cardio pulmonary resuscitation
DESCRIPTION
A presentation on cardiopulmonary resuscitationTRANSCRIPT
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Cardiopulmonary resuscitation
Dr.V.RavimohanWhat I learned in the ILS training
http://www.mrcogexam.net
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Chain of survival
• Early recognition and call for help• Early cardiopulmonary resuscitation (CPR)• Early defibrillation• Post resuscitation care
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Early recognition
• Most in-hospital cardiac arrests are not sudden or unpredictable events
• Hypoxia or hypotension are either not noticed by staff ,or are recognised but treated poorly.
• 2 systems early warning scores
calling criteria“cardiac arrest team” “Medical emergency team”
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Medical emergency team calling criteria
Acute change in Physiology
Airway Threatened
Breathing All respiratory arrestsRespiratory rate < 5/ minRespiratory rate >36/min
Circulation All cardiac arrestsPulse rate <40/minPulse rate > 140/minSystolic pressure <90 mmHg
Neurology Sudden decrease in level of consciousnessDecrease in GCS of > 2 points Repeated or prolonged seizures
Other Any patient causing concern who doesn’t fit the above criteria
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Airway obstruction
• Treatment– Remove any obstruction unless
contraindicated turn the patient to a side– Simple airway opening manoeuvres head tilt,
jaw thrust or chin lift (remember to give oxygen)– Oropharyngeal airway or nasal airway– Elective tracheal intubation– Tracheostomy– Always remember to give oxygen
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Breathing problems
• Causes– Poor respiratory drive-CNS depression– Poor respiratory effort-muscle weakness/nerve
damage– Lung disorders
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Breathing problems
• Recognition– Irritability, confusion, lethargy and depressed
consciousness(from hypoxia and hypercapnia)– High respiratory effort(>30/min)– Pulse oxymetry• Non invasive measure of oxygenation but not a
measure of ventilation
– Blood gas analysis
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Circulation problems
• Causes– Primary heart problemsarrythmia secondary to
ischaemia– Secondary heart problems severe anaemia,
hypothermia
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Acute coronary syndromes
• Unstable angina• Non ST segment elevation MI• ST segment elevation MI
– Treatment• O2 high concentration• Aspirin 300 mg• Nitro-glycerine S/L• Morphine
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ABCDE approach
• A-airway• B-breathing• C-circulation• D-disability• E-exposure
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Airway Obstruction
• Airway obstruction-”sea-saw” respirations– complete• no breath sounds at the mouth or nose
– Incomplete• noisy
• clear the airway• Give O2 10 l/min
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Breathing
• General signs of respiratory distress– Use of accessory muscles of respiration– Sweating– Cyanosis
• Respiratory rate• Pulse oxymeter• Trachea• Percuss• Listen
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Circulation• Colour & temperature of limbs• Capillary fill time
– Finger tip held at the heart level– Normal fill time is less than 2 seconds
• Pulse volumelow – poor cardiac output
high(bounding)-sepsisB.P low diastolic blood pressure arterial vasodilatation anaphylaxis or sepsis narrow pulse pressure-(normal 35-45 mmHg) arterial vasoconstrictionhypovolaemia/cardiogenic shock
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Disability
• AVPU– A-Alert– V-responds to vocal stimuli– P-responds to painful stimuli– U-unresponsive to all stimuli• Measure blood glucose to exclude hypoglycaemia
This is simpler than Glasgow coma scale
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Exposure
• Exposure to examine the patient properly– Minimise heat loss– Respect dignity
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“collapsed patients”
• Ensure personal safety• Check for patient response– “are you alright?”• If patient respondsABCDE approach”• If patient doesn’t respondcall for help
• Airway• Breathing-”look” “feel” “hear” for not more
than 10 secs
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Pulse
• Checking for pulse-can be difficult even for the trained staff
• If unsure about the pulse don’t start delaying CPR
• If there is pulse – Still call for help– Give O2 Ventilate lungs check for circulation ever 10 seconds
– Attach monitoring– IV access
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If there is no pulse or signs of life
• Call for help• 30 chest compression:2 ventilation• 100 compressions/min compression depth 4-5
cm• Once the defibrillator arrives apply electrodes
to patient and analyse rhythm• Minimise interruptions to chest compressions
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Advanced life support cardiac rhythm
• 2 groups of cardiac rhythm– Shock able rhythm• Ventricular fibrillation• Pulse less ventricular tachycardia
– Non shock able rhythm• Asytole• Pulse less electrical activity
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Shock able Rhythm
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3 possibilities
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VT/VF persists
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VF/VT still persists
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Some tips
• Lidocaine 100mg IV is an alternative for amidarone but isn’t an option if amidarone is already given
• If there is doubt about whether a rhythm is Asystole or very fine AF
• don’t defibrillate• Very fine VF is unlikely to respond to shock
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Precordial Thump
• May be useful in VF/VT cardiac arrest which was witnessed and monitored sudden collapse
• Ulnar edge of a tightly clenched fist• From height of about 20 cm• Thumb is most likely to be successful in
converting VT to sinus rhythm
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PULSELESS ELECTRICAL ACTIVITY
• Definition: organised electrical activity in the absence of any palpable pulses.
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Treatment for PEA
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If VT/VF persists
• Follow shock able side of algorithm
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Treatment for asystole and slow PEA(rate <60 min-1)
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During CPR
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Reversible causes4H 4T
Hypoxia Tension pneumothorax
Hypovolaemia Tamponade,cardiac
Hypo/Hyperkalaemia/metabolic Toxins
Hypothermia Thrombosis
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4 HHypoxia 100% oxygen
Ensure adequate chest rise & bilateral breath sounds
Hypovolaemia Crystalloid/ColloidSurgery
Hyperkalaemia 12 ECG may help in the diagnosisCheck for hypoglycaemia
Hypothermia
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4TTension pneumothorax May be a complication of inserting
central venous catheterSigns: decreased air entry decreased expansion hyperresonance percussion on affected sideDo: needle thoracocentesis
Tamponade cardiac Cardiac arrest after penetrating chest trauma 2 reasons:A.hypovolaemia B.cardiac tamponadeDo: needle pericardiocentesis or resuscitative thoracotomy
Toxins
Thrombosis Consider thrombolytic therapy
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CPR in a pregnant patient
• Left lateral tilt(15-30 degrees) of patient• Periarrest caesarean section should begin
within 4 minutes• Sterile preparation is not necessary• Moving the patient to operating theatre isn’t
necessary