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CARDIO - PULMO - (CEREBRAL) RESUSCITATION

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Title: Causes of stopped circulation Author: MUDr. Jozef Firment Last modified by: Spravca Created Date: 2/8/1998 3:59:06 PM Document presentation format – PowerPoint PPT presentation

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Title: CARDIO - PULMO - (CEREBRAL) RESUSCITATION


1
CARDIO - PULMO - (CEREBRAL) RESUSCITATION
  • Jozef Firment
  • Judita Capková
  • Department ofAnaesthesiology Intensive
    MedicineŠafárik University Faculty of Medicine,
    Košice

2
Most frequent causes of out-of-hospital cardiac
arrest CA
3
Most common causes of cardiac arrest CA
  • 1. place IHD...Myocardial infarction (80)
  • Hypertension
  • Valvular disease,..
  • Trauma
  • Poisoning
  • Drowning
  • Hypotermia...

Ventricular fibrilation
4
Most common causes of cardiac arrest CA
  • 1. place IHD...Myocardial infarction
  • Hypertension
  • Valvular disease,..
  • Trauma
  • Poisoning
  • Drowning
  • Hypotermia...

Electrical defibrillation only effective
treatment for VF
Ventricular fibrilation
4
5
Cause of CA in
  • Trauma
  • Drowning
  • Drug overdose Asphyxia
  • Children
  • Rescue breaths are critical for resuscitation

6
  • In- hospital arrests are due tu PEA or asystole
    (60-70)
  • - early recognition of pp at risk may prevent
    arrest Medical Emergency Teams
  • Overall survival to hospital discharge is 10

7
THE CHAIN OF SURVIVAL
8
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9
Cervical spine injury
  • Jaw thrust (no for lay rescuer) or chin lift
    with manual inline stabilisation of head and
    neck by an assistant

10
AGONAL BREATHING
  • Occurs shortly after the heart stops
  • in up to 40 of cardiac arrests
  • Described as barely, heavy, noisy or gasping
    breathing
  • Recognise as a sign of cardiac arrest

11
EXTERNAL CHEST COMPRESSIONS
one rescuer 302
f 100-120/min.
12
Effective chest compressions
13
Effective chest compressions
14
Continous chest compression - only
15
Only 1 in 4 patients in CA recieves bystander CPR
  • transmission of infection - tuberculosis,
    SARS, H1N1 small number, - HIV never
    reported

16
Protective devices
17
Continous chest compression - only
  • If layman is not able or is unwilling to perform
    mouth to mouth breathing
  • f 100/min without stopping

18
  • Basic life support C,A,B
  • Advanced life supportC, A, B, Drugs, ECG,
    Fibrilation treatment - defibrilation...

19
In hospital CPR- Advanced life support
  • One person starts 302others call resuscitation
    team defibrillator, r. equipments (airway,
    ambu bag, adrenalin,..)
  • only one person leaves the patient, calls
    resuscitation team starts 302

20
VENTILATION MANAGEMENT ALS In-hospital CPR
  • A
  • Oral/nasal airway
  • Tracheal intubation f 10/min , Fi02 1,0
    (reservoir bag), VT(tidal volume) 6-7 ml/kg,
    (chest compressions and ventilations continue
    uninterupted)

21
Laryngeal mask, laryngeal tube Oe-Trach
Combitube
22
BAG WITH OXYGEN SUPPLY
O2 FiO2 VT x f l/min adults
13 85-100 1000 x 15 - - 4 gt40
dtto children 5 85-100 300 x 20 - -
2 gt40 dtto
Campbell
B
23
Advanced life support
Self-inflating bag-mask oropharyngeal airway
CV 302
Hyperventilationreduces cerebral bloodflowThe
quality of chest compressions isfrequently
suboptimal, team leader shouldchange CPR
providers
24
Hearth rhytms associated with CA
25
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26
DEFIBRILLATION
  • Paddle positions (sternum, apex), no over the
    breast tissue
  • Self- adhesive pads (sparks!!)-the best
  • Biphasic defibrilators1. 150-200J2.
    150-360J,....
  • CPR for 2 min (5 x 302)after shock

27
DEFIBRILLATION
  • Check the rhythm(organised QRS
    complexesregular narrow- feeling for a
    pulse)
  • After the third shock giveadrenalin 1mg every
    3-5 min. ivamiodaron 300mg iv
  • Time between CC and shock delivery lt 5s
  • Signs of life return normal breathing,movement,
    coughing, puls

