cpr by dr nirmal taparia

SANIL VARGHESE

CARDIOPULMONARY

RESUSCITATION

HISTORICAL REVIEW

• In the 19th century, Doctor H. R. Silvester described a method “The Silvester Method”.

• Holger Neilson technique was in the United States in 1911.

• In the 20th century at Johns Hopkins University where the technique of CPR was originally developed. The first effort at testing the technique was performed on a dog by Redding, Safar and JW Perason. Soon afterward, the technique was used to save the life of a child.

• Peter Safar wrote the book ABC of resuscitation in 1957.

CPR For Health Care Providers

• Adult• Child• Infant

Terminology

• BLS / BCLS

• ALS / ACLS

• Respiratory Arrest

• Arrest, Cardiac Arrest, Code, Code Blue

• Ventilations

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Diagnosis of cardiac arrest

Symptoms of cardiac arrest absence of pulse on carotid arteries – a

pathognomonic symptom

respiration arrest – may be in 30 seconds after cardiac arrest

enlargement of pupils – may be in 90 seconds after cardiac arrest

Blood pressure measurement

Taking the pulse on peripheral arteries

Auscultation of cardiac tones

Loss of time !!!

AMERICAN HEART ASSOCIATION:2010 GUIDELINES

Health Care Provider* “PUSH HARD AND PUSH FAST”

At least 100 COMPRESSIONS / MINUTE*

Allow the chest to recoil -- equal compression and relaxation times

<10 seconds for pulse checks or rescue breaths

Compression Depth*

Adults 2”

Child/Infant 1/3 depth of chest 1.5" infant 2" child

Avoid excessive ventilations

A-B-C changed to C-A-B*

Critical element is chest compressions

Delay in A-B

Avoidance of A & B

Early defib

If alone--call and retrieve AED

Exception asphyxial arrest



• Cricoid pressure not recommended

• Advanced airway = 1 every 6-8 seconds

• Adult: 1 every 5-6 Peds: 1 every 3

• With advanced airway- no pause


AHA ECC Adult Chain of Survival - New

Simplified Universal BLS algorithm


Electrical Therapies• Shock first vs CPR first• No precordial thump• AED in hospital (goal to shock =< 3 mins)

• Use in infants (with or without attenuator)


ACLS• Simplified algorithm• Optimized CPR quality with monitoring• Waveform capnography (>12 mmHg)• Atropine deleted (PEA/Asystole)• Chronotropic drugs for brady, then pacing• Adenosine safe for monomorphic wide tachs• Post-cardiac arrest


AMERICAN HEART ASSOCIATIONCAPNOGRAPHY


Post-Cardiac Arrest – ROSC

• Therapeutic Hypothermia

– Remain comatose

– 32-34 degree C (all ages) (89.6-93.2 F)

– 12-24 hours

• PCI

• O2 sat ≥94% & PETCO 35-40


• Asthma

• Anaphylaxis

• Pregnancy

• Morbid obesity

• PE

• Electrolyte imbalance

• Toxins

Special Resuscitation Situations

• Hypothermia

• Avalanche

• Drowning

• Electric shock/lightening

• PCI

• Cardiac tamponade

• Cardiac surgery


Acute Coronary Syndromes• Out of hospital 12-lead• Triage to PCI• Oxygen – > 94 % is the goal (capno)• Morphine – use with caution in UA/non-STEMI


Stroke

• Stroke-prepared hospitals

• Triage to stroke centers

• TPA up to 4.5 hours

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C. CirculationRestore the circulation, that is start external cardiac massage

Hand Position

• At the nipple line

• Off the zyphoid process

2 fingers = infant1 hand = child2 hands = adult

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A (Airway) ensure open

airway

21

Open the airway using a head tilt lifting of chin. Do not tilt the head too far back

Check the pulse on carotid artery using fingers of the other hand

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B (Breathing)

Tilt the head back and listen for. If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise.

VENTRICULAR FIBRILLATION OR PULSELESS TACHYCARDIA

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Witnessed UnwitnessedPrecordial thump

Check pulse, if none:

Begin CPRDefibrillate with 200 joulesDefibrillate with 200-300 joulesEstablish IV access, intubateAdrenaline 1 mg pushDefibrillate with 360 joulesLidocaine 1 mg/kg IV, ETDefibrillate with 360 joules

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Operations in case of asystoleAsystole

• Start CPR• IV line• Adrenaline:IV 1 mg, each 3-5 min.- or- intratracheal 2 - 2.5 mg- in the absence of effect increase

the dose- Atropine 1 mg push (repeated once

in 5 min)

•Na Bicarbonate 1 Eq/kg IV•Consider pacing

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Drugs used in CPR

• Atropine – can be injected bolus, max 3 mg to block vagal tone, which plays significant role in some cases of cardiac arrest

• Adrenaline – large doses have been withdrawn from the algorithm. The recommended dose is 1 mg in each 3-5 min.

• Vasopresine – in some cases 40 U can replace adrenaline

• Amiodarone - should be included in algorithm• Lidocaine – should be used only in ventricular

fibrillation

Public Access Defibrillation -PAD

• Casinos• Airports• City buildings• Senior centers• Gated communities

Complications of Compressions

• fractured ribs• fractured sternum• lacerated lungs• lacerated liver, blood vessels, etc,.

2010 AHA GUIDELINESRecommendations

Component Adults Children Infants

Recognition Unresponsive (for all ages)

No breathing or no normalbreathing (ie, only gasping)

No breathing or only gasping

No pulse palpated within 10 seconds for all ages (HCP only)

CPR sequence C-A-B

Compression rate At least 100/min

Compression depth

At least 2 inches (5 cm)

At least 2 inches (5 cm)

About 1. inches (4 cm)

RecommendationsComponent Adults Children Infants

Chest wall recoil Allow complete recoil between compressionsHCPs rotate compressors every 2 minutes

Compression interruptions

Minimize interruptions in chest compressionsAttempt to limit interrruptions to <10 seconds

Airway Head tilt–chin lift (HCP suspected trauma: jaw thrust)

Compression-to-ventilationratio (until advancedairway placed)

30:21 or 2 rescuers

30:2Single rescuer

15:22 HCP rescuers

Ventilations: when rescueruntrained or trained andnot proficient

Compressions only

Ventilations with advancedairway (HCP)

1 breath every 6-8 seconds (8-10 breaths/min)

Asynchronous with chest compressionsAbout 1 second per breath

Visible chest rise

Defibrillation Attach and use AED as soon as available. Minimize interruptions in chest compressions before and after shock;resume CPR beginning with compressions immediately after each shock.

Thank you

cpr by dr nirmal taparia

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