cardio-pulmonary and cerebral resuscitation lecture 1

Cardio-Pulmonary and Cardio-Pulmonary and Cerebral ResuscitationCerebral Resuscitation

Lecture 1Lecture 1Department of Anesthesiology and Department of Anesthesiology and

Intensive CareIntensive CareThe The head of a departmenthead of a department: I.Titov, DrPh.: I.Titov, DrPh.

The theme of lecture N 1The theme of lecture N 1

1.1. Cardiopulmonary resuscitation. Cardiopulmonary resuscitation. Symptoms of clinical deathSymptoms of clinical death. Safar’s triple . Safar’s triple manoeuvre. Breathing.manoeuvre. Breathing.

2.2. Cardiopulmonary resuscitation. Chest Cardiopulmonary resuscitation. Chest compression. Complications of the CPR.compression. Complications of the CPR.

Part II. Cardiopulmonary Part II. Cardiopulmonary resuscitationresuscitation

LifeLife

For normal functioning all cells of the body For normal functioning all cells of the body require oxygen. If oxygen is not provided, require oxygen. If oxygen is not provided, death of organism appears within death of organism appears within 4..5 4..5 minutesminutes. .

BrainBrain is the tissue most susceptible to is the tissue most susceptible to anoxia (absence of oxygen). anoxia (absence of oxygen).


Process of the deathProcess of the death

Is not a momentary but stepwise process, which can take certain Is not a momentary but stepwise process, which can take certain

time. time.

FiveFive steps of the death: steps of the death:

– Preagony Preagony

– Terminal pauseTerminal pause

– AgonyAgony

– Clinical death Clinical death (reversible injury)(reversible injury)

– Biological deathBiological death (irreversible injury)(irreversible injury)


Agony Agony isis a staa stagege which preced which precedee to the death. to the death.

Function of vital organs is severFunction of vital organs is severee disturbed, and disturbed, and

conditions required for survival of organism conditions required for survival of organism

cannot be met. cannot be met.

UnconsciousnessUnconsciousness

Blood pressure is undetectableBlood pressure is undetectable

No pulse on arteriesNo pulse on arteries

Clinical death: Clinical death: circulation stops completely and that circulation stops completely and that

leads to the cessation of breathing and nervous leads to the cessation of breathing and nervous

system activity.system activity.


Symptoms of clinical deathSymptoms of clinical death

No pulse on arteriesNo pulse on arteries (carotid or (carotid or femoral)femoral)Change of skin colour Change of skin colour UnconsciousnessUnconsciousnessGasping, cessation of breathingGasping, cessation of breathingDilatation of eye pupils Dilatation of eye pupils

Duration of clinical death is 3(5) minutesDuration of clinical death is 3(5) minutes


Biological death Biological death is irreversible condition. Metabolism is irreversible condition. Metabolism

and functioning of vital organs has completely and functioning of vital organs has completely

ceasedceased. Organ damage is as extensive that . Organ damage is as extensive that

resuscitation of the body is impossible.resuscitation of the body is impossible.

Evident symptoms of the death:Evident symptoms of the death:

Rigor mortisRigor mortis

Death spots on the bodyDeath spots on the body

Drop of body temperature to the level of the Drop of body temperature to the level of the surrounding surrounding


Adult BLS sequenceAdult BLS sequenceBasic life support consists of the following actions:Basic life support consists of the following actions:1. Make sure that the victim, any bystanders, and you 1. Make sure that the victim, any bystanders, and you

are safe.are safe.2. Check the victim for a response (gently shake his 2. Check the victim for a response (gently shake his

shoulders and ask loudly, “Sir. Or Ms., are you all shoulders and ask loudly, “Sir. Or Ms., are you all right?”)right?”)

3 A. If he responds:3 A. If he responds: Leave him in the position in which you find him Leave him in the position in which you find him

provided there is no further danger.provided there is no further danger. Try to find out what is wrong with him and get help if Try to find out what is wrong with him and get help if

needed.needed. Reassess him regularly.Reassess him regularly.


