1. cardiorespiratory arrest
Post on 04-Jun-2018
219 Views
Preview:
TRANSCRIPT
-
8/13/2019 1. Cardiorespiratory Arrest
1/51
-
8/13/2019 1. Cardiorespiratory Arrest
2/51
Cardiorespiratory arrestis thesudden, unexpected cessation ofrespiration and functional circulation.
-
8/13/2019 1. Cardiorespiratory Arrest
3/51
CPCR Principle
4 6 minutes
CPCRDuring respiratory and cardiac arrest, CPCR may be successful
if performed before biological death of vital tissue develops.
-
8/13/2019 1. Cardiorespiratory Arrest
4/51
-
8/13/2019 1. Cardiorespiratory Arrest
5/51
-
8/13/2019 1. Cardiorespiratory Arrest
6/51
1. Degree of preexisting hypoxia of the cells.
2. The brain depends totally on oxygen and is
the organ least able to withstand hypoxia.
3. The whether circulatory or respiratory arrestoccurs first.
-
8/13/2019 1. Cardiorespiratory Arrest
7/51
A.Cardiac asystole.B.Ventricular fibrillation or Pulseless VT
Electrical defibrillation is required toreestablish spontaneous and effectivecardiac electrical activity.
C.Electromechanical dissociation
circulatory collapse that occurs despitesatisfactory electrical complexes on the ECG
-
8/13/2019 1. Cardiorespiratory Arrest
8/51
1. Low cardiac output.
2. Hyparcapnia.
3. Hyperkalemia.
4. Hypoxia and vagal stimulation.5. Stimulation of the heart.
6. Coronary occlusion.
7. Overdosage.
8. Hypothermia.
9. Hyperthermia
10. Acidosis
-
8/13/2019 1. Cardiorespiratory Arrest
9/51
-
8/13/2019 1. Cardiorespiratory Arrest
10/51
1. Airway obstructionby vomitus, foreign body,blood, secretions, solid material, mucous plugs,laryngeal or bronchial spasm, or tumor.
2. CNS depression: caused by stroke, head trauma,hypercapnia, barbiturates,narcotics, tranquilizers,or anesthetics.
3. Neuromuscular failure secondary topoliomyelitis, muscular dystrophy, myasthenia, ormuscle relaxant drugs.
-
8/13/2019 1. Cardiorespiratory Arrest
11/51
-
8/13/2019 1. Cardiorespiratory Arrest
12/51
Flail chestPneumothoraxMassive atelectasis
Acute pulmonary embolismCongestive heart failureOverwhelming pneumonia
Gram-negative septicemiaLung burnsCarbon monoxide poisoning
Massive blood loss.
-
8/13/2019 1. Cardiorespiratory Arrest
13/51
In geriatric or pediatric patients. In patients with a history of
arrhythmias, heart block, digitalistoxicity, myocarditis , myocardialinfarction, congestive heart failure,electrolyte imbalance , or dehydration.
In massive hemorrhage.During or following heart surgery.
-
8/13/2019 1. Cardiorespiratory Arrest
14/51
The initial goal of therapy is BRAIN oxygenation
The second goal is restoration of circulation.
Underlying condition must be corrected.
CPCR is not indicated for all patients.Natural death in the aged or in the terminalstages of a chronic illness
CPCR should be performed in cases of reversibleunexpected death
-
8/13/2019 1. Cardiorespiratory Arrest
15/51
Basic Life support (BLS):Airway, Breathing,Circulation, Drug (Defibrillation )
Advanced life support (ALS):Airway, Breathing, Circulation, Drug (Defibrillation),ECG, Fluid, Gauge, ICU
-
8/13/2019 1. Cardiorespiratory Arrest
16/51
ABCD stepsA, airway.B, breathing.
C, circulation.D, drugs and definitive therapy.
In a witnessed cardiac arrest (when treatment can beinitiated within 1 min of the onset of arrest), theABCD sequence should include use of a precordialthump.
