Cardiopulmanary and cerebral resuscitation - PowerPoint PPT Presentation

Loading...

PPT – Cardiopulmanary and cerebral resuscitation PowerPoint presentation | free to download - id: 3c1ccf-M2ZiY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Cardiopulmanary and cerebral resuscitation

Description:

Cardiopulmanary and cerebral resuscitation Recunoasterea traseelor EKG DEFIBRILAREA trebuie aplicata cat mai rapid pt o recuperare neurologica cat m completa; este ... – PowerPoint PPT presentation

Number of Views:371
Avg rating:3.0/5.0
Slides: 82
Provided by: captainjo6
Learn more at: http://www.captainjoe.info
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Cardiopulmanary and cerebral resuscitation


1
Cardiopulmanary and cerebral resuscitation
2
Basic Life Support Advanced Life
Support Prolonged Life Support
AED
3
(No Transcript)
4
Survival Rate in Cardiopulmonary Arrest
  • 0 50
  • (64, 80?)

5
AED
An AED uses voice prompts to guide the rescuer.
It analyses the ECG rhythm and informs the
rescuer if a shock is needed. AEDs are extremely
accurate and will deliver a shock only when VF
(or its precursor, rapid ventricular tachycardia)
is present .
  • Safety use
  • Permissive legislation to use AED (Good
    Samaritan Law)
  • 1 DEA 10.000 inhabitants
  • (population crowds, airports, police cars, fire
    fighters, casinos, etc.)

6
Early BLS
  • Done by lays (from bystanders)
  • Until an emergency staff is available
  • Double the surviving

7
DEFIBRILARE PRECOCE
  • Fiecare 1 minut scade sansa de supravietuire cu 7
    - 10
  • Dupa 4 - 6 minute - leziuni neurologice
  • Dupa 10 minute - tentative de resuscitare
    nereusite
  • DEA ÎN 8-10 MINUTE!

8
SUPORTUL VITAL DE BAZASVB
DEFINITION
Basic life support (BLS) refers to maintaining
airway patency and supporting breathing and the
circulation, without the use of equipment other
than a protective device
  • Scopul SVB cardiac and cerebral oxygenation
  • Increase the defibrillation efficiency

9
Consequences - 3-5 min. gt irreversible
nerve cells lesions.
Optmal time (until) to start CPR 4 min.
Longer time - hypothermia (temp rectala 19-24
grade C) - barbiturics influence - child lt
1 year old Shorter time, 2-3 min. -
respiratory arrest before heart stops ?
barbiturics overdose ? strangle
10
all cases accompanied with hypoxia
extracardiac
Causes of cardiac arrest
cardiac
Primary lesion of cardiac muscle leading to the
progressive decline of contractility,
conductivity disorders, mechanical factors
11
Causes of circulation arrest
  • Cardiac
  • ischemic heart disease (myocardial infarction,
    stenocardia)
  • arrhythmias of different origin and character
  • valvular disease
  • cardiac tamponade
  • pulmonary artery thromboembolism
  • ruptured aneurysm of aorta
  • reflector cardiac arrest
  • Extracardiac
  • airway obstruction
  • acute respiratory failure
  • shock
  • electrolytic disorders
  • embolisms of different origin
  • drug overdose
  • electrocution
  • poisoning
  • metabolic acidosis

12
FIOZIOPATOLOGIE
Încetarea (ceasing) activit de pompa a
cordului - lipsa debitului cardiac
P.pf. miocardica si coronariana gt hipoxia
cel, metabolism anaerob, acumularea de toxice

lez tisulare ireversibile
  • vasodilatatie sitemica
  • vasoconstrictie pulm
  • rasp la catecolamine

Acidoza
P.pf. cerebrala PAM PIC (P sist) P.pf.
miocard PAM P miocard (P diast)
13
DIAGNOSTIC of SCR
  • Rapid
  • unconscious no respiration
  • no pulse
  • ECG asistole, FV, TV (activit electrica fara
    puls), PEA
  • Late clinical picture - cyanosis and pale
    teguments
  • - areactive midriasis

14
BLS - sequence of operations
  • Check responsiveness
  • Call for help
  • Correctly place the victim and ensure the open
    airway
  • Check the presence of spontaneous respiration
  • Check pulse
  • Start external cardiac massage and artificial
    ventilation

