Cardio Pulmonary Resuscitation

Cardio-Pulmonary andCardio-Pulmonary and
Cerebral ResuscitationCerebral Resuscitation

The themeThe theme
1.1. Cardiopulmonary resuscitation.Cardiopulmonary resuscitation.
Symptoms of clinical deathSymptoms of clinical death. Safar’s triple. Safar’s triple
manoeuvre. Breathing.manoeuvre. Breathing.
2.2. Cardiopulmonary resuscitation. ChestCardiopulmonary resuscitation. Chest
compression. Complications of the CPR.compression. Complications of the CPR.

Part II. CardiopulmonaryPart II. Cardiopulmonary
resuscitationresuscitation
LifeLife
For normal functioning all cells of the bodyFor normal functioning all cells of the body
require oxygen. If oxygen is not provided,require oxygen. If oxygen is not provided,
death of organism appears withindeath of organism appears within 4..54..5
minutesminutes..
BrainBrain is the tissue most susceptible tois the tissue most susceptible to
anoxia (absence of oxygen).anoxia (absence of oxygen).

Process of the deathProcess of the death
Is not a momentary but stepwise process, which can take certainIs not a momentary but stepwise process, which can take certain
time.time.
FiveFive steps of the death:steps of the death:
– PreagonyPreagony
– Terminal pauseTerminal pause
– AgonyAgony
– Clinical deathClinical death (reversible injury)(reversible injury)
– Biological deathBiological death (irreversible injury)(irreversible injury)

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Medical Lecture Notes –Medical Lecture Notes – All SubjectsAll Subjects
USMLE Exam (America) –USMLE Exam (America) – PracticePractice

AgonyAgony isis a staa stagege which precedwhich precedee to the death.to the death.
Function of vital organs is severFunction of vital organs is severee disturbed, anddisturbed, and
conditions required for survival of organismconditions required for survival of organism
cannot be met.cannot be met.
 UnconsciousnessUnconsciousness
 Blood pressure is undetectableBlood pressure is undetectable
 No pulse on arteriesNo pulse on arteries
Clinical death:Clinical death: circulation stops completely andcirculation stops completely and
that leads to the cessation of breathing andthat leads to the cessation of breathing and
nervous system activity.nervous system activity.

Symptoms of clinical deathSymptoms of clinical death
No pulse on arteriesNo pulse on arteries (carotid or(carotid or
femoral)femoral)
Change of skin colourChange of skin colour
UnconsciousnessUnconsciousness
Gasping, cessation of breathingGasping, cessation of breathing
Dilatation of eye pupilsDilatation of eye pupils
Duration of clinical death is 3(5) minutesDuration of clinical death is 3(5) minutes

Biological deathBiological death is irreversible condition.is irreversible condition.
Metabolism and functioning of vital organs hasMetabolism and functioning of vital organs has
completelycompletely ceasedceased. Organ damage is as. Organ damage is as
extensive that resuscitation of the body isextensive that resuscitation of the body is
impossible.impossible.
Evident symptoms of the death:Evident symptoms of the death:
 Rigor mortisRigor mortis
 Death spots on the bodyDeath spots on the body
 Drop of body temperature to the level of theDrop of body temperature to the level of the
surroundingsurrounding

Adult BLS sequenceAdult BLS sequence
Basic life support consists of the following actions:Basic life support consists of the following actions:
1. Make sure that the victim, any bystanders, and1. Make sure that the victim, any bystanders, and
you are safe.you are safe.
2. Check the victim for a response (gently shake2. Check the victim for a response (gently shake
his shoulders and ask loudly, “Sir. Or Ms., arehis shoulders and ask loudly, “Sir. Or Ms., are
you all right?”)you all right?”)
3 A. If he responds:3 A. If he responds:
 Leave him in the position in which you find himLeave him in the position in which you find him
provided there is no further danger.provided there is no further danger.
 Try to find out what is wrong with him and getTry to find out what is wrong with him and get
help if needed.help if needed.
 Reassess him regularly.Reassess him regularly.