-
8/13/2019 1. Cardiorespiratory Arrest
17/51
Precord ial Thum b
-
8/13/2019 1. Cardiorespiratory Arrest
18/51
OPEN AIRWAY
BREATHE
CHECK BREATHING
Shake and shout
Head tilt / Chin lift
Look, listen and feel
2 effective breaths
CHECK
RESPONSIVENESS
If breathing:
recovery position
Adult Basic Life Support
-
8/13/2019 1. Cardiorespiratory Arrest
19/51
CIRCULATION PRESENT
Continue Rescue Breathing
NO CIRCULATION
Compress Chest
Check circulationEvery minute
100 per minute15:2 ratio
Send or go for help as soon as poss ib le
according to gu idelines
ASSESS
10 secs only Signs of a circulation
-
8/13/2019 1. Cardiorespiratory Arrest
20/51
1. vertically downward4-5 cm2. Push hard push fast3. 100 x/min.4. Ratio Comp : Vent30 : 2
External Cardiac Compression
-
8/13/2019 1. Cardiorespiratory Arrest
21/51
-
8/13/2019 1. Cardiorespiratory Arrest
22/51
Cardiac Compression
-
8/13/2019 1. Cardiorespiratory Arrest
23/51
-
8/13/2019 1. Cardiorespiratory Arrest
24/51
Defibrillate up to 3 times
Epinephrine several
dose optionsAntiarrhythmic agents
Lidocaine
Bretylium
Magnesium Procainamide
Ventricular fibrillation
-
8/13/2019 1. Cardiorespiratory Arrest
25/51
Search for reversible causes and treat
Epinephrine Atropine for absolute or relative bradicardia
-
8/13/2019 1. Cardiorespiratory Arrest
26/51
Epinephrine
AtropineConsider transcutaneous pacing
Search for reversible causes andtreat if possible
-
8/13/2019 1. Cardiorespiratory Arrest
27/51
Atropine
Dopamine Epinephrine
Transcutaneous pacing
Transvenous pacing
-
8/13/2019 1. Cardiorespiratory Arrest
28/51
Immediate cardioversion
Premedicate when possible
Synchronized setting
-
8/13/2019 1. Cardiorespiratory Arrest
29/51
Narrow-complex
Adenosine
Verapamil Diltiazem
-blockers
Digoxin Synchronized cardioversion
-
8/13/2019 1. Cardiorespiratory Arrest
30/51
Wide-complex
Lidocaine Procainamide
Bretylium
Consider adenosine
Synchronized cardioversion
-
8/13/2019 1. Cardiorespiratory Arrest
31/51
It is critical to survival from sudden cardiac arrest(SCA) for several reasons:
(1) the most frequent initial rhythm in witnessedis ventricular fibrillation (VF),
(2) the treatment for VF is electrical defibrillation,
(3) The probability of successful defibrillationdiminishes rapidly over time, and
(4) VF tends to deteriorate to asystole within a fewminutes.
-
8/13/2019 1. Cardiorespiratory Arrest
32/51
-
8/13/2019 1. Cardiorespiratory Arrest
33/51
Defibrillationdelivery of current through the chestand to the heart to depolarize myocardial cells andeliminate VF.
The energy settings for defibrillators are designed toprovide the lowest effective energy needed toterminate VF.
Electrophysiologic event that occurs in 300 to 500milliseconds after shock delivery.
Defibrillation (shock success) is typically defined astermination of VF for at least 5 seconds following theshock.
-
8/13/2019 1. Cardiorespiratory Arrest
34/51
Biphasic defibrillator (initial shock) :
selected energies of 150 J to 200 J
(biphasic truncated exponentialwaveform) or
120 J (rectilinear biphasic waveform).
For second and subsequent shocks, usethe same or higher energy
-
8/13/2019 1. Cardiorespiratory Arrest
35/51
Monophasic defibrillator : select adose of 360 J for all shocks.
If VF is initially terminated by ashock but then recurs later in the
arrest, deliver subsequent shocks atthe previously successful energylevel.
-
8/13/2019 1. Cardiorespiratory Arrest
36/51
Shock delivery that is timed (synchronized)with the QRS complex.
