This document provides information on cardiopulmonary resuscitation (CPR) including the patterns of cardiac arrest, causes of reversible cardiac arrest, the primary and secondary surveys of CPR, and treatments for different cardiac rhythms encountered during resuscitation such as asystole, bradycardia, and pulseless electrical activity. It details the steps for opening the airway, providing ventilation, performing chest compressions, and defibrillation. It also outlines advanced life support interventions including intubation, intravenous access, defibrillation, and medications for specific rhythms.
Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
A complete Theoretical as well as practical aspects of Cardiac defibrillation with the definition,history,defibrillator and cardiovesrsion,Equipments,pre procedural consideration,care of patient before and after defibrillation,cardiac defibrillation procedure steps with rationale,complications,documentation and legal aspects
Definition of arrhythmia - background on cardiac physiology including conduction in heart - action potential - pathogensis of arrhythmia - causes and risk factors for arrhythmia- diagnosis of arrhythmia - symptoms of tachyarrhythmias and bradyarrhythmias - investigations for arrhythmia - treatment of arrhythmia - pharmacological and other modalities of therapy for arrhythmia - managment of different types of arrhythmias
Cardiogenic shock : Medical Surgical NursingRaksha Yadav
This
presentation is designed for Nursing students and it gives a brief
about what you should know while caring for a client with Cardiogenic
shock and also its prevention.
Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
A complete Theoretical as well as practical aspects of Cardiac defibrillation with the definition,history,defibrillator and cardiovesrsion,Equipments,pre procedural consideration,care of patient before and after defibrillation,cardiac defibrillation procedure steps with rationale,complications,documentation and legal aspects
Definition of arrhythmia - background on cardiac physiology including conduction in heart - action potential - pathogensis of arrhythmia - causes and risk factors for arrhythmia- diagnosis of arrhythmia - symptoms of tachyarrhythmias and bradyarrhythmias - investigations for arrhythmia - treatment of arrhythmia - pharmacological and other modalities of therapy for arrhythmia - managment of different types of arrhythmias
Cardiogenic shock : Medical Surgical NursingRaksha Yadav
This
presentation is designed for Nursing students and it gives a brief
about what you should know while caring for a client with Cardiogenic
shock and also its prevention.
Sudden cardiac arrest (SCA) is an event caused by a problem with the heart's "electrical" system. SCA occurs when the heart suddenly stops beating. The heart’s electrical system sends signals to the heart to beat much too fast. The heart cannot beat that fast, so the heart muscle just quivers. Blood and oxygen do not reach vital organs like the brain. Then it stops altogether. The heart needs immediate treatment from an electrical shock (defibrillation) to restart the electrical system. If SCA is not treated within 7-10 minutes, it leads to sudden cardiac death.
This is a slightly updated version of a previous lecture on the science behind CPR. I have deleted the older version to avoid confusion, though they are both essentially the same
This lecture is good for first responders of all levels (from lifegaurds to paramedics) to really bring home the importance of CPR. It has been my experiance that current CPR classess are lacking in this regard, therefore compliance with new CPR standards is lacking, and this promotes LAZY CPR. This is my attempt to remedy that issue.
This presentation can help you understand the concept of Cardiogenic Shock more. It contains Definition, Causes, Risk Factors, Signs and Symptoms, Prevention, Prognosis, and Pathophysiology.
Cardiogenic Shock is a type of Shock wherein the main cause of problem is the inability of the heart itself to pump out the blood making the heart's workload and pressure increase.
Cardiac arrest, also known as cardiopulmonary arrest or circulatory arrest, is the end of normal circulation of the blood due to failure of the heart to contract effectively.
Also referred as a sudden cardiac arrest (SCA).
Cardiac arrest is a medical emergency that, in certain situations, is potentially reversible if treated early.
Unexpected cardiac arrest sometimes leads to death almost immediately; this is called sudden cardiac death (SCD).
Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest.
social cognition domains and impairment.pptxDoha Rasheedy
Social cognition refers to a set of neurocognitive processes underlying the individuals’ ability to “make sense of others’ behavior” as a “crucial prerequisite of social interaction” The different psychological processes by which we perceive, interpret, and process social information about ourselves and others. These processes allow people to understand social behavior and respond in ways that are appropriate and beneficial Social cognitive impairments are a prominent concern, or even a core facet, of several neurodegenerative (e.g., behavioral variant of frontotemporal dementia), neuropsychiatric (e.g., schizophrenia, major depressive disorder, and bipolar disorder), and neurodevelopmental (e.g., autism spectrum disorder and attention deficit hyperactivity disorder) conditions, and often occur after acute brain damage (e.g., traumatic brain injury and stroke). Moreover, such deficits are critical predictors of functional outcomes because they affect the ability to create and maintain interpersonal relationships, thereby removing their benefits in everyday life Social cognitive disturbances might be relatively subtle and harder to detect informally. Structured social cognitive assessment is, therefore , mandated.
Basic of geriatrics and internal medicine for physiotherapistDoha Rasheedy
collection of lectures for physiotherapy undergraduate students including notes of common health issues (frailty, sarcopenia, osteoporosis, neuropsychiatric issues, constipation, metabolic syndrome and its components, orthostatic hypotension, CLD, CKD, anemia, immobilization, dizziness, falls, fatigue) and how to handle in practice.
summary of age related changes and geriatric pharmacology, safe analgesic prescription in elderly
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
5. The primary survey
Airway: Open the airway
Breathing: Provide positive-pressure
ventilation.
Circulation: Give chest compressions.
Defibrillation: Identify and shock
ventricular fibrillation (VF) and ventricular
tachycardia (VT)
6. Airway
Assessment:
1- look for respiratory activity.
2-listen for breathing.
3- feel for air exchange at the patient’s nose and mouth.
If these are present,
assess the patient’s ability to protect the airway by asking
them to speak.
If the patient does not respond to questions, the absence
of a strong gag reflex:
confirms the inadequacy of protective airway mechanisms
steps must be taken to provide airway support.
7. Steps to support airway
1- immediately call for assistance.
2- place the patient in a supine position.
be careful in a patient with neck trauma in-line stabilization
of the cervical spine. This is performed by keeping one
hand behind the head and neck while the other hand
rolls the patient toward you.
3- open airway: use the head tilt-chin lift
maneuver or the jaw thrust maneuver.
4- Remove foreign material.
8.
9.
10. Breathing
1- bag-valve mask.(2 sec) if unsuccessful.
2-reposition the head and mask and try again.
If unsuccessful, (obstructed airway).
3- Open the patient’s mouth by grasping both
the tongue and the lower jaw between the
thumb and fingers, and then lift the mandible. If
you see obstructing material.
4- use a McGill forceps or clamp to remove it. If
this equipment is not available, slide your index
finger down the inside of the cheek to the base
of the tongue and dislodge any foreign bodies
using a hooking action. (if unsuccessful).
12. Circulation
check for a carotid pulse.( the most
central of the peripheral arteries).
If no pulse is present, chest compressions
should be initiated and the patient should
be placed on a cardiac monitor.
To adequately perform chest compressions, the
heel of one hand should be placed in the midline
on the lower part of the sternum (just above the
notch where the ribs meet the lower sternum).
13. The other hand is placed on top of the first hand
and the fingers interlocked and kept off of the
chest.
Position your shoulders directly over your hands
and lock your elbows.
Depress the sternum about 1.5–2 inches
approximately 100 times per minute.
Properly performed compressions can produce a
systolic blood pressure of 60mmHg.
14. Defibrillation
When defibrillation can be successful
performed within the first minute or two,
as many as 90% of patients return to their
pre-arrest neurologic status. The longer
the patient remains in cardiac arrest, the
more likely that defibrillation and
resuscitation will be unsuccessful. Survival
rates are 10% when defibrillation is
delayed 10 minutes or more after a
patient’s collapse.
15. Deliver an electric shock to convert the
nonperfusing rhythm to a perfusing one.
one paddle should be placed to the right
of the sternum below the right clavicle and
the other in the midaxillary line at the
level of the nipple.
Firm pressure of approximately 25 lb
should be applied to each paddle.
Alternatively, “hands off” defibrillator pads
can be used that are placed on the chest
and the back, sandwiching the heart.
17. Prepare patient
Correct reversible causes
Check lanoxin level
12 leads ECG before & after shock
Iv line present
Monitoring circulation and respiration
Fasting 8 hr , sedation if elective
cardioversion.