Adult BLS sequenceAdult BLS sequence
3 B. If he does not respond:3 B. If he does not respond:
 Shout for help, call 911 (USA andShout for help, call 911 (USA and
Canada) or 03 (Ukraine and Russian Fed)Canada) or 03 (Ukraine and Russian Fed)
 Turn the victim onto his back and thenTurn the victim onto his back and then
open the airway using head tilt and chinopen the airway using head tilt and chin
lift:lift:
- place your hand on his forehead and- place your hand on his forehead and
gently tilt head back.gently tilt head back.
- with your fingertips under the point of the- with your fingertips under the point of the
victim’s chin, lift the chin to open thevictim’s chin, lift the chin to open the
airway.airway.

resuscitationresuscitationAdult BLS sequenceAdult BLS sequence
4. Keep the airway open, look, listen, and4. Keep the airway open, look, listen, and
feel for normal breathing.feel for normal breathing.
 Look for chest movementLook for chest movement
 Listen at the victim’s mouth for breathListen at the victim’s mouth for breath
sounds.sounds.
 Feel for air on your cheekFeel for air on your cheek
Look, listen and feelLook, listen and feel forfor no moreno more thanthan 1010
secsec to determine if the victim breathingto determine if the victim breathing
normally.normally.

Opening the airwayOpening the airway
Head tiltHead tilt
Chin liftChin lift
If cervical spineIf cervical spine
injury suspected:injury suspected:
– jaw thrustjaw thrust

Assess BreathingAssess Breathing
Look for chestLook for chest
movementmovement
Listen for breathListen for breath
soundssounds
Feel for expired airFeel for expired air
Assess for 10Assess for 10
seconds beforeseconds before
deciding breathing isdeciding breathing is
absentabsent

Rescue breathingRescue breathing
(Expired air ventilation)(Expired air ventilation)
If he is not breathing normally:If he is not breathing normally:
Ask someone to call for anAsk someone to call for an
ambulance.ambulance.
 Kneel by the side of the victim.Kneel by the side of the victim.
 Pinch the soft part of the victim’sPinch the soft part of the victim’s
nose, using the index finger andnose, using the index finger and
thumb of your hand on histhumb of your hand on his
forehead.forehead.
 Allows his mouth to open, butAllows his mouth to open, but
maintain chin tilt.maintain chin tilt.
 Take a normal breath and placeTake a normal breath and place
your lips around his mouth,your lips around his mouth,
making sure that you have amaking sure that you have a

 Blow into his mouth and look on his chest, chestBlow into his mouth and look on his chest, chest
must rise; take about one second to make hismust rise; take about one second to make his
chest rise as in normal breathing; this is anchest rise as in normal breathing; this is an
effective rescue breath.effective rescue breath.
 Maintaining head tilt and chin lift, take yourMaintaining head tilt and chin lift, take your
mouth away from the victim and watch for hismouth away from the victim and watch for his
chest.chest.
 Take another normal breath and blow into theTake another normal breath and blow into the
victim’s mouth once more to give a total of twovictim’s mouth once more to give a total of two
effective rescue breaths.effective rescue breaths.
 Give each rescue breath over 1 sec rather thanGive each rescue breath over 1 sec rather than
2 sec.2 sec.

Assess CirculationAssess Circulation
Check the victim’s pulse.Check the victim’s pulse.
A. If pulse on the carotid artery is not palpable –A. If pulse on the carotid artery is not palpable –
begin chest compression.begin chest compression.
 Place the heel of one hand in the centre of thePlace the heel of one hand in the centre of the
victim’s chest.victim’s chest.
 Place the heel of your other hand on the top ofPlace the heel of your other hand on the top of
the first hand.the first hand.
 Interlock the fingers of your hands and ensureInterlock the fingers of your hands and ensure
that pressure is not applied over the victim’sthat pressure is not applied over the victim’s
ribs. Do not apply any pressure over the upperribs. Do not apply any pressure over the upper
abdomen or the bottom end of the bony sternumabdomen or the bottom end of the bony sternum
(breastbone).(breastbone).