Adult BLS sequenceAdult BLS sequence3 B. If he does not respond:3 B. If he does not respond:Shout for help, call 911 (USA and Canada) Shout for help, call 911 (USA and Canada)

or 03 (Ukraine and Russian Fed)or 03 (Ukraine and Russian Fed)Turn the victim onto his back and then Turn the victim onto his back and then

open the airway using head tilt and chin lift:open the airway using head tilt and chin lift: - place your hand on his forehead and - place your hand on his forehead and

gently tilt head back.gently tilt head back.- with your fingertips under the point of the - with your fingertips under the point of the victim’s chin, lift the chin to open the victim’s chin, lift the chin to open the airway.airway.


Adult BLS sequenceAdult BLS sequence

4. Keep the airway open, look, listen, and 4. Keep the airway open, look, listen, and feel for normal breathing.feel for normal breathing.

Look for chest movementLook for chest movement Listen at the victim’s mouth for breath Listen at the victim’s mouth for breath

sounds.sounds. Feel for air on your cheekFeel for air on your cheek

Look, listen and feelLook, listen and feel for for no moreno more than than 10 10 secsec to determine if the victim breathing to determine if the victim breathing normally. normally.

Shake and Shout

Opening the airwayOpening the airway

Head tiltHead tilt

Chin liftChin lift

If cervical spine If cervical spine injury suspected:injury suspected:– jaw thrustjaw thrust

Assess BreathingAssess Breathing

Look for chest Look for chest movementmovement

Listen for breath Listen for breath soundssounds

Feel for expired airFeel for expired air

Assess for 10 Assess for 10 seconds before seconds before deciding breathing is deciding breathing is absentabsent

Rescue breathingRescue breathing(Expired air ventilation)(Expired air ventilation)

If he is not breathing normally:If he is not breathing normally:

Ask someone to call for an Ask someone to call for an ambulance.ambulance.

Kneel by the side of the victim.Kneel by the side of the victim. Pinch the soft part of the victim’s Pinch the soft part of the victim’s

nose, using the index finger and nose, using the index finger and thumb of your hand on his thumb of your hand on his forehead.forehead.

Allows his mouth to open, but Allows his mouth to open, but maintain chin tilt.maintain chin tilt.

Take a normal breath and place Take a normal breath and place your lips around his mouth, your lips around his mouth, making sure that you have a making sure that you have a good seal. good seal.


Blow into his mouth and look on his chest, chest Blow into his mouth and look on his chest, chest must rise; take about one second to make his must rise; take about one second to make his chest rise as in normal breathing; this is an chest rise as in normal breathing; this is an effective rescue breath.effective rescue breath.

Maintaining head tilt and chin lift, take your mouth Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest.away from the victim and watch for his chest.

Take another normal breath and blow into the Take another normal breath and blow into the victim’s mouth once more to give a total of two victim’s mouth once more to give a total of two effective rescue breaths. effective rescue breaths.

Give each rescue breath over 1 sec rather than 2 Give each rescue breath over 1 sec rather than 2 sec.sec.

Assess CirculationAssess CirculationCheck the victim’s pulse.Check the victim’s pulse.

A. If pulse on the carotid artery is not palpable – A. If pulse on the carotid artery is not palpable – begin chest compression.begin chest compression.

Place the heel of one hand in the centre of the Place the heel of one hand in the centre of the victim’s chest.victim’s chest.

Place the heel of your other hand on the top of the Place the heel of your other hand on the top of the first hand.first hand.

Interlock the fingers of your hands and ensure that Interlock the fingers of your hands and ensure that pressure is not applied over the victim’s ribs. Do pressure is not applied over the victim’s ribs. Do not apply any pressure over the upper abdomen not apply any pressure over the upper abdomen or the bottom end of the bony sternum or the bottom end of the bony sternum (breastbone).(breastbone).


