cardio pulmo (cerebral resuscitation · thoracocenthesis and chest drainage
TRANSCRIPT
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CARDIO -
PULMO -
(CEREBRAL)
RESUSCITATION
Jozef Firment
Judita Capková Department of
Anaesthesiology & Intensive Care Medicine
Šafárik University Faculty of Medicine, Košice
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• Európske guidelines týkajúce sa resuscitácie boli publikované Európskou radou pre resuscitáciu (ERC) v International Journal Resuscitation v novembri 2005.
• www. erc.edu, www.resus.org.uk
European resuscitation counscil
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• www.erc.edu
• www.resus.org. uk
• Resuscitation (in october 2010)
• http://lf.upjs.sk/kaim/
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Most common causes of
cardiac arrest
• 1. place
IHD...Myocardial
infarction,
• Trauma
• Poisoning
• Drowning
• Hypotermia... Venticular fibrilation
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CARDIOPULMONARY
RESUSCITATION (CPR)
Basic life support
Advanced life support
CPR 1961: Peter Safar (1924 – 2003)
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THE CHAIN OF SURVIVAL
Early
access
to
emergency
services
Early
BLS
to
buy
time
Early
defibrillation
to reverse
VF
Early
advanced
care
to
stabilise
up to 4 min up to 8 min
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BASIC LIFE SUPPORT (BLS)
Airway
Breathing
Circulation (CAB)
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Shake shoulders gently
Ask “Are you all right?”
If he responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.
CHECK RESPONSE
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CHECK RESPONSE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
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SHOUT FOR HELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
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OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
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AIRWAY OPENING BY
NECK EXTENSION
Cam
pbell
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Cervical spine injury
• Jaw thrust for open airway (not for lay rescuer)
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CHECK BREATHING
• Look, listen and feel
for NORMAL
breathing
• Do not confuse
agonal breathing with
NORMAL breathing
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Recovery position 1
2
3
4
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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!
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Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
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Basic life support
• Unresponsiveness
• Apnoea, gasping
Call 112
Start chest compressions
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• Place the heel of one hand in
the centre of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
– Rate 100 min-1
– Depth 5-6 cm
– Equal compression : relaxation
ratio
• When possible change CPR
operator every 2 min
CHEST COMPRESSIONS
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EXTERNAL
CHEST
COMPRESSIONS
one rescuer
30:2
5 cm
f : 100/min.
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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
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Continous chest compression - only
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Continous chest compression - only
• If layman is not able or is unwilling to
perform mouth to mouth breathing
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VENTILATION
MANAGEMENT
During CPR oxygenation is paramount
CO2 elimination is on the second place
Ventilation: mouth-to-mouth, -to-nose, -to-
mouth-and-nose, -to-mask, -to-sheet.
30 : 2 , 500-600 ml, 6-7 ml/kg bw
FiO2=0,21, FETO20,16
hyperventilation – no!
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CARDIOPULMONARY
RESUSCITATION (CPR)
Basic life support
Advanced life support C, A, B, Drugs, ECG, ...
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In hospital CPR -
Advanced life support
One person starts 30 : 2
others call resuscitation team
+ defibrillator, r. equipments (airway, breathing bag,
adrenalin,..)
only one person: leave the patient,
call r. team (RRT)
30 : 2
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• Oral/nasal airway
• Tracheal intubation: f: 10/min , FiO2 = 1,0 (reservoir bag), VT 6-7 ml/kg
• Laryngeal mask
• Oe-Trach Combitube
• Surgical airway
– coniotomy
• Ventilation:
Self-inflating bag-mask
– Ventilator
– Transtracheal jet
ventilation
VENTILATION MANAGEMENT ALS – In-hospital CPR – A, B
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Campbell O2 FiO2 VT x f
l/min %
adults: 13 85-100 1000 x 15
- “ - 4 >40 dtto
children 5 85-100 300 x 20
- “ - 2 >40 dtto
Inlet O2 10 - 13 l/min
BAG WITH OXYGEN
SUPPLY
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Advanced life support Self-inflating bag-mask + airway
Hyperventilation
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Ventricular fibrillation Ventricular tachycardia
Asystole Electro-mechanical
disociation (EMD)
Pulseless ventricular
activity (PVA)
LIFE-THREATENING CARDIAC
RHYTHM DISTURBANCES
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DEFIBRILLATION
• Paddle positions (sternum, apex)
• Self- adhesive pads (sparks!!)
• Biphasic defibrilators:
1. 150-200J
2. 150-360J,....
• CPR for 2 min (5 x 30:2)
after shock
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DEFIBRILLATION
• Check the rhythm (organised QRS complexes: regular + narrow)
• After the third shock give: adrenalin 1 mg every 3-5 min. iv amiodaron 300 mg iv
• Time between CC and shock delivery < 5 s
• Signs of life return : normal breathing, movement, coughing
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McCormick Chicago
Arlanda Stockholm
Munchen
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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
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POTENTIALLY
REVERSIBLE CAUSES (5 H’s & 5 T’s):
• Hypoxia
• Hypovolemia
• Hypothermia
• Hyper/hypoK+and
metabolic disorders
• H+ ions (acidosis)
• Tension pneumothorax
• Tamponade
• Toxic/therap. disturbances
• Thrombosis coronary
• Thrombosis pulmonary
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POTENTIALLY REVERSIBLE
CAUSES – rescue acticities (5 H’s & 5 T’s):
• Hypoxia – ventilation with 100% oxygen
• Hypovolemia (haemorrhage-trauma, GIT bleeding, rupture of an aortic aneurysm - fluid (saline or Hartman´s solution + urgent surgery)
• Hypothermia (in drowning incident)
• Hyper/hypoK+ and metabolic disorders
• H+ ions (acidosis)
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POTENTIALLY REVERSIBLE
CAUSES – rescue acticities cont
(5 H’s & 5 T’s):
• Tension pneumothorax- needle thoracocenthesis and chest drainage
• Tamponade – needle pericardiocentesis
• Toxic substances – appropriate antidotes
• Thrombosis coronary - thrombolysis
• Thrombosis pulmonary – trombolytic drugs
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DRUGS USED CPR 1. Adrenaline
1 mg á 3’- 5 ’
2. Bicarbonate 50 ml 8,4% or 100 ml 4,2%
-pH < 7.1, BE < -10
-hyperkalaemia -tricyclic antidepressant overdose
& equipment • (defibrilator)
• oxygen
• Ambu bag
• face mask
• F1/1
• infusion set
• plastic IV cannula
3. Amiodarone 300 mg ...150 mg (inf. 900 mg/24h)
lidocaine 1 mg/kg
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DRUG DELIVERY ROUTES
• Intravenous (central, peripheral
+ 20 ml sol. F 1/1 + arm elevation 10 s)
• Intraosseal
• Tracheal (2-3 x more dose + 10 ml F1/1)
(adrenaline, lidocaine, atropine)
• NEVER IM nor SC !!!
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EZ-IO AD Proximal Tibial Access
Intraosseous Infusion System
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Automatic intraosseal injector
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Post – resuscitation care
Therapeutic hypothermia
• Comatose adults after out-of-hospital
VF cardiac arrest must be cooled to
32-34 oC for 12-24 h.
• Improved neurological outcomes
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PROTOCOL FOR CPR
INTERPRETATION „Utstein in-hospital“
TIME ~ disaster call
~ start CPR
~ emerg. team arrival
~ onset of circulation
~ living out
+ provided activities...
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RESULTS EVALUATION
• Criterion of temporary result of CPR is
ROSC
• Criterion of long term result of CPR is
return of neurological a psychical
competencies