15
In case of unconsciousness it is necessary to
estimate quickly
  • the open airway
  • respiration
  • hemodynamics

16
Main stages of resuscitation
A (Airway) ensure open airway by preventing the
falling back of tongue, tracheal intubation if
possible B (Breathing) start artificial
ventilation of lungs C (Circulation) restore
the circulation by external cardiac massage D
(Differentiation, Drugs, Defibrilation) quickly
perform differential diagnosis of cardiac arrest,
use different medication and electric
defibrillation in case of ventricular fibrillation
17
Probleme teoretice
Ventilatia artificiala cu aer inspirat (16-18
O2) Teoria pompei cardiace - 30 din perfuzia
cerebrala optima limita critica a viabil. cel.
corticale - fluxul miocardic 20-30 din
valoarea normala - fluxul visceral abdominal
5
18
1 Make sure you, the victim and any bystanders
are safe. 2 Check the victim for a response
Adult basic life support algorithm. gently
shake his shoulders and ask loudly Are you all
right? If he responds leave him in the
position in which you find him provided there is
no further danger try to find out what is wrong
with him and get help if needed reassess him
regularly
19
If he does not respond shout for help turn
the victim onto his back and then open the airway
using head tilt and chin lift - place your
hand on his forehead and gently tilt his head
back keeping your thumb and index finger free to
close his nose if rescue breathing is required.
with your fingertips under the point of the
victims chin, lift the chin to open the airway
20
Keeping the airway open, look, listen and feel
for normal breathing Look for chest
movement. Listen at the victims mouth for
breath sounds. Feel for air on your cheek.
In the first few minutes after cardiac arrest,
a victim may be barely breathing, or taking
infrequent, noisy gasps. Do not confuse this with
normal breathing. Look, listen, and feel for no
more than 10 s to determine whether the victim is
breathing normally. If you have any doubt
whether breathing is normal, act as if it is not
normal.
21
If he is breathing normally turn him into the
recovery position send or go for help/call
for an ambulance check for continued breathing
22
(No Transcript)
23
If he is not breathing normally send someone
for help or, if you are on your own, leave the
victim and alert the ambulance service return
and start chest compression as follows . kneel
by the side of the victim . place the heel of one
hand in the centre of the victims chest. place
the heel of your other hand on top of the first
hand . interlock the fingers of your hands and
ensure that pressure is not applied over the
victims ribs. . position yourself vertically
above the victims chest and, with your arms
straight, .after each compression, release all
the pressure on the chest without losing contact
between your hands and the sternum repeat at a
rate of about 100/min. . . compression and
release should take equal amounts of time
24
Combine chest compression with rescue breaths.
After 30 compressions open the airway again using
head tilt and chin lift. Pinch the soft part
of the nose closed, using the index finger and
thumb of your hand on the forehead. Allow the
mouth to open, but maintain chin lift. Take a
normal breath and place your lips around his
mouth, making sure that you have a good seal.
Blow steadily into the mouth while watching for
the chest to rise, taking about 1 s as in normal
breathing this is an effective rescue breath.
Maintaining head tilt and chin lift, take your
mouth away from the victim and watch for the
chest to fall as air passes out.
25
Take another normal breath and blow into the
victims mouth once more, to achieve a total of
two effective rescue breaths. Then return your
hands without delay to the correct position on
the sternum and give a further 30 chest
compressi. Continue with chest compressions and
rescue breaths in a ratio of 302. Stop to
recheck the victim only if he starts breathing
normally otherwise do not interrupt
resuscitation. If your initial rescue breath
does not make the chest rise as in normal
breathing, then before your next attempt check
the victims mouth and remove any obstruction
recheck that there is adequate head tilt and chin
lift do not attempt more than two breaths each
time before returning to chest compr. If there
is more than one rescuer present, another should
take over CPR every 12 min to prevent fatigue.
Ensure the minimum of delay during the changeover
of rescuers
26
Stop to recheck the victim only if he starts
breathing normally otherwise do not interrupt
resuscitation. Continue resuscitation until
qualifed help arrives and takes over the
victim starts breathing normally you become
exhausted
27
  • Ventilation
  • During CPR the purpose of ventilation is to
    maintain adequate oxygenation. The optimal tidal
    volume, respiratory rate and inspired oxygen
    concentration
  • to achieve this, however, are not fully
    known. The current recommendations are based on
    the following evidence
  • During CPR, blood flow to the lungs is
    substantially reduced, so an adequate ventilation
    perfusion ratio can be maintained with lower
    tidal volumes and respiratory rates than normal.
  • 2. Not only is hyperventilation (too many
    breaths or too large a volume) unnecessary, but
    it is harmful because it increases intrathoracic
    pressure, thus decreasing venous return to the
    heart and diminishing cardiac output. Survival is
    consequently reduced.
  • 3. When the airway is unprotected, a tidal
    volume of 1 l produces significantly more gastric
    distention than a tidal volume of 500 ml.