18. Size of paddle
Adult debrillation, both handheld paddle
electrodes and self-adhesive pad
electrodes 8—12 cm in diameter are used
and function well.
Debrillation success may be higher with
electrodes of 12-cm diameter compared
with those of 8-cm.
19. Position of paddles
the conventional sternal—apical position.
The right (sternal) electrode is placed to the
right of the sternum, below the clavicle.
The apical paddle is placed in the mid axillary
line, approximately level with the V6 ECG
electrode .
It does not matter which electrode
(apex/sternum) is placed in either
position.
20. Position of paddles-2
Other acceptable pad positions include:
each electrode on the lateral chest wall, one
on the right and the other on the left side
(biaxillary);
one electrode in the standard apical position
and the other on the right or left upper back;
one electrode anteriorly, over the left
precordium, and the other electrode posterior
to the heart just inferior to the left scapula.
21. Coupling agents
Do not use medical gels or pastes of poor
electrical conductivity (e.g., ultrasound gel).
Pads versus paddles
Self-adhesive debrillation pads are safe and
effective and are preferable to standard
debrillation paddles.
Consideration should be given to use of self-
adhesive pads in peri-arrest situations.
22. Successful defibrillation depends on the
amount of current transmitted across the
heart. (energy output of defibrillator
transthoracic impedance).
↑ paddle size →↑ efficiency of shock
current.
Conductive gel (contain salt) so less
energy is required, ↓ burn but not ↑
impedence.
23. The secondary survey
Airway: Definitive airway management
(tube).
Breathing: Confirmation of adequate
ventilation.
Circulation: Intravenous access, ACLS
medications, fluids.
Defibrillation: Continued rhythm analysis
and treatment.
24. Airway
Endotracheal intubation is the most
effective method of ensuring adequate
ventilation, oxygenation, and airway
protection against aspiration during
cardiac arrest. In addition, it is an
additional route of entry for some
resuscitation medications, such as
atropine, epinephrine, and lidocaine.
25. Breathing
the adequacy of intubation should be checked
by auscultating the chest for equal bilateral
breath sounds, identifying fog in the
endotracheal tube on exhalation,
Monitoring end-tidal CO2 (using colorimetry or
capnography). The presence of exhaled CO2 on
a monitor indicates proper tracheal tube
placement and can detect subsequent tube
dislodgement.
A chest X-ray can help determine the location of
the tip of the endotracheal tube in relation to
the carina.
26. Breathing-2
The patient should be placed on a
ventilator for positive pressure ventilation.
Continuous high flow oxygen and pulse
oximetry should be maintained.
27. Circulation
Intravenous (IV) access should be obtained,
preferably with a central venous catheter in the
internal jugular, subclavian, or femoral vein. Two
large bore peripheral lines may be acceptable.
And IV fluids should be infused. The patient’s
rhythm should be identified and appropriate
interventions instituted based on accepted ACLS
guidelines.
28.
29.
30.
31. Asystole and bradycardia
Atropine has a vagolytic effect by
antagonizing the parasympathetic system.
Epinephrine improves myocardial and
cerebral blood flow during CPR.
Early transcutaneous pacing should be
considered for bradycardia.transcutaneous
pacing for asystole has not been shown to
improve survival. As some
32. Somme patients with asystole are actually in fine
VF, two or more cardiac leads should be checked
before determining that the patient is truly in
asystole.
recent large randomized study from Europe
comparing epinephrine with vasopressin for
patients in asystole demonstrated that
vasopressin was superior to epinephrine,
suggesting that vasopressin followed by
epinephrine may be more effective than
epinephrine alone in the treatment of refractory
cardiac arrest.
33. Pulseless electrical activity
electromechanical dissociation
Focus on determining and reversing the
cause:
The most common causes include severe
hypovolemia (usually related to significant
blood loss), hypoxia, acidosis, pericardial
tamponade, tension pneumothorax, large
pulmonary embolus, myocardial infarction,
hypothermia, or drug overdose.
34. Patient should be intubated to provide adequate
oxygenation and given a rapid IV infusion of
crystalloid.
If the patient has a treatable rhythm, appropriate
rhythm-specific ACLS algorithms
If the situation warrants, pericardiocentesis or
needle thoracostomy should be performed.
