cardio pulmonary cerebral rescucitation and management-eric w

8/13/2019 Cardio Pulmonary Cerebral Rescucitation and Management-eric W

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CARDIOPULMONARY

CEREBRALRESUSCITATIONAN

MANAGEMENT

Advisor: dr. Nicolaas P.S, Sp. An


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BAB I INTRODUCTION

1.1 Background

o Every minute 4-6 people died in the world because ofheart attack, 80% happens at home & needs CPR to

save a life. If this condition treated properly, it could be reversible

potentially

CPR is an act of lifesaving procedure that increases the

chance of survival after cardiac arrestAHACPR 2010 recommendations confirm CPR and

ECC 2005safe but not efficient and useable in anyresuscitation for all emergency conditions.


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OVERVIEW

Is a first aid practiceunconscius person w/ abnormal

breathing & no pulse

Successfull resuscitation following cardiac arrest requires

several key actions

CARDIOPULMONARY RESUSCITATION

CHAIN OF SURVIVAL


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BAB II DISCUSSION

2.1 Definition

CPR, first aid is given to someone who has stopped

breathing, with the aim that the person can recover and

avoid the death

Clinical death (6 minutes = golden period) CPR

Biological death (> 6menit) necrosis of the brain,

heart, kidney, lung, liver

2.2 Epidemiology

Cardiac arrest cause of death in various parts of the

country

Patients with cardiac arrest is an adult


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2.3 CPR Indication everyone who is not conscious, not breathing or gasping.

A. Stop breathing

Respiratory arrestcan be caused by many things :

stroke, drug poisoning, drowning, inhalation of smoke /

steam / gas, airway obstruction by foreign bodies, etc. In early stop breathingheart is still beatingstill

palpable pulsecirculation of O2 to the brain and other

vital organs are still quite up to several minutes

To the layman, if looking someone there is no chestmovement and abnormal breathing (gasping)CPR


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B. Cardiac Arrest

Primary cardiac arrest is the inability of the cardiac output

to provide sufficient oxygen needs to the brain and other

vital organs suddenly and if the right actions done, it can

return to normal. Cardial causesarrhythmias, decreased cardiac muscle

contractility (decompensatio cordis, cardiogenic shock),

coronary blood flow stops, trauma to the heart or on the

sternum, and coronary blockage. Ekstracardial causessevere hypoxia, severe

hypovolemia, hyperkalemia, the flow of electricity.


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CARDIAC ARREST


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CHAIN OF SURVIVAL

NEW AHA ADULT CHAIN OF SURVIVAL

Immediate recognition and activation of

emergency response system

Early CPR, w/emphasis on chestcompressions

Rapid defibrillation

Effective advanced life support

Integrated post-cardiac arrest care


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FOURSTEPSOFBLS SURVEY

Step I : Check Responsiveness

Step II : Activate the emergency response system

and get an AED (Automated External Defibrillators)

Step III : Check for carotid pulse Do not spend more than 10 seconds checking for a pulse

No pulse = begin CPR

Step IV : Defibrilation


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CHANGE IN SEQUENCE

10


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CARDIOPULMONARYRESUSCITATION

11

BLS

ALS

Perform at the scene

Perform at

hospital


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ADULT Basic life support (BLS) is the foundation for saving lives

following cardiac arrest.

Fundamental aspects of BLS include:

immediate recognitionof sudden cardiac arrest (SCA)

activationof the emergency response system early cardiopulmonary resuscitation(CPR)

rapid defibrillationwith an automated external defibrillator

(AED).

12


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Universal

Algorithm forAdult CPR


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Without effective chest compressions

Oxygen flow to brain stops.

Oxygen flow to heart stops.

Drugs go nowhere.

Chest Compressions Critical


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RESCUEBREATH


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Rescue BreathingAHA Guidelines for CPR and ECC 2010 recommendation

to compression before ventilation Helpers have to open the airwayHead Tilt / Chin Lift / Jaw

thrust Must be careful of trauma to the neckcan only Jaw Thrust Helpers should provide assistance breathing through the

mouth to mouth or appliance into the mouth or BVM (BagValve Mask) to the mouth to provide oxygenation and

ventilation. A ratio of compression: ventilation is 30:2.

c. Early defibrillation with AEDIf there are two or more helper, a helper should immediatelygive chest compressions while the second helper activateemergency response system and retrieve AED

Stages of defibrillation: Turn on AED

follow the instructions

Continue chest compressions immediately after the shock(minimizing disruption)


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2.6. Guidelines for CPR 2010

(AHA Guidelines for CPR and ECC 2010)

1. Emphasize to a good quality CPR continuously

An effective early chest compression is one of the mostimportant aspect in cardiac arrest resuscitation

Helper has to do chest compression to all cardiac arrest

patients without notice their skill, characteristic or availableresources

2. Change from A-B-C to C-A-B

The main priority is Circulation and then after that focus on

Airway and Breathing The only exception is for newborn (neonatus) asphyxia

No more look, listen, feel


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3. Average of compression

Minimum compression should be done is 100 times/minute

The amount of compression per minute is very important to

determine the ROSC (return of spontaneous circulation)and good function of neurology

More compression related to high average of patients

survival


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4. Depth of compression

For adult : 1 -2 inchesminimum 2 inches (5 cm)

Effective compressionstrong and fast compression

produce blood flow and oxygen to the heart and brain

5. Hands only CPR

It is easier to be done by untrained helper

Hands only CPR = compression using ventilation

6. Dispatcher Identification of Agonal Gasps

CPR when the victim doesnt breath or theres an

abnormal breathing


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7. Emergency Response System Activation

If you cant feel the pulse for 10 seconds, CPR has to be

initiated immediately and use electric defibrillator if

available

8. Resuscitation team

A resuscitation team is needed to make sure the

resuscitation works well and effective


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2.5.2 BLS In Children

using one hand with your palms resting on the upper

sternum, in the middle of the sternum. Compression one-third of the anteroposterior diameter of

chest, depth of about 2 inches (5 cm).

2.5.3 BLS In Infants The position of chest compressions using two fingers of

the middle finger and ring finger on top of the breastbone

or a finger below the imaginary line between the nipples.

Compression one-third of the anteroposterior diameter ofthe chest, with a depth of about 1.5 inches (4 cm)


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1. Patient back to healthy condition

2. Rescuer too tired

3. Patient definitely death already

4. After 30 min1 hour without improvement

When we stop resuscitation?


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1. RIB FRACTURES

2. FRACTURE STERNUM

3. RIB SEPARATION

4. PNEUMOTHORAX

5. HEMOTHORAX

6. LUNG CONTUSIONS

7. LIVER LACERATIONS8. FAT EMBOLI

9. HIV, HEPATITIS

10.INFECTIONS

PROBLEMS AND

COMPLICATIONS OF

CHEST COMPRESSIONS


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BAB III

CONCLUSION

By changing the order of ABC to CAB then it

becomes easier to perform CPR by untrained

rescuers

CPR guidelines in 2010 which is more compact is

expected to spur an untrained lay rescuers torescue patients experiencing cardiac arrest, so that

the average survival of patients who experienced

cardiac arrest can be increased


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THANK

YOU

cardio pulmonary cerebral rescucitation and management-eric w

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