– 3030 compressionscompressions
: 2 breaths for: 2 breaths for
1-person1-person
CPRCPR
2-person2-person
CPRCPR

ChestChest
compressions:compressions:
Depress sternumDepress sternum
4-5 cm4-5 cm
Rate: 100 perRate: 100 per
minuteminute

PRECORDIALPRECORDIAL BLOWBLOW
IndicationsIndications::
ConfirmedConfirmed ofof
blood circulationblood circulation
stopstop

Continue resuscitation until:Continue resuscitation until:
Qualified help arrives and takesQualified help arrives and takes
overover
The victim shows signs of lifeThe victim shows signs of life
You become exhaustedYou become exhausted

Airway management andAirway management and
ventilationventilation
Basic airway management andBasic airway management and
The laryngeal mask airway andThe laryngeal mask airway and
CombitubeCombitube
Advanced techniques of airwayAdvanced techniques of airway
managementmanagement
Basic mechanical ventilationBasic mechanical ventilation

Safar’s tripleSafar’s triple manoeuvremanoeuvre
Open mouthOpen mouth
Head Tilt andHead Tilt and
Chin LiftChin Lift

Ventilation by mouth through aVentilation by mouth through a
maskmask
AdvantagesAdvantages::
Allows to avoid direct contactAllows to avoid direct contact
Reduces probabilityReduces probability ofof
infectedinfected
Allows to raiseAllows to raise O2O2
RestrictionsRestrictions::
Tightness maintenanceTightness maintenance
Stomach inflatingStomach inflating

Ventilation by means of bagVentilation by means of bag
ААmbumbu
AdvantagesAdvantages
Direct contact allows toDirect contact allows to
avoidavoid
Allows to increaseAllows to increase
concentration О2concentration О2 -- toto 8585
%%
Can be used with anCan be used with an
obverse mask,obverse mask, LLММ,,
Combitube,Combitube,
endotrachealendotracheal tubetube
RestrictionsRestrictions
At use with an obverseAt use with an obverse
maskmask::
Risk of inadequateRisk of inadequate
Risk of inflating of aRisk of inflating of a
stomachstomach
4 hands are necessary4 hands are necessary
for optimum usefor optimum use

InstallationInstallation LLММ

LaryngealLaryngeal maskmask
Speed and simplicity ofSpeed and simplicity of
installationinstallation
Presence of thePresence of the
different sizesdifferent sizes
More effectiveMore effective
ventilation inventilation in
comparison with ancomparison with an
obverse maskobverse mask
Allows to avoidAllows to avoid
laryngoscopylaryngoscopy
Does not protect fromDoes not protect from
aspirationaspiration
Does not approach inDoes not approach in
situations when highsituations when high
pressure use on a breathpressure use on a breath
is requiredis required
It is impossibleIt is impossible toto
aspirate fromaspirate from bottombottom BPBP

Choice of an air line of the suitableChoice of an air line of the suitable
sizesize

Simple adaptations for maintenanceSimple adaptations for maintenance
of BPof BP

InstallationInstallation of pharyngo-oralof pharyngo-oral an airan air
lineline

InstallationInstallation of pharyngonasalof pharyngonasal an air linean air line

CombitubeCombitube
Speed and simplicity ofSpeed and simplicity of
installationinstallation
Allows to avoidAllows to avoid
laryngoscopylaryngoscopy
It is possible to use,It is possible to use,
when pressure upon awhen pressure upon a
breath the highbreath the high
It is accessible only 2 sizesIt is accessible only 2 sizes
There is a risk of ventilationThere is a risk of ventilation
through a gastric gleamthrough a gastric gleam
Damage of cuffs at installationDamage of cuffs at installation
Trauma in an installation timeTrauma in an installation time
Only for disposable useOnly for disposable use

Ventilation by means ofVentilation by means of
CombitubeCombitube

Intubation ofIntubation of ttracheasracheas
AttemptAttempt of intubationof intubation::
Preoxygenation ofPreoxygenation of the patientthe patient
3030 seconds on each attemptseconds on each attempt
Spend a tube through a vocal crack under theSpend a tube through a vocal crack under the
control of direct sightcontrol of direct sight
At any doubts or complexitiesAt any doubts or complexities,, reoxygenationreoxygenation thethe
patient before the subsequent attemptspatient before the subsequent attempts
Patients are harmed by unsuccessful attemptsPatients are harmed by unsuccessful attempts
of oxygenation, instead ofof oxygenation, instead of intubationintubation!!