If no reversible cause can be determined, the patient
should be given epinephrine every 3–5 minutes. If
the PEA rate is slow, atropine can also be given.
Unless a reversible cause is discovered, the
prognosis of PEA is poor, with only 1–4% of patients
surviving to hospital discharge.
35. PEA ASYSTOLE (monitor analysis)
{nonshockable}
CPR (5 cycles-30:2) 2 min
Epinephrine 1mg (repeat 3-5 min)
Vasopressin 40 IU then epinephrine.
Atropine 1 mg (repeat 3-5 min) {max
3mg} (single dose)
Then CPR 5 cycles
Check pulse → CPR →E,A,V →CPR→
check pulse.
36. Ventricular fibrillation )VF( or
pulseless
)ventricular tachycardia )VT
Attempt debrillation immediately (4 J kg-1 for all
shocks).
Resume CPR as soon as possible.
After 2 min, check the cardiac rhythm on the
monitor.
Give second shock if still in VF/pulseless VT.
Immediately resume CPR for 2 min and check
monitor; if no change, give adrenaline followed
immediately by a 3rd shock.
CPR for 2 min.
Give amiodarone if still in VF/pulseless VT
followed immediately by a 4th shock.
37. Give adrenaline every 3—5 min during CPR.
If remains in VF/pulseless VT, continue to
alternate shocks with 2 min of CPR.
If signs of life become evident, check the
monitor for an organised rhythm; if this is
present, check for a central pulse.
Identify and treat any reversible causes (4Hs
&4Ts).
If debrillation was successful but VF/pulseless VT
recurs, resume CPR, give amiodarone and
debrillate again at the dose that was effective
previously. Start a continuous infusion of
amiodarone.
38. Precordial thump
Consider giving a single precordial thump when
cardiac arrest is confirmed rapidly after a witnessed,
sudden collapse and a defibrillator is not immediately
to hand.
the technique:
Using the ulnar edge of a tightly clenched fist, deliver a
sharp impact to the lower half of the sternum from a
height of about 20 cm, then retract the fist immediately to
create an impulse-like stimulus.
A precordial thump is most likely to be successful in
converting VT to sinus rhythm.
39. Drug administration Routes
IV access: central peripheral
Drugs typically require 1 to 2 minutes to reach
the central circulation when given via a peripheral
vein but require less time when given via central
venous access.
If a resuscitation drug is administered by a
peripheral venous route, administer the drug by
bolus injection and follow with a 20-mL bolus of
IV fluid. Elevate the extremity for 10 to 20
seconds to facilitate drug delivery to the central
circulation.
40. Intraosseous (IO) cannulation:
provides access to a noncollapsible venous
plexus, enabling drug delivery similar to that
achieved by central venous access.
In the sternum , proximal tibia (2 cm below tt) ,
distal tibia (2 cm above mm)
In endotracheal tube:
Epinepherine , Atropine , Vasopressin ,
lidocaine , naloxone.
Give at dose 2.5-3 times usual iv dose.
Dilute in 5-10 ml saline.
41. Medications for Arrest Rhythms
Vasopressors :
at any stage during management of pulseless
VT, VF, PEA, or asystole increases the rate of
neurologically intact survival to hospital
discharge.
Epinepherine: It is appropriate to administer a 1-
mg dose of epinephrine IV/IO every 3 to 5
minutes during adult cardiac arrest. Higher
doses may be indicated to treat specific
problems, such as В-blocker or calcium channel
blocker overdose. may be given by the
endotracheal route at a dose of 2 to 2.5 mg.
42. Vasopressin: Vasopressin is a
nonadrenergic peripheral vasoconstrictor
that also causes coronary and renal
vasoconstriction.(40 U, with the dose
repetition only once).
43. Atropine
in asystole or slow PEA arrest.
The recommended dose of atropine for
cardiac arrest is 1 mg IV, whichcan be
repeated every 3 to 5 minutes (maximum
total of 3 doses or 3 mg) if asystole
persists.
Endotracheal route also used.
44. Antiarrhythmics
Amiodarone:
administered for VF or pulseless VT
unresponsive to CPR, shock, and a vasopressor.
An initial dose of 300 mg IV/IO can be followed
by one dose of 150 mg IV/IO.