– 3030 compressions compressions : 2 breaths for: 2 breaths for

1-person 1-person CPRCPR

2-person 2-person CPRCPR


Chest Chest compressions:compressions:

Depress sternum Depress sternum 4-5 cm4-5 cm

Rate: 100 per Rate: 100 per minuteminute

PRECORDIALPRECORDIAL BLOWBLOW

IndicationsIndications::

Confirmed Confirmed of of blood circulation blood circulation stopstop

Continue resuscitation until:Continue resuscitation until:

Qualified help arrives and takes Qualified help arrives and takes overover

The victim shows signs of lifeThe victim shows signs of life

You become exhaustedYou become exhausted

Airway management and Airway management and ventilationventilation

Basic airway management and Basic airway management and ventilationventilation

The laryngeal mask airway and The laryngeal mask airway and CombitubeCombitube

Advanced techniques of airway Advanced techniques of airway managementmanagement

Basic mechanical ventilationBasic mechanical ventilation

Safar’s triple Safar’s triple manoeuvremanoeuvre

Open mouthOpen mouth

Head Tilt and Head Tilt and Chin LiftChin Lift

Jaw ThrustJaw Thrust

SUCTIONSUCTION

Ventilation by mouth through a Ventilation by mouth through a maskmask

AdvantagesAdvantages::

Allows to avoid direct contact Allows to avoid direct contact

Reduces probability Reduces probability of of infectedinfected

Allows to raiseAllows to raise O2O2

RestrictionsRestrictions::

Tightness maintenanceTightness maintenance

Stomach inflatingStomach inflating

Bag-valve-maskBag-valve-mask

Ventilation by means of bag АVentilation by means of bag Аmbumbu

AdvantagesAdvantages

Direct contact allows to Direct contact allows to avoidavoid

Allows to increase Allows to increase concentration О2concentration О2 - - toto 85 % 85 %

Can be used with an Can be used with an obverse mask, obverse mask, LLММ, , Combitube, Combitube, endotrachealendotracheal tubetube

RestrictionsRestrictions At use with an obverse At use with an obverse maskmask::Risk of inadequate Risk of inadequate ventilationventilationRisk of inflating of a Risk of inflating of a stomachstomach 4 hands are necessary 4 hands are necessary for optimum usefor optimum use

Installation Installation LLММ

LaryngealLaryngeal mask mask

AdvantagesAdvantagesSpeed and simplicity of Speed and simplicity of installationinstallation

Presence of the different Presence of the different sizessizes

More effective ventilation in More effective ventilation in comparison with an comparison with an obverse maskobverse mask

Allows to avoid Allows to avoid laryngoscopylaryngoscopy

RestrictionsRestrictionsDoes not protect from Does not protect from aspirationaspirationDoes not approach in Does not approach in situations when high situations when high pressure use on a breath pressure use on a breath is requiredis requiredIt is impossible It is impossible to to aspirate fromaspirate from bottom bottom BPBP

Choice of an air line of the suitableChoice of an air line of the suitable

sizesize

Simple adaptations for maintenance Simple adaptations for maintenance of BPof BP

Installation Installation of pharyngo-oralof pharyngo-oral an air an air lineline

Installation Installation of pharyngonasalof pharyngonasal an air line an air line

CombitubeCombitube AdvantagesAdvantages

Speed and simplicity of Speed and simplicity of installationinstallation

Allows to avoid Allows to avoid laryngoscopylaryngoscopy

It is possible to use, It is possible to use, when pressure upon a when pressure upon a breath the highbreath the high

RestrictionsRestrictionsIt is accessible only 2 sizesIt is accessible only 2 sizes

There is a risk of ventilation There is a risk of ventilation through a gastric gleamthrough a gastric gleam

Damage of cuffs at installationDamage of cuffs at installation

Trauma in an installation timeTrauma in an installation time

Only for disposable useOnly for disposable use

Ventilation by means of Ventilation by means of CombitubeCombitube

Intubation ofIntubation of ttracheasracheas Attempt Attempt of intubationof intubation::

Preoxygenation ofPreoxygenation of the patient the patient30 30 seconds on each attemptseconds on each attemptSpend a tube through a vocal crack under the Spend a tube through a vocal crack under the control of direct sightcontrol of direct sightAt any doubts or complexitiesAt any doubts or complexities, , reoxygenationreoxygenation the the patient before the subsequent attemptspatient before the subsequent attemptsPatients are harmed by unsuccessful attempts Patients are harmed by unsuccessful attempts of oxygenation, instead of of oxygenation, instead of intubationintubation!!

