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Cardiopulmonary Resuscitation- CPR.pptx
- 1. Cardiopulmonary Resuscitation (CPR) SamsonPeter Mvandal
- 3. Introduction • CPR isneeded for patient whose breathing or heart has stopped • Ventilations are given to oxygenate blood whe n breathing is inadequate or has stopped • If heart has stopped, chest compressions are g iven to circulate blood to vital organs • Ventilation combined with chest compressions is called cardiopulmonary resuscitation (CPR) • CPR is commonly given to patients in cardiac a rrest as a result of heart attack
- 4. CAUSES OF CARDIACARREST
- 5. Causes of cardiacarrest 2. Cardiac c auses 1. Extra cardiac cau ses All cases leading to the progressive decline of contractility, conductivity disorders, mechanical factors All cases accompanied with hy poxia
- 6. Causes of circulationarrest Cardiac • Ischemic heart disease (myocardial infarction) • Arrhythmias of differen t origin and character • Cardiac tamponade • Pulmonary artery thro mboembolism • Ruptured aneurysm of aorta Extracardiac/Non cardiac • airway obstruction • acute respiratory failure • shock • embolisms of different o rigin • drug overdose • poisoning 6
- 7. 7 INDICATIONS FOR CPR Symptomsof cardiac arrest 1. Absence of pulse on carotid arteries 2. Respiration arrest measurement Taking the pulse on peripheral art eries Auscultation of cardiac tones Taking BP Loss of time !!!
- 8. CPR cont… When Notto Perform CPR • Patient obviously dead • or clear signs of prolonged death, such as r igor mortis How long to resuscitate ? • CPR can be continued for 30 minutes if the time to onset of CPR is less than 6 minutes, but if there is a delay to onset of CPR longe r than 6 minutes, CPR should be terminate d after 15 minutes.
- 9. FACTS ABOUT CPR •75% of all cardiac arrests happen in peopl e's homes. • CPR doubles a person's chance of survival from sudden cardiac arrest. • There has never been a case of HIV trans mitted by mouth-to-mouth CPR. • Approximately 15% of patients are discha rged neurologically intact
- 10. Facts cont… • CPRprovides a flow of oxygenated blood to the brain and heart and keeps these organs alive until defibrillation can shock the heart i nto a normal rhythm. • If CPR is started within 4 minutes of collapse and defibrillation provided within 10 minute s, a person has a 40% chance of survival.
- 11. 11 Main stages ofresuscitation A (Airway) Look in oropharynx for swelling, secretions or other object causin g obstruction Noisy or abnormal breathing sounds Inability to speak or change in voice External evidence of trauma or compressive masses B (Breathing) Assess for the presence of breathing If present assess for adequacy Look for trachea deviation Decreased or absence of breath sounds NB.Current resuscitation guidelin e follow the sequence of CABDE not ABCDE
- 12. 12 A (Airway) ensure anopen airw ay
- 13. C (Circulation) Rapid assessmentand management of C problems is t he most important aspect for CPR Feel for a central pulse for no more than 10 seconds If present look for sign of circulatory compromise A pulse that is weak and either too fast or too slow Hypotension Evidency of poor peripheral perfusion Evidence of poor organ perfusion
- 14. Intervention on C Managementon C problems depends on whether cardiac arre st is present or not Patients in cardiac arrest needs CPR and rapid access to AED or defibrillator Patient with shock need rapid assessment and correction of th e underlying cause. The tool for circulation management includes Chest compression AED Defibrillator IV access for drugs and fluids Devices and Drugs aimed at the underlying cause
- 15. 15 Check the pulseon carotid artery using fingers of the other hand fo r 5-10 seconds If pulse is absent start CPR at once and get AED
- 16. 16 2 Mechanisms explainingthe restoration of ci rculation by external cardiac massage Cardiac pum p Thoracic pu mp
- 17. 17 Cardiac pump duringthe cardiac massag e Blood pumping is assure d by the compression of heart between sternum an d spine Between compressions th oracic cage is expanding a nd heart is filled with bloo d
- 18. 18 Thoracic pump atthe cardiac massage Blood circulation is restored d ue to the change in intra thora cic pressure During the chest compression blood is directed from the pul monary circulation to the syst emic circulation. Cardiac valv es function as in normal cardi ac cycle.
- 19. General technique ofCPR • Verify Scene safety • Shake victim’s shoulders and shout "are you okay?" • If unresponsive, not breathing, and no pulse • Place victim flat on his/her back on a hard surface. • Call for help • Start CPR
- 20. General technique cont… •Find the correct hand position (At the breast born) – Two hands for adults – One or 2 hands for child – Two fingers for infant
- 21. General technique cont… •Begin CPR cycle • 30:2 for adult • 15:2 for children Quality of CPR • Compress chest hard and fast at a rate of 100 compres sions/minute – Adult = 1 1/2 to 2 inches deep – Infant/child = 1/3 to 1/2 inches depth • Release completely between compressions
- 22. General technique cont… •If AED/defibrillator available • Check rhythm • If shock able rhythm administer 1 shock • Immediately return CPR for 2 minutes then reassess rhyt hm • If non -shockable rhythm • Immediately CPR for 2 minutes then reassess rhythm •
- 23. Placing pocket maskor BVM 1. Give 2 ventilations, each l asting 1 second 2. Determine victim has no p ulse
- 24. Put hand(s) incorrect position for chest comp ressions
- 25. Give 30 chestcompressions at rate of 100 per minute Then give 2 ventilations
- 26. Continue CPR until: •Patient begins to move • You are too exhausted to continue • If patient starts moving, check for adequate breathin g • If patient is breathing adequately, put patient in reco very position and monitor breathing CPR cont…
- 27. Chest Compressions Alert •Be careful with your h and position • Do not give compressi ons over bottom tip of breastbone
- 28. Chest Compressions Alert •When compressing, k eep elbows straight an d hands in contact wit h patient’s chest at all times
- 29. Chest Compressions Alert •Compress chest hard a nd fast, but let chest r ecoil completely betw een compressions. • Minimize amount of ti me used giving ventil ations between sets of compressions.