The energy (shock dose) used is lower than
that used for unsynchronized shocks(defibrillation).
These low-energy shocks if delivered asunsynchronized are likely to induce VF.
If cardioversion is needed and it is impossibleto synchronize a shock (eg, the patientsrhythm is irregular), use high-energy
unsynchronized shocks.
-
8/13/2019 1. Cardiorespiratory Arrest
37/51
-
8/13/2019 1. Cardiorespiratory Arrest
38/51
Electrode Position
-
8/13/2019 1. Cardiorespiratory Arrest
39/51
-
8/13/2019 1. Cardiorespiratory Arrest
40/51
-
8/13/2019 1. Cardiorespiratory Arrest
41/51
Adrenaline - the primary sympathomimetic agentfor the management of cardiac arrest for 40 years.
Alpha-adrenergic actions,vasoconstrictive effectssystemic vasoconstriction, which increasescoronary and cerebral perfusion pressures.
Beta-adrenergic actions,(inotropic,
chronotropic) may increase coronary and cerebralblood flow.
.
-
8/13/2019 1. Cardiorespiratory Arrest
42/51
Indications Adrenaline is the first drug used in cardiac arrest of any
aetiology: it is included in the ALS algorithm for useevery 35 min of CPR.
Adrenaline is preferred in the treatment of anaphylaxis. Adrenaline is second-line treatment for cardiogenic
shock.
Dose. During cardiac arrest, the initial intravenous dose ofadrenaline is 1 mg.
When intravascular (intravenous or intra-osseous) accessis delayed or cannot be achieved, give 23 mg, diluted to10 ml with sterile water, via the tracheal tube. Absorptionvia the tracheal route is highly variable.
-
8/13/2019 1. Cardiorespiratory Arrest
43/51
Amiodarone is a membranestabilising anti-arrhythmic drug that increases the duration of the
action potential and refractory period in atrial andventricular myocardium.
Atrioventricular conduction is slowed, and asimilar effect is seen with accessory pathways.
Amiodarone has a mild negative inotropic actionand causes peripheral vasodilation through non-competitive alpha-blocking effects.
-
8/13/2019 1. Cardiorespiratory Arrest
44/51
Indications. refractory VF/VT haemodynamically stable ventricular tachycardia (VT)
and other resistant tachyarrhythmias
Dose. Consider an initial intravenous dose of 300mg amiodarone, diluted in 5% dextrose to a
volume of 20 ml (or from a pre-filled syringe), ifVF/VT persists after the third shock.
Amiodarone can cause thrombophlebitis wheninjected into a peripheral vein; use a central
venous catheter if one is in situ but,if not, use alarge peripheral vein and a generous flush.
-
8/13/2019 1. Cardiorespiratory Arrest
45/51
Indications. Lidocaine is indicated inrefractory VF/VT (when amiodarone isunavailable).
Dose. an initial dose of 100 mg (11.5mg/kg) for VF/pulseless VT refractory tothree shocks.
Give an additional bolus of 50 mg ifnecessary.
The total dose should not exceed 3 mg/kgduring the first hour.
-
8/13/2019 1. Cardiorespiratory Arrest
46/51
Atropine. antagonises the action of theparasympathetic neurotransmitter
acetylcholine at muscarinic receptors.Blocks the effect of the vagus nerve on
both the sinoatrial (SA) node and the
atrioventricular (AV) node, increasingsinus automaticity and facilitating AVnode conduction.
-
8/13/2019 1. Cardiorespiratory Arrest
47/51
is indicated in: asystole
pulseless electrical activity (PEA) with a
rate
-
8/13/2019 1. Cardiorespiratory Arrest
48/51
-
8/13/2019 1. Cardiorespiratory Arrest
49/51
-
8/13/2019 1. Cardiorespiratory Arrest
50/51
CPR must be continued until Cardiopulmonary system is stabilized
The patient is pronounced death
Alone rescuer is physically unable tocontinue
-
8/13/2019 1. Cardiorespiratory Arrest
51/51
top related