28
4. Low minute-ventilation (lower than normal
tidal volume and respiratory rate) can maintain
effective oxygenation and ventilation during CPR.
During adult CPR, tidal volumes of approximately
500600 ml (67 ml kg-1) should be adequate. 5.
Interruptions in chest compression (for example
to give rescue breaths) have a detrimental effect
on survival. Giving rescue breaths over a shorter
time will help to reduce the duration of
essential interruptions. 6. The current
recommendation is, therefore, for rescuers to
give each rescue breath over about 1 s, with
enough volume to make the victims chest rise,
but to avoid rapid or forceful breaths. This
recommendation applies to all forms of
ventilation during CPR, including mouth-to-mouth
and bagvalve-mask (BVM) with and without
supplementary oxygen. 7. Mouth-to-nose
ventilation is an effective alternative to
mouth-to-mouth ventilation. It may be considered
if the victims mouth is seriously injured or
cannot be opened, the rescuer is assisting a
victim in the water, or a mouth-to-mouth seal is
difcult to achieve.
29
RESUSCITAREA
EFECTUATA DE UN SINGUR SALVATOR
RATA CTE RESPIRATII 152
EFECTUATA DE DOI SALVATORI
RATA CTE RESPIRATII 51
RECOMANDAREA ANULUI 2002
RATA CTE RESPIRATII 152 INDIFERENT DE
NUMARUL DE SALVATORI
RECOMANDAREA ANULUI 2006
RATA CTE RESPIRATII 302 INDIFERENT DE
NUMARUL DE SALVATORI
30
OBSTRUCTIA CRS PRIN CORP STRAIN
RECUNOASTERE
- TUSE
- FLUX AERIAN BUN
- PARTIALA
- EFORT RESPIRATOR
  • TUSE INEFICIENTA

- FLUX AERIAN PROST
  • INSPIR ZGOMOTOS

Noisy inspiration
  • CIANOZA

- COMPLETA
31
OBSTRUCTIA CU CORP STRAIN A CAILOR AERIENE
32
(No Transcript)
33
ÎNDEPARTAREA OBSTRUCTIEI
5 LOVITURI CU PODUL PALMEI LA NIVELUL SPATIULUI
INTERSCAPULOVERTEBRAL
5 COMPRESIUNI ABDOMINALE MANEVRA HEIMLICH
34
MANEVRA HEIMLICH
VICTIMA CONSTIENTA
VICTIMA INCONSTIENTA
35
(No Transcript)
36
CPR Advanced Life Support
37
SUPORTUL VITAL AVANSAT
  • Scop restore heart pomp activity by medication
    and defibrillation
  • - 8 min. since the heart stoped
  • maintaining BLS!!
  • IOT
  • venous acces
  • medication
  • DEFIBRILLATION !! as soon as possible