Installation Installation of endotracheal of endotracheal tubetube

Intubation of tracheaIntubation of trachea

AdvantagesAdvantages

Allows to increase Allows to increase PO2PO2 to to 100 %100 %

Isolates Isolates BPBP, preventing , preventing of aspirationof aspiration

Allows Allows aspirated of BPaspirated of BP

Alternative way for Alternative way for introductionintroduction of medicine of medicine

RestrictionsRestrictionsTraining and Training and experience are experience are absolutely necessaryabsolutely necessaryUnfortunate attempt, Unfortunate attempt, esophageal intubationesophageal intubationRisk of deterioration of Risk of deterioration of damage back and a damage back and a brain during brain during laryngoscopelaryngoscope

Confirmation of correct position Confirmation of correct position of ETTof ETT in a trachea in a trachea

Direct visualisation during Direct visualisation during laryngoscopelaryngoscopeAuscultationAuscultation::– With two sidesWith two sides,, on average on average axillary'saxillary's lines lines– Over Over epigastriumepigastrium

Symmetric movements Symmetric movements of thoraxof thorax during during ventilationventilation

Pressure on Pressure on cricoidcricoid cartilage on purpose cartilage on purpose of of occlusionocclusion a gullet about a gullet about cervical department of a cervical department of a backbonebackbone

Sellick”s manoeuvreSellick”s manoeuvre

Sellick”s manoeuvreSellick”s manoeuvre

AdvantagesAdvantagesDDecrease ecrease of rof risk isk of of aspirationaspiration and and regurgitationregurgitation

It can be applied at It can be applied at intubationintubation,, and also and also ventilation by means of ventilation by means of an obverse mask and an obverse mask and LMLM

LacksLacks

Can complicate Can complicate intubationintubation

Can complicate Can complicate ventilation by means ventilation by means of an obverse mask of an obverse mask or or LMLM

Avoid at active Avoid at active vomitingvomiting

CricothireotomyCricothireotomy

IndicationsIndicationsImpossibility of maintenanceImpossibility of maintenance passableness passableness oof f BPBP in in another wayanother way

ComplicationsComplicationsDisplacement Displacement of cannulaof cannula– EmphysemaEmphysema– BleedingBleeding– Gullet punchingGullet punching

HypoventilationHypoventilation

DEFIBRILLATIONDEFIBRILLATION

Rhythm of a stop of blood Rhythm of a stop of blood circulationcirculation

Fibrillation Fibrillation of ventriclesof ventricles

Ventricle'sVentricle's tachycardia «without pulse» tachycardia «without pulse»

AsystoleAsystole

Electro-mechanical Electro-mechanical dissociationdissociation ( (EMDEMD))

AsystoleAsystole

There is no activity There is no activity of ventricles of ventricles ((complex complex QRS)QRS)

Activity of auricles Activity of auricles (wave(wave P) P) can becan be

Seldom straight lineSeldom straight line

Possibility Possibility of sof small wavemall waves ofs of VFVF

The mechanism The mechanism of of DEFIBRILLATIONDEFIBRILLATION

DefinitionDefinition– ““The termination of fibrillation or absence The termination of fibrillation or absence

VF/VT VF/VT in in 5 5 seconds after the seconds after the discharge”discharge”

DepolarizedDepolarized all weight of a myocardium all weight of a myocardium

Natural Natural pacemekerpacemeker renew job renew job

Automatic external Automatic external DEFIBRILLATORDEFIBRILLATOR

Analyze a Analyze a heart heart rhythmrhythmMake the Make the dischargedischargeSpecificity in Specificity in recognition of the recognition of the rhythm rhythm in in subject which subject which is is defibrillationdefibrillation comes comes nearer to nearer to 100 %100 %