InstallationInstallation of endotrachealof endotracheal
tubetube

Intubation of tracheaIntubation of trachea
Allows to increaseAllows to increase FiO2FiO2
toto 100 %100 %
IsolatesIsolates BPBP, preventing, preventing
of aspirationof aspiration
AllowsAllows aspirated of BPaspirated of BP
Alternative way forAlternative way for
introductionintroduction of medicineof medicine
Training andTraining and
experience areexperience are
absolutely necessaryabsolutely necessary
Unfortunate attempt,Unfortunate attempt,
esophageal intubationesophageal intubation
Risk of deterioration ofRisk of deterioration of
damage back and adamage back and a
brain duringbrain during
laryngoscopelaryngoscope

Confirmation of correct positionConfirmation of correct position
of ETTof ETT in a tracheain a trachea
Direct visualisation duringDirect visualisation during laryngoscopelaryngoscope
AuscultationAuscultation::
– With two sidesWith two sides,, on averageon average axillary'saxillary's lineslines
– OverOver epigastriumepigastrium
Symmetric movementsSymmetric movements of thoraxof thorax duringduring

Pressure onPressure on cricoidcricoid
cartilage on purposecartilage on purpose ofof
occlusionocclusion a gullet abouta gullet about
cervical department of acervical department of a
backbonebackbone
Sellick”s manoeuvreSellick”s manoeuvre

Sellick”s manoeuvreSellick”s manoeuvre
DDecreaseecrease of rof riskisk ofof
aspirationaspiration andand
regurgitationregurgitation
It can be applied atIt can be applied at
intubationintubation,, and alsoand also
ventilation by means ofventilation by means of
an obverse mask andan obverse mask and
LMLM
LacksLacks
Can complicateCan complicate
intubationintubation
Can complicateCan complicate
ventilation by meansventilation by means
of an obverse maskof an obverse mask
oror LMLM
Avoid at activeAvoid at active
vomitingvomiting

CricothireotomyCricothireotomy
IndicationsIndications
Impossibility of maintenanceImpossibility of maintenance
passablenesspassableness ooff BPBP inin
another wayanother way
ComplicationsComplications
DisplacementDisplacement of cannulaof cannula
– EmphysemaEmphysema
– BleedingBleeding
– Gullet punchingGullet punching
HypoventilationHypoventilation

Rhythm of a stop of bloodRhythm of a stop of blood
circulationcirculation
FibrillationFibrillation of ventriclesof ventricles
Ventricle'sVentricle's tachycardia «without pulse»tachycardia «without pulse»
AsystoleAsystole
Electro-mechanicalElectro-mechanical dissociationdissociation ((EMDEMD))

AsystoleAsystole
There is no activityThere is no activity of ventriclesof ventricles
((complexcomplex QRS)QRS)
Activity of auriclesActivity of auricles (wave(wave P)P) can becan be
Seldom straight lineSeldom straight line
PossibilityPossibility of sof small wavemall waves ofs of VFVF

The mechanismThe mechanism ofof
DEFIBRILLATIONDEFIBRILLATION
DefinitionDefinition
– ““The termination of fibrillation or absenceThe termination of fibrillation or absence
VF/VTVF/VT inin 55 seconds after theseconds after the discharge”discharge”
DepolarizedDepolarized all weight of a myocardiumall weight of a myocardium
NaturalNatural pacemekerpacemeker renew jobrenew job

