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Cardiopulmonary Resuscitation Chaiyanfen Tianjin Medical University General Hospital Department of Emergency Medicine
OBJECTIVE ,[object Object],[object Object],[object Object],[object Object],[object Object]
COURSE CONTENT ,[object Object],[object Object],[object Object],[object Object],[object Object]
Gerneral Consideration ,[object Object],[object Object],[object Object],[object Object],[object Object]
CPR Defination ,[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object]
History of CPR ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
History of CPR Inversion method Silvester’s method of artificial Ventilation
History of CPR
History of CPR ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy and function of the circulatory  system ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object]
Death Concepts ,[object Object],[object Object],[object Object],[object Object]
Clinical Death ,[object Object],[object Object]
Biologic death ,[object Object],[object Object]
Sudden  cardiac death ,[object Object],Sudden cardiac death is  clinical death
[object Object],[object Object],[object Object],[object Object]
Causes of circulation arrest ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Extracardiac 1.airway obstruction 2.acute respiratory failure 3.shock 4.Reflective cardiac arrest 5.embolisms of different origin 6.drug overdose 7.Electrocution 8.poisoning
follwing abrupt cessation of  effective cardiac output : ,[object Object],[object Object],[object Object],[object Object]
Sudden cardiac arrest is  reversible  in most victims if it's treated within a few minutes with an electric shock to the heart to restore a normal heartbeat. This process is called defibrillation.
Sudden  cardiac death - ECG ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ventricular fibrillation Asystole Electric –mechanical activity dissociation Pulseless Ventricular  tachycardia
Epidemiology of Sudden cardiac death Cardiac arrest accounts for between  250 000-350 000  death each year in  USA.   Expert estimate that the overall survival rate may be beween  3% and 5% , in many large urban areas maybe less than  2% .  In China , approximately  1 000 000 - 1800,000  people suffer cardiac arrest every year .Mortality of cardiac arrest is  95%-98%  in USA , and  98%-99%  in China 。 Delay Initiation of CPR are the main cause o f low  survival rate. .
Chain of Survival ,[object Object],[object Object],[object Object],[object Object],In 1991 ,  American Heart  Association has introduced
Chain of Survival
Chain of Survival Early Defibrillation   Resuscitation success depend on each link in the chain. Early defibrillation has emerged the greatest impact on ultimate survival. When defibrillation alone is added to the BLS regimen,survival increases from 6% to 25% for prehospital VF.
Survival Rates ,[object Object],[object Object],[object Object],[object Object],Source:  American Heart Association, 1994
 
Better chance of survival Brain damage starts in 4-6 minutes Brain damage is certain after 10 minutes without  CPR
Sudden death is unique. Time constraints are extreme. A victim's chances of survival are reduced by 7 to 10%with every minute that passes without defibrillation
[object Object],[object Object]
Most survivors of cardiac arrest are from the group of patients . . . ,[object Object],[object Object],[object Object]
COURSE CONTENT ,[object Object],[object Object],[object Object],[object Object],[object Object]
CPR Steps ,[object Object],[object Object]
Basic Life Support-  BLS ,[object Object]
BLS ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
BLS 1.CALL    Check the victim for  unresponsiveness 2. BLOW  Tilt the head back and listen for  breathing . . 3. PUMP   If the victim is still not breathing normally, coughing or moving, begin chest compressions.   Push   .
New BLS process  (2005) unresponsiveness opening the airway&  check the victim   CPR 2:30 until defibrillation or monitoring   defibrillation   once :360J Continue CPR for 5 groups (2:30)
BLS ,[object Object],[object Object],[object Object],[object Object],[object Object]
1.Recognition of Cardiac Arrest ,[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],Start  BLS  Immediately
[object Object],Positioning the patient supine on a flat, firm surface with arms along the sides of the body,  Always be aware of head and spinal cord injuries
2.A – airway control ,[object Object]
[object Object]
if no concern cervical spine injury . Head-tilt/neck stretch
Head-tilt/chin-lift if no concern cervical spine injury  . (2005 guidline new) In patients with suspected cervical spine injuries-if unable to open airway using the jaw thrust, use the head-tilt chin lift
Jaw-thrust T he jaw –thrust is the safest method for opening the airway if there is the possibility of cervical spine injury.
[object Object],[object Object]
3.B-breathing support ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],mouth-to-mouth mouth-to-mouth
[object Object],[object Object],[object Object],[object Object],[object Object],mouth-to nose
After tracheotomy , the stoma becomes the patient’s airway . mouth-to-stoma
[object Object]
mouth to mask
[object Object],[object Object]
4.C-circulation  (extenal chest compression) ,[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
WRONG  1
WRONG  2
5.D-defibrillation ,[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object]
The method of defibrillation ,[object Object],[object Object],[object Object]
 