38
Recognize ECG waves
39
FIBRILATIA VENTRICULARA
activitatea anarhica a mai multor centri
ectopici raspanditi difuz in micoardul
ventricular acesti centri genereaza automatism
producand descarcari electrice zonale ce duc la
contractii parcelare, facand incapabila functia
de pompa FV primara apare pe un cord indemn
hipoxic ( frecvent la copii) FV secundara un
mecanism de alterare morfofunctionala a
miocardului
40
TAHICARDIA VENTRICULARA
expresia unor depolarizari succesive de origine
ventriculara (sub bifurcatia hisiana), de obicei
cauzata de boala cornoraniana ischemica TV
nesustinuta lt 30 sec. TV sustinuta gt 30 sec.
colaps hemodinamic In functie de morfologia
complexului ORS clasificarea TV se va face in TV
monomorfa si TV polimorfa
O forma particulara de TV este torsada varfurilor
generata de posdepolarizarea precoce in anumite
conditii QT lung (efect toxic a fenotiazidelor,
antidepresive triciclice, haloperidol,
antiaritmice), bradicardie severa, AVC-uri,
dezechilibre hidroelectrolitice, hipotermie, boli
cardiace
41
(No Transcript)
42
(No Transcript)
43
ASISTOLA
  • lipsa totala a activitatii electrice a
    cordului, cu un prognostic rezervat, rata de
    supravietuire 1-2
  • reprezentata de o linie sinusoidala (nu
    izoelectrica) compusa de mici unde date de
    depolarizarile de mica intensitate a musculaturii
    scheletice
  • trebuie diferentiata de FV cu unde mici

44
(No Transcript)
45
DISOCIATIA ELECTROMECANICA
entitate patologica particulara a SCR,
caracterizata prin asocierea dintr-e o activitate
electrica prezenta (alta decat FV/TV) si lipsa
activitatii mecanice a miocardului
ventricular. DEM cu complexe QRS largi cu
frecventa scazuta apar in IM masiv,
hipopotasemie severa, hipotermie, hipoxie
acidoza, supradoajul de antidepresive triciclice,
beta-blocante, blocante ale canalelor de calciu,
digitalice. DEM cu complexe inguste cu frecventa
crescuta (d.p.d.v. electric cordul raspunde
relativ normal) hipovolemie, tampodana cardiaca,
pneumotorace compresiv, TEP masiv.
46
(No Transcript)
47
Shockable rhythms (ventricular fibrillation/pulsel
ess ventricular tachycardia)
VF may be preceded by a period of VT or even
supraventriculr tachycardia (SVT)
VF/VT confirmed
one shock (150 200 J biphasic)
without reassessing the rhythm
resume CPR (CV ration 302) 2 min.
check monitor if there is still VF/VT
second shock (200 J biphasic)
resume CPR (CV ration 302) 2 min.
48
check monitor if there is still VF/VT
Adrenaline 1 mg
3rd shock (200 J biphasic)
resumption of CPR for 2 min.
analyze the rhythm if is still present VF/VT
i.v. bolus of Amiodarone 300 mg
4th shock
- adrenaline 1 mg every 3-5 min., once every
two loops of the algorithm
49
Non-shockable rhythms (PEA and asystole)
Asystole
  • PEA pulseless electrical activity is defined as
    cardiac activity in the absence of any palpable
    pulses
  • mechanical myocardial contractions, but these
    are too weak to produce pulse
  • caused by reversible conditions

CPR 302
Asystole/PEA
i.v. Adrenaline 1mg Atropine 3 mg
secure airway, IOT
Recheck the rhythm every 2 min
50
Airway and ventilation
- without a good oxygenation it may be impossible
to restore a spontaneous cardiac output.
- consider reversible causes (4 Hs and 4 Ts)
and, if identified, correct them.
Tracheal intubation provides the most reliable
healthcare provider but only for trained
staff. - do not hyperventilate, ventilate the
lungs at 10 breaths/min.
Alternatives - combitube - laryngeal mask
airway (LMA) - laryngeal tube
Deliver chest compressions, uninterrupted during
ventilation.
51
Suportul Vital Avansat Intubatia oro-traheala
52
(No Transcript)
53
(No Transcript)
54
(No Transcript)
55
(No Transcript)
56
(No Transcript)
57
(No Transcript)
58
(No Transcript)
59
(No Transcript)
60
(No Transcript)
61
PRESIUNEA CRICOIDIANA
PENTRU EVITAREA REGURGITARII CONTINUTULUI GASTRIC
62
(No Transcript)
63
(No Transcript)
64
(No Transcript)
65
(No Transcript)
66
(No Transcript)
67
(No Transcript)
68
(No Transcript)
69
Recunoasterea traseelor EKG
70
DEFIBRILAREA
  • trebuie aplicata cat mai rapid pt o recuperare
    neurologica cat m completa
  • este tratamentul propriu-zis al FV

aplicarea unui soc electric miocardului pt a
realiza depolarizarea fibrelor miocardice
simultan si pt a permite preluarea controlului de
catre struct naturale generatoare de impulsuri.
71
Mecanismul defibrilarii
  • depolarizarea unei mase de miocard prin
    traversarea curentului electric
  • marimea electrozilor 10-30 cm
  • plasarea corecta a padelelor, gel transconductor