Automatic externalAutomatic external
DEFIBRILLATORDEFIBRILLATOR
Analyze aAnalyze a heartheart rhythmrhythm
Make theMake the dischargedischarge
Specificity inSpecificity in
recognition of therecognition of the
rhythmrhythm inin subject whichsubject which
isis defibrillationdefibrillation comescomes
nearer tonearer to 100 %100 %

Automatic externalAutomatic external
DEFIBRILLATORDEFIBRILLATOR
Attach sticky electrodesAttach sticky electrodes
Follow the sound andFollow the sound and
visual instructionvisual instruction
The automatic analysis ofThe automatic analysis of
an electrocardiograman electrocardiogram -- dodo
not touch the patientnot touch the patient
The automaticThe automatic dischargedischarge
at a correspondingat a corresponding
rhythmrhythm
+/-+/-a manual overloada manual overload

ManualManual DEFIBRILLATIONDEFIBRILLATION
It is based onIt is based on::
The rhythm is recognisedThe rhythm is recognised
by the operatorby the operator
The operator puts theThe operator puts the
dischargedischarge
It can be used forIt can be used for
synchronisedsynchronised cardioversioncardioversion

SafetySafety of defibrillationof defibrillation
Never hold both electrodes in one handNever hold both electrodes in one hand
Charge only when electrodes on a breastCharge only when electrodes on a breast
of the victimof the victim
Avoid direct or indirect contactAvoid direct or indirect contact
Wipe dry a breast of the patientWipe dry a breast of the patient
Remove oxygen from a zoneRemove oxygen from a zone ofof
defibrillationdefibrillation

ManualManual DEFIBRILLATION (1)DEFIBRILLATION (1)
DiagnosticsDiagnostics VFVF//VTVT andand
signs of a stop of bloodsigns of a stop of blood
circulationcirculation
Choice of suitable energy ofChoice of suitable energy of
thethe dischargedischarge
To load condensersTo load condensers
(electrodes on the patient)(electrodes on the patient)
The commandThe command ““all to departall to depart””
Visual check of a zoneVisual check of a zone ofof
defibrillationdefibrillation
To check up the monitorTo check up the monitor
TheThe dischargedischarge

ManualManual DEFIBRILLATION (2)DEFIBRILLATION (2)
Repeatedly to estimate a rhythmRepeatedly to estimate a rhythm
To hold electrodes on a breast betweenTo hold electrodes on a breast between
dischargesdischarges
To increase energyTo increase energy
– The assistant makesThe assistant makes,, oror
– To place an electrode onTo place an electrode on defibrillatordefibrillator and toand to
choose energy level independentlychoose energy level independently
Not to spendNot to spend BLSBLS betweenbetween dischargedischarges ifs if
there is no long delaythere is no long delay

The conclusionThe conclusion
DefibrillationDefibrillation it is unique effective atit is unique effective at
restoration of circulation at patients withrestoration of circulation at patients with
VFVF oror VTVT without pulsewithout pulse
DefibrillationDefibrillation shouldshould bebe spent quickly,spent quickly,
effectively and safelyeffectively and safely
New technologies increase possibilitiesNew technologies increase possibilities
of equipment and simplify useof equipment and simplify use

Introduction of medicines inIntroduction of medicines in
ttimeime ofof СРСРRR

The central venous accessThe central venous access
Internal jugular veinInternal jugular vein
SubclavianSubclavian veinvein

ComplicationsComplications of catheterizationof catheterization
the central veinsthe central veins
Artery punctureArtery puncture
HematomaHematoma
HemothoraxHemothorax
PneumothoraxPneumothorax
AirAir embolismembolism
Damage of surrounding fabricsDamage of surrounding fabrics
ААrrhythmiasrrhythmias

IntatrachealIntatracheal introductinintroductin of medicinesof medicines
Preparations whichPreparations which
cancan be introducebe introducedd
into a tracheainto a trachea::
AdrenalineAdrenaline
LidocaineLidocaine
AtropineAtropine
NaloxoniNaloxoni
Preparations whichPreparations which
cannotcannot be entered intobe entered into
a trachea:a trachea:
AmiodaroniAmiodaroni
Sodium bicarbonateSodium bicarbonate
CalciumCalcium