- 30. Problems with CPRTechnique • CPR often ineffective because of poor technique • Compressions not delivered steadily and constantly d uring resuscitation efforts • Often compressions are too shallow, resulting in ineff ective blood flow • Compressions may be given at too fast a rate • Only good-quality CPR improves chances of survival
- 31. Chest Compressions • Infantor child being given rescue breaths or oxygen may have a pulse but still inadequate perfusion • If pulse < 60 beats/minute and infant or child has sign s of poor perfusion, provide CPR
- 32. Two-Rescuer CPR forAdults and Children • Minimizes time betwee n rescue breaths and co mpressions – CPR becomes more effective • Reduces rescuer fatigue
- 33. Two-Rescuer CPR • Performedin cycles of 30:2 for adult (15:2 for infant or child) • One rescuer provides breaths, second rescuer gives ch est compressions • Rescuers switch positions every 2 minutes – Change done after full CPR cycle – Accomplish change in < 5 seconds
- 34. Two-Rescuer CPR continued •If defibrillation present, one rescuer gives CPR while the other sets up unit • If unit advises CPR, rescuers give CPR together • Third rescuer can apply cricoid pressure
- 35. Transitioning from One-RescuerCPR to Two- Rescuer CPR • Second rescuer moves into position on other side to pr epare to take over chest compressions • First rescuer completes a cycle of compressions and ve ntilations While first rescuer pauses to check for a pulse, second rescuer finds correct hand position for compressions
- 36. Transitioning from One-RescuerCPR to Two- Rescuer CPR • When first rescuer says, “No pulse, continue CPR,” se cond rescuer begins chest compressions and first rescu er then gives only ventilations
- 37. Skill For CPRin Adult or Child (Two Rescuers)
- 38. Rescuer 1 checksABCs. Rescuer 2 locates site for che st compressions.
- 39. If no pulse,rescuer 2 gives 30 chest compressions for adult (15 for child) at rate of 100/minute.
- 40. Rescuer 1 gives2 recue breaths.
- 41. Continue cycles of30:2 for adults (15:2 for chil d). After 5 cycles (~ 2 minutes) switch position s.
- 42. Adult or ChildTwo-Rescuer CPR Continued • Continue CPR until: – Patient moves – Advanced help arrives and takes over • If patient starts breathing and has pulse, put in recovery p osition and monitor ABCs • If AED brought to scene, start AED sequence
- 43. Two-Rescuer CPR: Infants •Uses different hand position • Place thumbs of both hands on sternum while fingers encircle chest • Compress breastbone with both thumbs while squeez ing chest with fingers • Same rate and depth as usual
- 44. Skills for CPRInfants (Two Rescuers)
- 45. Rescuer 1 checksABC s. Rescuer 2 locates sit e for chest compressio ns.
- 46. If no pulse,rescuer 2 giv es 15 chest compressio ns.
- 47. Rescuer 1 gives2 breaths.
- 48. Infant Two-Rescuer CPRContinued • Continue cycles of 15:2 for ~ 2 minutes then switch r oles • Continue CPR until: – Infant moves – Advanced help arrives and takes over • If infant starts breathing, hold in recovery position an d monitor ABCs
- 49. CPR 30:2 Attach defibrillator/Monitor Minimizeinterruption Assess rhythm Immediately resume CPR for 2 Min Minimize interruption s Non shockable PEA/Asystole Immediately resu me CPR for 2 Mi n Minimize Interr uption Immediate post cardiac arrest treatment Use ABCDE approach Controlled oxygenation and v entilation 12-Lead ECG Treat precipitating cause Call for Help Shockable (VF/Pulseless)/T Return of spontaneous c irculation 1 Shock Unresponsive patient
- 50. During CPR • Ensurehigh quality CPR rate, depth and recoil • Plan intervention before interrupting CPR • Give oxygen • Consider advanced airway and capnography • Continuous chest compressions when advanced air in place • Vascular access (IV,IO) • Give adrenaline every 3-5 min • Correct reversible causes
- 51. Reversible causes • Hypoxia •Hypovolaemia • Hypo/Hyperkalaemia • Hypothermia • Thrombosis-pulmonary or coronary • Tamponade-cardiac • Toxins • Tension PTX
- 52. Reasons to StopCPR • Patient revives. • You are so exhausted you can not continue.
- 53. Complications of Compressions •Fractured ribs • Fractured sternum • Lacerated lungs • Lacerated liver, blood vessels, etc.,,
- 54. 54 Drugs used inCPR Atropine • Can be injected bolus • Plays significant role in some cases of cardiac arrest • Increases heart rate Adrenaline • Large doses have been withdrawn from the algorithm. Th e recommended dose is 1 mg in each 3-5 min • Increases heart rate and blood pressure
- 55. Drugs cont… Lidocaine • Lowdoses as local anesthetics, high dose as anti-arrh ythmic
- 56.