 
[object Object]
[object Object]
The method of defibrillation ,[object Object]
traditional handheld defibrillator
Automated external defibrillators (AED) With a large pads are currently available. These machine can recognize VF and deliver direct current (DC) countershock with better than 85% sensivity and with 100%specificity.
[object Object],[object Object]
Procedure of Electrical defibrillation ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Checking for CPR Effectiveness ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
 
[object Object],[object Object]
Advanced Life Support-ALS ,[object Object]
[object Object]
1.Artificial airway ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
2. Artificial ventilation ,[object Object],[object Object]
3.Support of circulation ,[object Object],[object Object]
[object Object]
Venous access ,[object Object],[object Object],[object Object]
[object Object],[object Object]
Other access ,[object Object]
[object Object],[object Object],[object Object]
The roles of fluid and drug therapy ,[object Object],[object Object],[object Object],[object Object]
IV fluid ,[object Object],[object Object]
Drug therapy ,[object Object],[object Object]
① Epinephrine ,[object Object]
[object Object],[object Object]
[object Object],[object Object]
②  Lidocaine ,[object Object],[object Object]
[object Object],[object Object]
③  Amiodarone ,[object Object],[object Object]
④ Atropine ,[object Object],[object Object]
[object Object],[object Object],[object Object]
⑤ Magnesium ,[object Object],[object Object],[object Object]
⑥ Sodium bicarbonate ,[object Object]
[object Object],[object Object]
[object Object],[object Object]
[object Object]
[object Object],[object Object]
4. Different diagnosis ( 5H 、 5T ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Complications of CPR ,[object Object]
Complication of ECC : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
Complication of artificial ventilation:   Gastric distension and regurgitation and aspiration are common without endotracheal.
1.Vomiting ,[object Object],[object Object],[object Object],[object Object]
2.Stomach Distension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
Late complication ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Monitoring during CPR ,[object Object],[object Object]
1.Blood pressure ,[object Object]
3.Endotracheal CO2 monitoring ,[object Object]
4.Laboratory investigation ,[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Terminating Resuscitation
When Can I Stop CPR? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
Why CPR May Fail ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 

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2.Cpr 2

  • 1. Cardiopulmonary Resuscitation Chaiyanfen Tianjin Medical University General Hospital Department of Emergency Medicine
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  • 10. History of CPR Inversion method Silvester’s method of artificial Ventilation
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  • 23. Sudden cardiac arrest is reversible in most victims if it's treated within a few minutes with an electric shock to the heart to restore a normal heartbeat. This process is called defibrillation.
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  • 25. Ventricular fibrillation Asystole Electric –mechanical activity dissociation Pulseless Ventricular tachycardia
  • 26. Epidemiology of Sudden cardiac death Cardiac arrest accounts for between 250 000-350 000 death each year in USA. Expert estimate that the overall survival rate may be beween 3% and 5% , in many large urban areas maybe less than 2% . In China , approximately 1 000 000 - 1800,000 people suffer cardiac arrest every year .Mortality of cardiac arrest is 95%-98% in USA , and 98%-99% in China 。 Delay Initiation of CPR are the main cause o f low survival rate. .
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  • 29. Chain of Survival Early Defibrillation Resuscitation success depend on each link in the chain. Early defibrillation has emerged the greatest impact on ultimate survival. When defibrillation alone is added to the BLS regimen,survival increases from 6% to 25% for prehospital VF.
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  • 32. Better chance of survival Brain damage starts in 4-6 minutes Brain damage is certain after 10 minutes without CPR
  • 33. Sudden death is unique. Time constraints are extreme. A victim's chances of survival are reduced by 7 to 10%with every minute that passes without defibrillation
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  • 41. BLS 1.CALL Check the victim for unresponsiveness 2. BLOW Tilt the head back and listen for breathing . . 3. PUMP If the victim is still not breathing normally, coughing or moving, begin chest compressions.  Push .
  • 42. New BLS process (2005) unresponsiveness opening the airway& check the victim CPR 2:30 until defibrillation or monitoring defibrillation once :360J Continue CPR for 5 groups (2:30)
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  • 50. if no concern cervical spine injury . Head-tilt/neck stretch
  • 51. Head-tilt/chin-lift if no concern cervical spine injury . (2005 guidline new) In patients with suspected cervical spine injuries-if unable to open airway using the jaw thrust, use the head-tilt chin lift
  • 52. Jaw-thrust T he jaw –thrust is the safest method for opening the airway if there is the possibility of cervical spine injury.
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  • 59. After tracheotomy , the stoma becomes the patient’s airway . mouth-to-stoma
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  • 78. Automated external defibrillators (AED) With a large pads are currently available. These machine can recognize VF and deliver direct current (DC) countershock with better than 85% sensivity and with 100%specificity.
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  • 121. Complication of artificial ventilation: Gastric distension and regurgitation and aspiration are common without endotracheal.
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