Any rhythm at a blood circulation stopAny rhythm at a blood circulation stop
BradycardiaBradycardia
Special circumstancesSpecial circumstances::
Anaphylactic shockAnaphylactic shock

DoseDose::
1 mg IV1 mg IV inin 10 1:10,000 (1 ml 1:1,000) every 2-310 1:10,000 (1 ml 1:1,000) every 2-3
minmin at resuscitationat resuscitation
2-3 mg2-3 mg throwthrow EEТТТТ
2–10 mkg min2–10 mkg min-1-1
atat bbradycardia resistant toradycardia resistant to
atropineatropine
0.50.5 ml 1:1,000 iml 1:1,000 i//m, 3-5 ml 1:10,000 im, 3-5 ml 1:10,000 i//vv
at anaphylactic shockat anaphylactic shock,, in din depending on weightepending on weight

ActionAction::
aa-agonist-agonist::
-- arterialarterial vasoconstrictionvasoconstriction
-- ОПССОПСС
-- a cerebral and coronary blood-groovea cerebral and coronary blood-groove
bb-agonist-agonist -- ↑↑ HCHC
-- ↑↑ forces offorces of heartheart reductionsreductions
-- requirements of a myocardium for oxygenrequirements of a myocardium for oxygen ((cancan
strengthen an ischemiastrengthen an ischemia))

AtropineAtropine
AsystoleAsystole
EMD (F of HCEMD (F of HC < 60 in min)< 60 in min)

AtropineAtropine
ActionAction ::
Blockade of effects of nervBlockade of effects of nervus vagusus vagus
SStrengtheningtrengthening of aof automatismutomatism of sinoatrialof sinoatrial
nodenode
Increase А-В of conductivityIncrease А-В of conductivity

AtropineAtropine
DoseDose ::
Asystole / EMD (F of HCAsystole / EMD (F of HC < 60 in min)< 60 in min)
– 3 mg3 mg ii//v, uv, unitarynitary
– 6 mg6 mg throwthrow EEТТТТ
– 0.50.5 mgmg ii//v, tv, to repeat at necessity, maximumo repeat at necessity, maximum 3 mg3 mg

IndicationsIndications ::
RefractoryRefractory VF / VTVF / VT without pulsewithout pulse
HemodynamicHemodynamic stablestable VTVT
Other resistantOther resistant tachyarrhythmiatachyarrhythmia

DoseDose ::
300 mg in 20 ml 5% dextrose, i300 mg in 20 ml 5% dextrose, i//vv
TachyarrhythmiaTachyarrhythmia
– 150 mg in 20 ml 5% dextrose150 mg in 20 ml 5% dextrose duringduring 10 min10 min
– RRepeatepeat 150 mg150 mg at necessityat necessity
– 300 mg300 mg inin 100 ml 5% dextrose100 ml 5% dextrose duringduring 1 hour1 hour

ActionAction::
Increases duration of potential of actionIncreases duration of potential of action
Extends intervalExtends interval Q-TQ-T
Weak negativeWeak negative inotropicinotropic actionaction -- can call acan call a
hypotensionhypotension

LidocaineLidocaine
– aat inaccessibilityt inaccessibility of amiodaroniof amiodaroni
– aas alternatives alternative for amiodaroni

LidocaineLidocaine
DoseDose ::
– 100 mg100 mg ii//vv
– afterafter boluses 50 mg, max 200 mgboluses 50 mg, max 200 mg
– 50 mg50 mg ii//v.v.
– afterafter boluses 50 mg, max 200 mgboluses 50 mg, max 200 mg
To lower a dose at elderly and at hepatic insufficiencyTo lower a dose at elderly and at hepatic insufficiency

Heavy metabolicHeavy metabolic acidosis (pH <7.1)acidosis (pH <7.1)
↑↑ K in bloodK in blood
Special circumstancesSpecial circumstances
PoisoningPoisoning byby energizersenergizers