Automatic external Automatic external DEFIBRILLATORDEFIBRILLATOR

Attach sticky electrodesAttach sticky electrodesFollow the sound and Follow the sound and visual instructionvisual instructionThe automatic analysis of The automatic analysis of an electrocardiograman electrocardiogram - - do do not touch the patientnot touch the patient The automatic The automatic dischargedischarge at a corresponding at a corresponding rhythmrhythm+/-+/-a manual overloada manual overload

Manual Manual DEFIBRILLATIONDEFIBRILLATION

It is based onIt is based on::

The rhythm is recognised The rhythm is recognised by the operatorby the operator

The operator puts the The operator puts the dischargedischarge

It can be used for It can be used for synchronised synchronised cardioversioncardioversion

Safety Safety of defibrillation of defibrillation

Never hold both electrodes in one handNever hold both electrodes in one hand

Charge only when electrodes on a breast Charge only when electrodes on a breast of the victimof the victim

Avoid direct or indirect contactAvoid direct or indirect contact

Wipe dry a breast of the patientWipe dry a breast of the patient

Remove oxygen from a zone Remove oxygen from a zone of of defibrillation defibrillation

Manual Manual DEFIBRILLATION (1)DEFIBRILLATION (1)Diagnostics Diagnostics VFVF//VTVT andand signs of a stop of blood signs of a stop of blood circulationcirculationChoice of suitable energy of Choice of suitable energy of the the dischargedischargeTo load condensers To load condensers (electrodes on the patient)(electrodes on the patient)The commandThe command “ “all to departall to depart””Visual check of a zone Visual check of a zone of of defibrillationdefibrillationTo check up the monitorTo check up the monitorThe The dischargedischarge

Manual Manual DEFIBRILLATION (2)DEFIBRILLATION (2)

Repeatedly to estimate a rhythmRepeatedly to estimate a rhythmTo hold electrodes on a breast between To hold electrodes on a breast between dischargesdischargesTo increase energyTo increase energy– The assistant makesThe assistant makes, , oror– To place an electrode on To place an electrode on defibrillatordefibrillator and to and to

choose energy level independentlychoose energy level independently

Not to spendNot to spend BLS BLS between between dischargedischarges if s if there is no long delaythere is no long delay

The conclusionThe conclusion

DefibrillationDefibrillation it is unique effective at it is unique effective at restoration of circulation at patients with restoration of circulation at patients with VFVF or or VTVT without pulse without pulseDefibrillationDefibrillation should it is spent quickly, should it is spent quickly, effectively and safelyeffectively and safelyNew technologies increase possibilities of New technologies increase possibilities of equipment and simplify useequipment and simplify use

Introduction of medicines inIntroduction of medicines in

ttime ime of of СРСРRR

The central venous accessThe central venous access

Internal jugular veinInternal jugular vein

SubclavianSubclavian veinvein

Complications Complications of catheterizationof catheterization the central veinsthe central veins

Artery punctureArtery punctureHematomaHematomaHemothoraxHemothoraxPneumothoraxPneumothoraxAir Air embolismembolismDamage of surrounding fabricsDamage of surrounding fabricsААrrhythmiasrrhythmias

IntatrachealIntatracheal introductinintroductin of medicines of medicines

Preparations whichPreparations which cancan it is entered into it is entered into a tracheaa trachea::

AdrenalineAdrenaline

LidocaineLidocaine

AtropineAtropine

NaloxoniNaloxoni

Preparations whichPreparations which cannotcannot be entered into be entered into a trachea:a trachea:

AmiodaroniAmiodaroni

Sodium bicarbonateSodium bicarbonate

CalciumCalcium



Any rhythm at a blood circulation stopAny rhythm at a blood circulation stop

BradycardiaBradycardia

Special circumstancesSpecial circumstances::

Anaphylactic shockAnaphylactic shock

AdrenalineAdrenalineDoseDose::

