS algorithm
  11. 11. AMERICAN HEART ASSOCIATION: 2010 GUIDELINES Electrical Therapies • Shock first vs CPR first • No precordial thump • AED in hospital (goal to shock =< 3 mins) • Use in infants (with or without attenuator)
  12. 12. AMERICAN HEART ASSOCIATION: 2010 GUIDELINES ACLS • • • • • • • Simplified algorithm Optimized CPR quality with monitoring Waveform capnography (>12 mmHg) Atropine deleted (PEA/Asystole) Chronotropic drugs for brady, then pacing Adenosine safe for monomorphic wide tachs Post-cardiac arrest
  13. 13. AMERICAN HEART ASSOCIATION CAPNOGRAPHY
  14. 14. AMERICAN HEART ASSOCIATION: 2010 GUIDELINES Post-Cardiac Arrest – ROSC • Therapeutic Hypothermia – Remain comatose – 32-34 degree C (all ages) (89.6-93.2 F) – 12-24 hours • PCI • O2 sat ≥94% & PETCO 35-40
  15. 15. AMERICAN HEART ASSOCIATION: 2010 GUIDELINES Special Resuscitation Situations • Asthma • Hypothermia • Anaphylaxis • Avalanche • Pregnancy • Drowning • Morbid obesity • PE • Electrolyte imbalance • Toxins • Electric shock/lightening • PCI • Cardiac tamponade • Cardiac surgery
  16. 16. AMERICAN HEART ASSOCIATION: 2010 GUIDELINES Acute Coronary Syndromes • Out of hospital 12-lead • Triage to PCI • Oxygen – > 94 % is the goal (capno) • Morphine – use with caution in UA/non-STEMI
  17. 17. AMERICAN HEART ASSOCIATION: 2010 GUIDELINES Stroke • Stroke-prepared hospitals • Triage to stroke centers • TPA up to 4.5 hours
  18. 18. C. Circulation Restore the circulation, that is start external cardiac massage 18
  19. 19. Hand Position • At the nipple line • Off the zyphoid process 2 fingers = infant 1 hand = child 2 hands = adult
  20. 20. A (Airway) ensure open airway 20
  21. 21. Open the airway using a head tilt lifting of chin. Do not tilt the head too far back Check the pulse on carotid artery using fingers of the other hand 21
  22. 22. B (Breathing) Tilt the head back and listen for. If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise. 22
  23. 23. VENTRICULAR FIBRILLATION OR PULSELESS TACHYCARDIA Witnessed Unwitnessed Precordial thump Check pulse, if none: Begin CPR Defibrillate with 200 joules Defibrillate with 200-300 joules Establish IV access, intubate Adrenaline 1 mg push Defibrillate with 360 joules Lidocaine 1 mg/kg IV, ET Defibrillate with 360 joules 23
  24. 24. Operations in case of asystole Asystole Start CPR • IV line • Adrenaline:IV 1 mg, each 3-5 min. -or - intratracheal 2 - 2.5 mg - in the absence of effect increase the dose -Atropine 1 mg push (repeated once in 5 min) • •Na Bicarbonate 1 Eq/kg IV •Consider pacing 24
  25. 25. Drugs used in CPR • Atropine – can be injected bolus, max 3 mg to block vagal tone, which plays significant role in some cases of cardiac arrest • Adrenaline – large doses have been withdrawn from the algorithm. The recommended dose is 1 mg in each 3-5 min. • Vasopresine – in some cases 40 U can replace adrenaline • Amiodarone - should be included in algorithm • Lidocaine – should be used only in ventricular fibrillation 25
  26. 26. Public Access Defibrillation -PAD • • • • • Casinos Airports City buildings Senior centers Gated communities
  27. 27. Complications of Compressions • • • • fractured ribs fractured sternum lacerated lungs lacerated liver, blood vessels, etc,.
  28. 28. 2010 AHA GUIDELINES Recommendations Component Recognition Adults Children Infants Unresponsive (for all ages) No breathing or no normal breathing (ie, only gasping) No breathing or only gasping No pulse palpated within 10 seconds for all ages (HCP only) CPR sequence Compression rate Compression depth C-A-B At least 100/min At least 2 inches (5 At least 2 inches (5 cm) cm) About 1. inches (4 cm)
  29. 29. Component Adults Recommendations Children Infants Chest wall recoil Allow complete recoil between compressions HCPs rotate compressors every 2 minutes Compression interruptions Minimize interruptions in chest compressions Attempt to limit interrruptions to <10 seconds Airway Compression-toventilation ratio (until advanced airway placed) Ventilations: when rescuer untrained or trained and not proficient Head tilt–chin lift (HCP suspected trauma: jaw thrust) 30:2 1 or 2 rescuers 30:2 Single rescuer 15:2 2 HCP rescuers Compressions only
  30. 30. Ventilations with advanced airway (HCP) Defibrillation 1 breath every 6-8 seconds (8-10 breaths/min) Asynchronous with chest compressions About 1 second per breath Visible chest rise Attach and use AED as soon as available. Minimize interruptions in chest compressions before and after shock; resume CPR beginning with compressions immediately after each shock.
  31. 31. Thank you

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