Lidocaine:
considered an alternative treatment to
amiodarone.The initial dose is 1 to 1.5 mg/kg IV.
If VF/ pulseless VT persists, additional doses of
0.5 to 0.75mg/kg IV push may be administered
at 5- to 10 minute intervals, to a maximum dose
of 3 mg/kg.
45. Magnesium:
When VF/pulseless VT cardiac arrest is
associated with torsades de pointes,
magnesium sulfate at a dose of 1 to 2 g
diluted in 10 mL D5WIV/IO push, typically
over 5 to 20 minutes.
When torsades is present in the patient
with pulses, the same 1 to 2 g is mixed in
50 to 100 mL of D5Wand given as a
loading dose. It can be given more slowly
(eg, over 5 to 60 minutes IV)
46. Pacing in Arrest
Several randomized controlled trials failed
to show benefit from attempted pacing for
asystole.
At this time use of pacing for patients
with asystolic cardiac arrest is not
recommended.
47. Routine Administration of IV Fluids
During
Cardiac Arrest
There were no published human studies
evaluating the effect of routine fluid
administration during normovolemic cardiac
arrest
There is insufficient evidence to recommend
routine administration of fluids to treat cardiac
arrest.
Fluids should be infused if hypovolemia is
suspected.
48. Monitoring
Assessment During CPR:
At present there are no reliable clinical
criteria that clinicians can use to assess
the efficacy of CPR. Although end-tidal
CO2 serves as an indicator of cardiac
output produced by chest compressions
and may indicate return of spontaneous
circulation
49. Assessment of Hemodynamics
1-Coronary Perfusion Pressure
(CPP= aortic relaxation [diastolic] pressure
minus right atrial relaxation phase blood
pressure)
during CPR correlates with both myocardial
blood flow and ROSC.
A CPP of 15 mm Hg is predictive of ROSC.
Increased CPP correlate with improved 24-hour
survival rates in animal studies.
Rarely available
50. Pulses-2
Clinicians frequently try to palpate arterial pulses
during chest compressions to assess the
effectiveness of compressions.
No studies have shown the validity or clinical
utility of checking pulses during ongoing CPR.
Because there are no valves in the inferior vena
cava, retrograde blood flow into the venous
system may produce femoral vein pulsations.
Thus palpation of a pulse in the femoral triangle
may indicate venous rather than arterial blood
flow.
Carotid pulsations during CPR do not indicate the
efficacy of coronary blood flow or myocardial or
cerebral perfusion during CPR.
51. Assessment of Respiratory
Gases
1-Arterial Blood Gases
not a reliable indicator of the severity of
tissue hypoxemia, hypercarbia, or tissue
acidosis.
2-Oximetry
During cardiac arrest, pulse oximetry will
not function because pulsatile blood flow
is inadequate in peripheral tissue beds.
52. End-Tidal CO2 Monitoring
useful as a noninvasive indicator of cardiac
output generated during CPR.
major determinant of CO2 excretion is its rate of
delivery from the peripheral production sites to
the lungs.
In the low-flow state during CPR, ventilation is
relatively high compared with blood flow, so that
the end-tidal CO2 concentration is low.
If ventilation is reasonably constant, then
changes in end-tidal CO2 concentration reflect
changes in cardiac output.
53. Duration of CPR
Arrest time< 6 min→30 min CPR
Arrest time> 6 min→15 min CPR
54. Post-CPR Management
Induced hypothermia(32-34o)(12-24 hr)
Glucose control
Organ-Specific Evaluation and Support
55. Prognosis
1-strongly predict death or poor neurologic
outcome, with 4 of the 5 predictors
detectable at 24 hours after resuscitation:
Absent corneal reflex at 24 hours
Absent pupillary response at 24 hours
Absent withdrawal response to pain at 24
hours
No motor response at 24 hours
No motor response at 72 hours
56. 2-An electroencephalogram performed 24
2-
to 48 hours after resuscitation has also
been shown to provide useful predictive
value.
3-GCS: <5 ON 3rd day =no chance for
neurological recovery.
4- Duration of coma:
>4-6 hr =poor prognosis
>24 hr =10% recovery
>72 hr = 5% recovery
> 2 wk = no recovery at all.