1 mg I\V1 mg I\V inin 10 1:10,000 (1 ml 1:1,000) every 2-3 10 1:10,000 (1 ml 1:1,000) every 2-3 minmin at resuscitationat resuscitation2-3 mg2-3 mg throwthrow EEТТТТ

2–10 mkg min2–10 mkg min-1-1 at at bbradycardia resistant to radycardia resistant to atropineatropine0.50.5 ml 1:1,000 iml 1:1,000 i//m, 3-5 ml 1:10,000 im, 3-5 ml 1:10,000 i//vvat anaphylactic shockat anaphylactic shock, , in din depending on weightepending on weight


ActionAction::

aa-agonist-agonist:: - - arterial arterial vasoconstriction vasoconstriction ОПССОПСС a cerebral and coronary blood-groovea cerebral and coronary blood-groove

bb-agonist-agonist ↑↑ HC HC ↑↑ forces of forces of heartheart reductions reductions requirements of a myocardium for oxygen requirements of a myocardium for oxygen ((can can strengthen an ischemiastrengthen an ischemia))

AtropineAtropine


AsystoleAsystoleBradycardia Bradycardia EMD (F of HCEMD (F of HC < 60 in min)< 60 in min)

AtropineAtropine

ActionAction ::Blockade of effects of nervBlockade of effects of nervus vagusus vagusSStrengthening trengthening of aof automatism utomatism of sinoatrial of sinoatrial nodenodeIncrease А-В of conductivityIncrease А-В of conductivity

AtropineAtropine

DoseDose ::

Asystole / EMD (F of HCAsystole / EMD (F of HC < 60 in min)< 60 in min)– 3 mg3 mg ii//v, uv, unitarynitary– 6 mg6 mg throwthrow EEТТТТ

BradycardiaBradycardia– 0.50.5 mgmg ii//v, tv, to repeat at necessity, maximum o repeat at necessity, maximum 3 mg 3 mg


IndicationsIndications ::

RefractoryRefractory VF / VTVF / VT without pulse without pulseHemodynamicHemodynamic stable stable VTVTOther resistant Other resistant tachyarrhythmiatachyarrhythmia

AmiodaroniAmiodaroniDoseDose ::

RefractoryRefractory VF / VTVF / VT without pulse without pulse

300 mg in 20 ml 5% dextrose, i300 mg in 20 ml 5% dextrose, i//vv

TachyarrhythmiaTachyarrhythmia

– 150 mg in 20 ml 5% dextrose150 mg in 20 ml 5% dextrose duringduring 10 min10 min– RRepeatepeat 150 mg 150 mg at necessity at necessity– 300 mg300 mg inin 100 ml 5% dextrose100 ml 5% dextrose duringduring 1 hour1 hour


ActionAction::

Increases duration of potential of actionIncreases duration of potential of action

Extends intervalExtends interval Q-T Q-T

Weak negative Weak negative inotropicinotropic action action - - can call a can call a hypotensionhypotension

LidocaineLidocaine


RefractoryRefractory VF / VTVF / VT without pulse without pulse– aat inaccessibilityt inaccessibility of amiodaroni of amiodaroni

HemodynamicHemodynamic stable stable VTVT– aas alternative s alternative for amiodaroni

LidocaineLidocaine

DoseDose ::

RefractoryRefractory VF / VTVF / VT without pulse without pulse– 100 mg100 mg ii//vv– afterafter boluses 50 mg, max 200 mgboluses 50 mg, max 200 mg

HemodynamicHemodynamic stable stable VTVT– 50 mg50 mg ii//v.v.– afterafter boluses 50 mg, max 200 mgboluses 50 mg, max 200 mg

To lower a dose at elderly and at hepatic insufficiencyTo lower a dose at elderly and at hepatic insufficiency



Heavy metabolic Heavy metabolic acidosis (pH <7.1)acidosis (pH <7.1)↑↑ K in bloodK in bloodSpecial circumstancesSpecial circumstancesPoisoning Poisoning by by energizersenergizers


DoseDose ::