28
A precordial thump
  • Generates a small electrical shock
  • In witnessed and monitored VF/VT arrests if a
    defibrillator is not immediately available
  • The ulnar edge of fist the lower half of
    sternum from a height of 20 cm
  • Converting VT to sinus rhytm

29
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30
LIFE-THREATENING CARDIAC RHYTHM DISTURBANCES
  • Cardiac arrest (asystole)Fine VF will not be
    shocked successfully
  • Pulseless electrical activity (PEA, EMD)-
    myocardial contractions are too weak to produce
    pulse or blood pressure

31
POTENTIALLY REVERSIBLE CAUSES (5 Hs 5 Ts)
  • Hypoxia
  • Hypovolemia
  • Hypothermia
  • Hyper/hypoKand metabolic disorders
  • H ions (acidosis)
  • Tension pneumothorax
  • Tamponade
  • Toxic/therap. disturbances
  • Thrombosis coronary
  • Thrombosis pulmonary

32
POTENTIALLY REVERSIBLE CAUSES (5 Hs 5 Ts)
  • Hypoxia ventilation with 100 oxygen
  • Hypovolemia (haemorrhage-trauma, GIT
    bleeding,rupture of an aortic aneurysm- fluid (
    saline or Hartmans solution urgent surgery)
  • Hypothermia (in drowning incident)
  • Hyper/hypoKand metabolic disorders
  • H ions (acidosis)

33
POTENTIALLY REVERSIBLE CAUSES (5 Hs 5 Ts)
  • Tension pneumothorax- needle thoracocentesis and
    chest drain
  • Tamponade needle pericardiocentesis
  • Toxic substances appropriate antidotes
  • Thrombosis coronary - thrombolysis
  • Thrombosis pulmonary trombolytic drug

34
Thoracocentesis
35
Needle pericardiocentesis
36
Thrombosis pulmonary
37
DRUGS USED CPR
  • 1. Adrenaline (EPINEPHRINE)
  • 1 mg á 3- 5 (EVERY SECOND LOOP(5x CV 302) OF
    THE ALGORYTHM)
  • alpha adrenergic actions cause vasoconstriction,
    increases myocardial and cerebral perfusion
    pressure
  • 2. Bicarbonate 50ml 8,4
  • -pH lt 7.1, BE lt -10-hyperkalaemia-tricyclic
    antidepressant overdose
  • equipment
  • (defibrilator)
  • oxygen
  • Ambu bag
  • face mask
  • F1/1
  • infusion set
  • plastic IV cannula

3. Amiodarone 300 mg after a third unsuccessful
defibrillation in VF/VT...150 mg (inf.
900mg/24h)lidocaine 1 mg/kg- alternative
38
DRUG DELIVERY ROUTES
  • Intravenous (central, peripheral 20 ml sol. F
    1/1 elevate 10-20 s)
  • Intraosseal effective concentrations of drugs
    is achieved very quickly
  • Tracheal (2-3x more dose 10 ml water)
    (adrenaline, lidocaine, atropine)
  • NEVER IM nor SC !!!

39
EZ-IO AD Proximal Tibial Access
Intraosseous Infusion System
40
Automatický intraoseálny injektor
41
Post resuscitation care
  • Stable cardiac rhythm, normal haemodynamic
    function (thrombolysis, percutaneous coronary
    intervention)
  • Intubation, ventilation, sedation
  • Therapeutical hypothermia
  • Comatose adults after out-of-hospital VF cardiac
    arrest were cooled to 32-34 oC for 12-24 h.
  • Improved neurological outcome

42
  • www.erc.edu
  • www.resus.org. uk
  • Resuscitation (in october 2010)
  • http//www.lf.upjs.sk/kaim/pregradualne_vzdelavani
    e.html

42
43
Thank you!
jcapkova_at_capko.sk
44
Open chest CPR
  • better coronary perfusion
  • Trauma, after cardiothoracic surgery, when chest
    or abdomen is already open

45
Ectopic rhythm
Normal SR
1
2
5
Rhythm disorders at AMI
3
Thrombus development
Acute MI
4
46
LIFE-THREATENING CARDIAC RHYTHM DISTURBANCES
  • 1. Ventricular fibrillation,pulseless
    ventricular tachycardia
  • 2. Cardiac arrest (asystole)
  • 3. Pulseless electrical activity (PEA, EMD)
  • circulatoty arrest

47
  • Basic life support - to buy time for
  • Advanced life support to restore circulation

1961 Peter Safar
48
Effective chest compressions
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