150 - 200 J bifazic 360 J monofazic
Energia socului electric
72
CARDIOVERSIA SINCRONA
  • tratamentul - TV, TA (pacientul constient
    trebuie sedat)
  • socul sincronizat cu unda R a complexului QRS
  • 50 J, 100J, 200J, 300J, 360J

Securitatea manoperei
73
LOVITURA CU PUMNUL
poate -stimula activitatea electrica
in asistola - converti o TV (11-40)
- converti o FiV (2,5),
74
LOVITURA CU PUMNUL
Leziuni fizice directe -fracturi
sternale, -fracturi costale, -contuzii
miocardice -rupturi(?)de cord Accelerarea
frecventei unei TV Precipitarea FiV(risc mai
mare la bolnavii digitalizati).
75
TERAPIA MEDICAMENTOASA
76
ADRENALINA
amina simpaticomimetica
  • primul medicament utilizat în algoritmul SCR
  • actiune betaexcitatoare efect B, D, C, I ()
  • alfa adrenergic creste R.art.perif.
    ameliorarea PAM

Doze în SCR - 1 mg i.v repetabil la 3 min.
- 3 mg IOT diluat in 10-20 ml SF.
Ef. sec. artimogena când miocardul este
ischemic sau hipoxic
77
ATROPINA
Ind - asistola - DEM cu fclt60/min.
- bradicardii sinusale, atriale sau nodale hTA
  • antagonizeaza ef. parasimpatic al acetilcolinei
    la niv. rec. muscarinici
  • determina bloc ef vagale la niv nodului
    sinoatrial sau AV - creseterea automatismului
    sinusal facilitarea conducerii

Doze - 0,5 1 mg i.v., repetabila la 5 min.
in bradicardii - max 3 mg i.v. o
singura data in SCR - asistolie - IOT 9
mg/20 ml solutie de dilutie
78
AMIODARONA
  • scade automatismul nodului sinusal, alungeste
    timpul de conducere si perioada refractara a
    nodului AV si a miocardului V.
  • creste durata potentialului de actiune in
    miocardul atrial si ventricular.
  • eficace inotrop negativ si cronotrop negativ
    proprietati antianginoase
  • poate deveni paradoxal proartimogena.
  • INDICATII
  • FV/TV fara puls refractara la defibrilare (dupa
    3 socuri)
  • doza este de 300 mg diluata in 20 ml G 5 bolus
  • a doua doza este ½ din prima, poate fi urmata de
    perf continua 1 mg/min timp de 6 ore in anumite
    situatii (doza totala este 2 g)

79
LIDOCAINA
Ind - TV instabile hemodinamic - FV
refractara la defibrilare
Efecte - scade automatismul V. - ef anestezic
local suprima activitatea ectopica V - creste
pragul FV !!! Nu are efect pe artimiile
atriale - eficienta scade în hipo-K, hipo-Mg
Doza - initial 100 mg i.v sau 1 mg/kg (efect 10
min), repetabil - pfz 2-4 mg/min
80
CALCIU
Ind - disociatia electromecanica dat hiper-K,
hipo-Ca, supradozarea Ca-blocan
Doze - CaCl 10 - 2 ml/70kg - gluconat de Ca
10 - 3-8ml/70 kg - repeabile la interval de 10
min.
BICARBONATUL DE Na
Ind - acidoza metabolica severa, pH lt 7,1
- hiper-K (exces de baze 10mmol/l)
Doze mici de bicarbonat de Na 8,4, repetabile !!
Monitorizarea gazelor sanguine
81
SUPORTUL VITAL PRELUNGIT
Scop mentinerea activitatii cordului si a
respiratiei si refacerea integrala a
functiilor neuronale
  • recuperarea pacientului intr-o sectie ATI
  • supraveghere si monitorizare permanenta
  • Rx toracica !!

Protectie cerebrala - ameliorarea fluxului
sanguin cerebral - reducerea
metabolismului cerebral - prevenirea
autolizei postischemice
About PowerShow.com