50 mmol (50 ml 8.4% solution) i50 mmol (50 ml 8.4% solution) i//vv


ActionAction::AlkalineAlkaline agent agent ((increaseincrease pH) pH) ButBut can callcan call::– Increase in loading СО2Increase in loading СО2– Reduction of liberation О2 in fabricsReduction of liberation О2 in fabrics– Decrease Decrease contractility ofcontractility of myocardium myocardium– IncreaseIncrease Na in blood Na in blood

Co-operates with adrenalineCo-operates with adrenaline

CalciumCalcium

ActionAction::

It is necessary for normal reduction of a It is necessary for normal reduction of a myocardiummyocardium

Surplus can call Surplus can call arrhythmiaarrhythmia The trigger of destruction of cages The trigger of destruction of cages ischemicischemic

myocardiummyocardium Surplus can break brain restorationSurplus can break brain restoration

CalciumCalcium


EMDEMD calling by :calling by :– ↑↑ K in bloodK in blood– ↓ ↓ Ca in bloodCa in blood – Overdose Overdose of of calcium calcium blockerblocker

DoseDose : :

10 ml 10% Ca Cl (6.8 mmol\l)10 ml 10% Ca Cl (6.8 mmol\l)Not to enter at once before or after bicarbonate Not to enter at once before or after bicarbonate sodiumsodium

NaloxoniNaloxoni


Overdose Overdose of opiatesof opiates

Oppression of breath after appointment Oppression of breath after appointment of of opiatesopiates

NaloxoniNaloxoni

DoseDose ::

0.2 - 2.0 mg0.2 - 2.0 mg ii//vvIt can be demanded repeatedlyIt can be demanded repeatedly,, possible to possible to 10 10 mgmgInfusion can be demandedInfusion can be demanded

To estimaterhythm

+/- check up pulse

VF/VT

Defibrillation X 3if necessary

СРR 1 min

Ventricle fibrillation / Ventricle tachycardia without pulsewithout pulse

VF/VT

DischargeDischarge 200 J*



To make To make 3 3 dischargesdischarges if it is if it is necessarynecessary, , in a current in a current of 1 of 1 minuteminute

Not to interrupt Not to interrupt defibrillationdefibrillation for for BLSBLS

After the After the dischargedischarge, palpate , palpate pulse on carotids, only if on pulse on carotids, only if on an electrocardiogram a an electrocardiogram a rhythm correspondingrhythm corresponding to job to job of heartof heart

During СРRCorrection of the reversible reasons

If it is not made:To check up electrodes, an arrangement

and contactTo provide / to check up

- Passableness BP and O2 - Venous access

Adrenaline each 3 minesTo consider:

amidaroni, atropine / pacing buffers

Compression, respiratory ways Compression, respiratory ways and ventilationand ventilation

Passableness of respiratory waysPassableness of respiratory ways::– EndotrachealEndotracheal tube tube– LMLM– CombitubeCombitube

After maintenance of passableness After maintenance of passableness of of BPBP do not interrupt a compression for do not interrupt a compression for ventilationventilation

Venous access and preparationsVenous access and preparations FV/VTFV/VT

The central or peripheral veinThe central or peripheral vein

AdrenalineAdrenaline of 1 of 1 mg mg ii//vv or or 2-3 2-3 mg mg endotrachealendotracheal

To consider To consider amiodaroniamiodaroni 300 300 mg if mg if FV/VT FV/VT presentpresent after after 33rd categoryrd category

Alternatively Alternatively -- lidocaine lidocaine of 100 of 100 mgmg

To consider magnesium To consider magnesium 8 8 mmolmmol

False False asystoleasystole

When monitoring with paddle-gel padsWhen monitoring with paddle-gel pads

More likely with increasing number of More likely with increasing number of shocks and high chest impedanceshocks and high chest impedance

Displays apparent “asystole”Displays apparent “asystole”

Confirm rhythm with monitoring leadsConfirm rhythm with monitoring leads

cardio-pulmonary and cerebral resuscitation lecture 1

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