DoseDose ::
50 mmol (50 ml 8.4% solution) i50 mmol (50 ml 8.4% solution) i//vv

ActionAction::
AlkalineAlkaline agentagent ((increaseincrease pH)pH)
ButBut can callcan call::
– Increase in loading СО2Increase in loading СО2
– Reduction of liberation О2 in fabricsReduction of liberation О2 in fabrics
– DecreaseDecrease contractility ofcontractility of myocardiummyocardium
– IncreaseIncrease Na in bloodNa in blood
Co-operates with adrenalineCo-operates with adrenaline

CalciumCalcium
ActionAction::
It is necessary for normal reduction of aIt is necessary for normal reduction of a
myocardiummyocardium
Surplus can callSurplus can call arrhythmiaarrhythmia
The trigger of destruction of cagesThe trigger of destruction of cages ischemicischemic
myocardiummyocardium
Surplus can break brain restorationSurplus can break brain restoration

CalciumCalcium
EMDEMD calling by :calling by :
– ↑↑ K in bloodK in blood
– ↓↓ Ca in bloodCa in blood
– OverdoseOverdose ofof calciumcalcium blockerblocker
DoseDose ::
10 ml 10% Ca Cl (6.8 mmoll)10 ml 10% Ca Cl (6.8 mmoll)
Not to enter at once before or after bicarbonateNot to enter at once before or after bicarbonate
sodiumsodium

NaloxoniNaloxoni
OverdoseOverdose of opiatesof opiates
Oppression of breath after appointmentOppression of breath after appointment ofof
opiatesopiates

NaloxoniNaloxoni
DoseDose ::
0.2 - 2.0 mg0.2 - 2.0 mg ii//vv
It can be demanded repeatedlyIt can be demanded repeatedly,, possible topossible to 1010
mgmg
Infusion can be demandedInfusion can be demanded

To
estimate
rhythm
+/- check up pulse
VF/VT
Defibrillation X 3
if necessary
СРR 1 min
Ventricle fibrillation
/ Ventricle tachycardia
without pulsewithout pulse

VF/VT
DischargeDischarge 200 J*
To makeTo make 33 dischargesdischarges if it isif it is
necessarynecessary,, in a currentin a current of 1of 1
minuteminute
Not to interruptNot to interrupt defibrillationdefibrillation
forfor BLSBLS
After theAfter the dischargedischarge, palpate, palpate
pulse on carotids, only if onpulse on carotids, only if on
an electrocardiogram aan electrocardiogram a
rhythm correspondingrhythm corresponding to jobto job
of heartof heart

During СРR
Correction of the reversible reasons
If it is not made:
To check up electrodes, an arrangement
and contact
To provide / to check up
- Passableness BP and O2
- Venous access
Adrenaline each 3 mines
To consider:
amidaroni, atropine / pacing buffers

Compression, respiratory waysCompression, respiratory ways
and ventilationand ventilation
Passableness of respiratory waysPassableness of respiratory ways::
– EndotrachealEndotracheal tubetube
– LMLM
– CombitubeCombitube
After maintenance of passablenessAfter maintenance of passableness ofof
BPBP do not interrupt a compression fordo not interrupt a compression for

Venous access and preparationsVenous access and preparations
FV/VTFV/VT
The central or peripheral veinThe central or peripheral vein
AdrenalineAdrenaline of 1of 1 mgmg ii//vv oror 2-32-3 mgmg endotrachealendotracheal
To considerTo consider amiodaroniamiodaroni 300300 mg ifmg if FV/VTFV/VT
presentpresent afterafter 33rd categoryrd category
AlternativelyAlternatively -- lidocainelidocaine of 100of 100 mgmg
To consider magnesiumTo consider magnesium 88 mmolmmol

FalseFalse asystoleasystole
When monitoring with paddle-gel padsWhen monitoring with paddle-gel pads
More likely with increasing number ofMore likely with increasing number of
shocks and high chest impedanceshocks and high chest impedance
Displays apparent “asystole”Displays apparent “asystole”
Confirm rhythm with monitoring leadsConfirm rhythm with monitoring leads

Cardio Pulmonary Resuscitation

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