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Cardio-pulmonary Cerebral Resuscitation

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DR SUJATA PROFESSOR DEPT.OF ANAESTHESIOLOGY &CRITICAL CARE UCMS & GTB HOSPITAL CPBR/ CPCR CPR Cardiopulmonary brain resuscitation -CPBR Cardiopulmonary cerebral ... – PowerPoint PPT presentation

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Title: Cardio-pulmonary Cerebral Resuscitation


1
CARDIOPULMONARY RESUSCITATION
DR SUJATA PROFESSOR DEPT.OF ANAESTHESIOLOGY
CRITICAL CARE UCMS GTB HOSPITAL
2
CPBR/ CPCR
  • CPR
  • Cardiopulmonary brain resuscitation -CPBR
  • Cardiopulmonary cerebral resuscitation-CPCR

3
Goal
  • Support restore effective oxygenation,
  • ventilation and circulation with return of
    intact
  • neurological function.
  • Intermediate Goal
  • Return of spontaneous circulation (ROSC)

4
Approach
  • BLS ( Basic Life Support) Primary survey.
  • ACLS (Advanced Cardiovascular Life Support)
    Secondary survey

5
Cardiopulmonary Resuscitation
ACLS
PROLONGED LIFE SUPPORT
BLS
A - Airway B - Breathing C - Circulation D-
Defibrillation
6
  • Does BLS work?
  • BLS- maximum attention of public
  • .MMajority(70-80) of cardiac arrests
  • Out-of-Hospital
  • .Pre-hospital care key factor
  • ajority(70-80) of cardiac arrests
  • Out-of-Hospital
  • .Pre-hospital care key factor

7
Adult Chain of Survival
8
CHAIN OF SURVIVAL
Early Defibrillation
Early ACLS
Early access
Early CPR
1.Recognition of Early warning signs 2.Activation
of Emergency Medical Services 3.Basic
CPR 4.Defibrillation
9
Before BLS Primary Survey
  • Scene safety
  • Check responsiveness
  • Activate EMS and get AED
  • Assess Perform appropriate action.
  • Performance of the action improves chances of
    survival and better neurological outcome

10
Before BLS Primary Survey
11
BLS Primary survey
  • Support/ restore effective oxygenation,
    ventilation and circulation until ROSC or ACLS
    team takes over.
  • No advanced interventions- airway tech./ drugs
    (use universal precautions)
  • Early CPR and early defibrillation

12
BLS Primary Survey.components
13
Basic airway skills
  • Head tilt- chin lift
  • Jaw thrust without head extension (? Cx spine
    trauma)
  • Mouth- to- mouth ventilation
  • Mouth- to- nose ventilation
  • Mouth- to- barrier device (pocket mask)
  • Bag-mask ventilation

14
A
C
B
AIRWAY
BREATHING
CIRCULATION
DEFIBRILLATION
D
15
  • Airway
  • Head tilt, Chin lift, Jaw thrust
  • AVOID HEAD TILT IF TRAUMA
  • Keeping airway open- LOOK, LISTEN, FEEL
  • LOOK LISTEN FEEL
  • CHEST MOVEMENTS BREATH SOUNDS
    AIR FLOW
  • RESP. RATE VOICE QUALITY
    CHEST MOVEMENTS
  • CYANOSIS ABNORMAL SOUNDS
    TRACHEAL POSITION
  • TRAUMA
  • FLUID/BLOOD /VOMITING
  • NOT MORE THAN 10 SECONDS

16
BREATHING ABSENT
BREATHING PRESENT
  • 2 EFFECTIVE RESCUE BREATHS
  • SLOW BREATHS
  • TIDAL VOL. 8-10 ml/kg
  • Deliver in one sec.
  • Rate- 10-12/min.
  • Chest rise/ expand

RECOVERY POSITION AND TRANSPORT
17
Assessing the victim
  • 1-- Make sure the victim, any bystanders, and you
    are safe.
  • 2-- Check the victim for a response.
  • Shake shoulders gently
  • Ask Are you all right
  • If he responds
  • Leave as you find him.
  • Find out what is wrong.
  • Reassess regularly
  • If he does not respond
  • Activate Code Blue and get AED
  • 4 --Keeping the airway open, look, listen, and
    feel for normal breathing.
  • OPEN AIRWAY
  • Look, listen and feel for NORMAL breathing
  • Do not confuse agonal breathing with NORMAL
    breathing

18
Keeping the airway open, look, listen, and feel
for normal breathing. OPEN AIRWAY
19
Look, listen and feel for NORMAL breathing
20
If he is breathing normally Turn him into the
recovery position Send or go for help, or call
for an ambulance. Check for continued breathing.
21
If he is not breathing normally
  • Give 2 rescue breaths
  • Pinch the nose
  • Take a normal breath
  • Place lips over mouth
  • Blow until the chest rises
  • Take about 1 second
  • Allow chest to fall
  • Repeat

22
Chest Compressions
  • Patient positioning
  • Firm and hard surface (ground, table/ hard bed)
    deflate air/ water mattresses.
  • Rescuer's position
  • Level with patient, elbows vertically straight
    and locked, shoulders directly above the hands,
    heel of one palm over the other.
  • Site sternum in inter-mammary line.
  • Depth 11/2- 2 inches.
  • Rate100 per minute (5 cycles of 302-CV over 2
    min.).
  • Allow complete chest recoil.

