CARDIO - PULMO - (CEREBRAL) RESUSCITATION - PowerPoint PPT Presentation

Loading...

PPT – CARDIO - PULMO - (CEREBRAL) RESUSCITATION PowerPoint presentation | free to download - id: 74792b-YTJlY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

CARDIO - PULMO - (CEREBRAL) RESUSCITATION

Description:

CARDIO - PULMO - (CEREBRAL) RESUSCITATION Jozef Firment Judita Capkov Department of Anaesthesiology & Intensive Medicine af rik University Faculty of Medicine ... – PowerPoint PPT presentation

Number of Views:59
Avg rating:3.0/5.0
Slides: 54
Provided by: MUD92
Learn more at: http://www.upjs.sk
Category:

less

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

Title: CARDIO - PULMO - (CEREBRAL) RESUSCITATION


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

2
  • Basic life support A,B,C - to buy time for
  • Advanced life support A,B,C,D,E to restore
    circulation

1961 Peter Safar
3
Most frequent causes of out-of-hospital cardiac
arrest CA
4
Most common causes of cardiac arrest CA
  • 1. place IHD...Myocardial infarction (80)

Ventricular fibrilation
5
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
5
6
Most common causes of cardiac arrest CA
  • 1. place IHD...Myocardial infarction (80)
  • Hypertension
  • Valvular disease,..
  • Trauma
  • Poisoning
  • Drowning
  • Hypotermia...

Ventricular fibrilation
7
Cause of CA in
  • Trauma
  • Drowning
  • Drug overdose Asphyxia
  • Children
  • Rescue breaths are critical for resuscitation

8
  • 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

9
THE CHAIN OF SURVIVAL
10
(No Transcript)
11
Open AirwayCervical spine injury
  • Jaw thrust (no for lay rescuer) or chin lift
    with manual inline stabilisation of head and
    neck by an assistant

12
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

13
EXTERNAL CHEST COMPRESSIONS
one rescuer 302
f 100-120/min.
14
The quality of cc is frequently suboptimal
Effective chest compressions
15
Continous chest compression - only
16
Only 1 in 4 patients in CA recieves bystander CPR
  • transmission of infection - tuberculosis,
    SARS, H1N1 small number, - HIV never
    reported

17
Protective devices
18
Continous chest compression - only
  • If layman is not able or is unwilling to perform
    mouth to mouth breathing
  • Chest compressions f 100/min without stopping

19
Basic life support C,A,B
  • Continue chest compressions and rescue
    breathing
  • - victim starts breathing normally (signs of
    life)- Medical emergency service arrives
  • - you become exhausted

20
  • Basic life support C,A,B
  • Advanced life supportC, A, B, Drugs, ECG,
    Fibrilation treatment - defibrilation...

21
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

22
VENTILATION MANAGEMENT ALS In-hospital CPR
  • A and B
  • Oral/nasal airway

23
VENTILATION MANAGEMENT ALS In-hospital CPR
  • A and B
  • 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)

24
Laryngeal mask, laryngeal tube Oe-Trach
Combitube
25
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
26
Advanced life support
Self-inflating bag-mask oropharyngeal airway
CCV 302
Hyperventilationreduces cerebral blood flow
27
  • The quality of chest compressions is frequently
    suboptimal
  • team leader shouldchange CPR providers every 2
    minutes (5x ccv 302)

28
Hearth rhytms associated with CA
29
(No Transcript)
30
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

31
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
    coronary perfusion pressure falls substantially
  • Signs of life return normal breathing,movement,
    coughing, puls

32
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

33
(No Transcript)
34
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

35
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

36
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(detected by
    biochemical tests, renal failure)
  • H ions (acidosis) - bicarbonate

37
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

38
Thoracocentesis
39
Needle pericardiocentesis
Cardiac tamponade- difficult to diagnose-
penetrating chest trauma is suggestive
40
Thrombosis pulmonary and coronary
  • thrombolysis
  • percutaneous coronary intervention -PCI

41
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
42
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 !!!

43
EZ-IO AD Proximal Tibial Access
Intraosseous Infusion System
44
Automatický intraoseálny injektor
45
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

46
  • www.erc.edu
  • www.resus.org. uk
  • Resuscitation (in october 2010)
  • http//www.lf.upjs.sk/kaim/pregradualne_vzdelavani
    e.html

46
47
Thank you!
jcapkova_at_capko.sk
48
Open chest CPR
  • better coronary perfusion
  • Trauma, after cardiothoracic surgery, when chest
    or abdomen is already open

49
PROTOCOL FOR CPCR INTERPRETATION Utstein
in-hospital
  • TIME
  • disaster call
  • start CPCR
  • emerg. team arrival
  • onset of circulation
  • living out
  • provided activities...

50
HODNOTENIE VÝSLEDKOVKPCR
  • Kritériom krátkodobého výsledku KPCR je obnovenie
    krvného obehu
  • Kritériom dlhodobého výsledku KPCR je návrat
    neurologických a psychických schopností pacienta

51
Ectopic rhythm
Normal SR
1
2
5
Rhythm disorders at AMI
3
Thrombus development
Acute MI
4
52
LIFE-THREATENING CARDIAC RHYTHM DISTURBANCES
  • 1. Ventricular fibrillation,pulseless
    ventricular tachycardia
  • 2. Cardiac arrest (asystole)
  • 3. Pulseless electrical activity (PEA, EMD)
  • circulatoty arrest

53
European resuscitation counscil
  • Európske guidelines týkajúce sa resuscitácie boli
    publikované Európskou radou pre resuscitáciu
    (ERC) v International Journal Resuscitation
    v novembri 2010.
  • www. erc.edu, www.resus.org.uk
About PowerShow.com