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See all Premium member Presentation Transcript CARDIOPULMONARY RESUSCITATION : CARDIOPULMONARY RESUSCITATION Dr.Narendranath Jena Consultant A&E OVERVIEW : OVERVIEW INTRODUCTION PATHOPHYSIOLOGY CPR (AIRWAY, BREATHING, CIRCULATION AND DEFIBRILLATION) BLS ALGORITHM POST RESUSCITATION CARE TIME CONSIDERATIONS TERMINATION OF EFFORTS SUMMARY INTRODUCTION : INTRODUCTION Sudden Cardiac Arrest (SCA) is the leading cause of death worldwide One of the defining characteristics of ED staff is their ability to recognize and manage the patient in cardiac or respiratory arrest ED staff must be experts in understanding the pathophysiology of cardiopulmonary arrest and principles behind the resuscitation of these patients PATHOPHYSIOLOGY : PATHOPHYSIOLOGY Cardiac arrest results in cessation of blood circulation throughout the body. Anaerobic metabolism begins almost immediately A cascade of metabolic events is created including calcium release, generation of free radicals and activation of catabolic enzymes that further injures body cells PATHOPHYSIOLOGY : PATHOPHYSIOLOGY The brain is most susceptible to the absence of circulation and traditionally suffers irreversible damage after 5 minutes, in an arrest state Restoration of pre arrest neurologic function rarely occurs with untreated cardiac arrest of longer than 10 minutes duration PATHOPHYSIOLOGY : PATHOPHYSIOLOGY The heart is second most susceptible organ to the absence of circulation CPR- Even the best quality chest compressions, can generate only 30% of baseline cardiac output PATHOPHYSIOLOGY : PATHOPHYSIOLOGY The resuscitation period , therefore, still contributes to “GLOBAL ISCHEMIA” The Goal of CPR is to preferentially direct blood flow to the Heart and the Brain, in order to adequately restore organized myocardial electrical activity while minimizing ischemic brain injury CARDIAC COMPRESSION THEORY : CARDIAC COMPRESSION THEORY The heart is squeezed between the sternum and thoracic spine, creating a pressure gradient between the ventricles and great vessels CPR : CPR Health care providers need a systematic approach to resuscitation The simplest and familiar approach follows the concept of the PRIMARY AND SECONDARY SURVEY, and utilize the ABCDs (Airway, Breathing, Circulation and Defibrillation) as a reminder PRIMARY SURVEY : PRIMARY SURVEY Assess responsiveness of the patient. If unresponsive Activate code blue team Call for defibrillator Airway: Open the airway Breathing: Provide positive-pressure ventilation Circulation: Give chest compressions AIRWAY : AIRWAY Look for the signs of Airway Obstruction Open the airway by Head Tilt and Chin Lift (for patients without C-spine injuries) and by Jaw Thrust (for patients with suspected C-spine injury) Remove any foreign body from the mouth if visible HEAD TILT AND CHIN LIFT : HEAD TILT AND CHIN LIFT JAW THRUST : JAW THRUST BREATHING : BREATHING Assess breathing by looking, listening and feeling for no more than 10 seconds If the patient is not breathing, give 2 Rescue breaths at 1 second per breath Look for adequate chest rise as an indicator of effective ventilation LOOK, LISTEN, FEEL : LOOK, LISTEN, FEEL E-C Technique : E-C Technique BREATHING : BREATHING If no chest rise, reposition the airway, check for the foreign body obstruction of the airway and if present remove by using Magill forceps OR Give abdominal thrusts for adults and children and Back slaps and chest thrusts for infants BREATHING : BREATHING RATE OF VENTILATION should be 10-12 per minute for adults and 12-20 per minute for infants and children (Rescue breathing without chest compressions) and it should be 8-10 per minute for all (CPR with advanced airway) CIRCULATION : CIRCULATION Check Carotid pulse in adults and children and Brachial or Femoral pulse in infants, for no more than 10 seconds If no definite pulse is felt, start compressions at the rate of 100 compressions per minute Central pulse (Carotid) : Central pulse (Carotid) COMPRESSIONS : COMPRESSIONS Quality: PUSH HARD, PUSH FAST, ALLOW COMPLETE RECOIL AND MINIMIZE INTERRUPTIONS Site: Lower half of the sternum between nipples for adult and child; Just below nipple line for infants Depth: 1 ½ to 2 inches for adults; 1/3 to ½ of the depth of the chest for infants and children SITE FOR COMPRESSION : SITE FOR COMPRESSION COMPRESSION VENTILATION RATIO : COMPRESSION VENTILATION RATIO For Adults its 30:2 (1 or 2 rescuers) For Children and Infants 30:2 (1 rescuer) and 15:2 (2 rescuers) One set of compressions and ventilations form one cycle Five cycles of compression and ventillation over 2 minutes BLS ALGORITHM : BLS ALGORITHM BLS ALGORITHM : BLS ALGORITHM Call code blue team , get defibrillator BLS ALGORITHM : BLS ALGORITHM BLS ALGORITHM : BLS ALGORITHM POST RESUSCITATION CARE : POST RESUSCITATION CARE Provide cardiorespiratory support to optimize tissue perfusion, especially to the brain Transport the patient to an appropriate intensive or critical care unit (ICU or CCU) Continue efforts to identify the precipitating causes of the arrest Institute measures to prevent recurrence Induce hypothermia (up to 35 deg. C) TIME CONSIDERATIONS : TIME CONSIDERATIONS For every minute without CPR, survival from witnessed SCA decreases 7% to 10% BLS must begin within 4 minutes and ACLS within 8 minutes of arrest CPR plus defibrillation within 3-5 minutes of collapse can produce survival rates as high as 49% to 75% Hands off time during a CPR should never exceed 10 seconds except for doing some procedures like ET Intubation or Defibrillation TERMINATION OF EFFORTS : TERMINATION OF EFFORTS Prolonged resuscitation efforts are unlikely to be successful if there is no return of spontaneous circulation at any time during 30 minutes of cumulative ACLS Reversible causes of cardiac arrest such as drug overdose, electrolyte abnormalities, or profound hypothermia should be taken into account when considering termination of efforts When all BLS or ACLS measures have been reasonably attempted and the likelihood of survival is minimal, resuscitation efforts should be discontinued Reversible causes of cardiac arrest : Reversible causes of cardiac arrest Hypothermia Hypoxia Hypokalemia Hyperkalemia H+ ion (Acidosis) Hypovolemia Hypoglycemia Tamponade Tension pneumothorax Thrombosis Myocardial infarction Pulmonary embolism Tablets / Toxins CHAIN OF SURVIVAL : CHAIN OF SURVIVAL SUMMARY : SUMMARY CPBR is not a single skill but a series of assessments and interventions There is no substitute to a HIGH QUALITY Compressions in a patient with cardiopulmonary arrest Different maneuvers in CPR are dependant on the age of the victim and number of rescuers Guidelines can be modified depending on the patient’s needs and the clinical judgment of the physician Slide 35: THANK YOU Thank you You do not have the permission to view this presentation. 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