23
CHEST COMPRESSIONS30 CHEST COMPRESSIONS
24
Hands off- time
  • Less than 10 sec.
  • Specific interventions defibrillation, advanced
    airway, moving the patient.
  • Avoid
  • Prolonged rhythm analysis
  • Frequent pulse checks
  • Too long breaths
  • Unnecessary moving the pt.

25
CHECK FOR SIGNS OF CIRCULATION
PULSE PRESENT
PULSE ABSENT / NOT DETECTED
CONTINUE VENTILATION TILL SPONTANEOUS RESPIRATION





  • PULSE CHECK
  • NOT RECOMMENDED FOR LAY RESCUERS
  • POOR SENSITIVITY-55
  • POOR SPECIFICITY-90
  • ACCURACY RATE -65
  • CHEST COMPRESSIONS
  • Rate 100/MIN., SITE- Sternal depression -1.5
    in.-2 in.
  • Universal compression-ventilation ratio (302) -
    Recommended for all
  • single rescuers of infant, child and adult
    victims (excluding newborns)
  • Two Rescuers 302- ALL ADULTS,
  • 152 Infants and
    child
  • PURPOSE PUSH HARD,PUSH FAST

26
Defibrillation
  • AED Follow the prompts.
  • Manual defibrillator Analyse rhythm, shockable-
    decide shock (Monophasic 360 J, Biphasic 120-200
    J ), apply gel, charge, clear the patient, no
    inflammables (incl. oxygen), deliver shock..
    Resume CPR immediately.

27
AED

28
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29
Positioning of electrodes for automated external
defibrillator

30
DEFIBRILLATION
ATTACH PADS TO VICTIMS BARE CHEST
31
Ventricular Fibrillation
32
Continuous electrocardiogram showing successful
treatment of ventricular fibrillation by a
countershock (given at the arrow)
33
ANALYSING RHYTHM DO NOT TOUCH VICTIMSHOCK
INDICATEDStand clearSpeak Aloud- I
Clear......You Clear.......All Clear!Deliver
shockIF VICTIM STARTS TO BREATHE NORMALLY PLACE
IN RECOVERY POSITION
34
ACLS Secondary survey
  • Advanced, invasive assessment and management
    techniques required.
  • Basic airway adjuncts
  • OPA, NPA
  • Advanced Airway interventions
  • Combitube, LMA, Endotracheal intubation.
  • Advanced circulatory interventions
  • Drugs to control heart rhythm and blood pressure.

35
ACLS Secondary Survey components
36
AIRWAY EQUIPMENTS
TECHNIQUES- Mouth-Mouth, Mouth-Nose VENTILATORY
DEVICES Masks, Bag-Valve Devices Airway
Adjuncts 1.Oropharygeal Airway 2.Nasopharyngeal
Airway 3.Esophageal Tracheal Combitube 4.Laryngea
l Mask Airway 5.Transtracheal catheter
ventilation 6.Cuffed oropharyngeal airway
ADJUNCT of CHOICE TRACHEAL TUBE
PURPOSE MAINTAIN AIRWAYAND OXYGENATE
37
ACLS Secondary Survey.components
38
Common Reversible Causes
39
  • PROBLEMS AND COMPLICATIONS OF CHEST COMPRESSIONS
  • RIB FRACTURES
  • FRACTURE STERNUM
  • RIB SEPARATION
  • PNEUMOTHORAX
  • HEMOTHORAX
  • LUNG CONTUSIONS
  • LIVER LACERATIONS
  • FAT EMBOLI
  • HIV, HEPATITIS
  • INFECTIONS

MANAGE ACCORDINGLY BUT CONTINUE CPR
40
  • EFFECTIVE CHEST COMPRESSION WITH MINIMAL HANDS
    OFF
  • IS
  • KEY
  • FOR
  • EFFECTIVE CPR

41
When to stop BLS
  • ROSC, Conscious pt.
  • ACLS team takes over
  • Rescuer tired

42
SUMMARY
43
DRUGS
  • EPINEPHRINE
  • Peripheral vasoconstriction- ?
    -adrenergic
  • Increase in Central aortic perfusion pressure
  • Decrease Threshold for Defibrillation
  • Fine VF to Coarse VF

44
DRUGS
  • For Rhythm
  • Amiodarone
  • Lidocaine
  • Atropine
  • Magnesium
  • For Blood Pressure
  • Epinephrine
  • Vasopressin
  • DOPAMINE-2-4 micro/kg/min.-DA rec
  • 4-10 micro/kg/min-
    Beta-rec.
  • 10-20 micro/kg/min-
    Alpha rec.

45
DEFIBRILLATOR
ECG
WHITE-RIGHT SIDE RED- RIBS-LEFT
MID-AXILLARY LEFT-OVER-LEFT SHOULDER
46
The dying heart
IDENTIFY THE RHYTHM
47

RHYTHMS
1.VENTRICULAR FIBRILLATION 2.
RAPID VENTRICULAR TACHYCARDIA 3.
PULSELESS ELECRICAL ACTIVITY 4. ASYSTOLE

48
2
Asystole
OR
Pulseless Electrical Activity
49
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53
UCMS GTBH,DELHI
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