DR J.O OLATOSI D.A,FWACS

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CARDIAC ARRESTSudden cessation of spontaneous and

effective heart functionDiagnosis’unresponsive Sudden deep unconsciousnessAbsent major peripheral pulsesAbsent spontaneous ventilation/agonal

breathing Fixed dilated pupils not index for diagnosis or

prognosis

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CAUSES OF CARDIAC ARREST

Airway obstructionBlood, vomit, foreign bodyTraumaInfection, inflammationLaryngospasmBronchospasm

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Decreased respiratory drive-CNS depression

Decreased respiratory effort-neurological lesion-muscle weakness-restrictive chest defect

Pulmonary disorders-pneumothorax, lung pathology

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Cardiac abnormalitiesPrimary

IschaemiaMyocardial infarctionHypertensive heart diseaseValve diseaseDrugsElectrolyte abnormalities

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SecondaryAsphyxiaHypoxaemiaBlood lossSeptic shock

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Cardiopulmonary ResuscitationA technique combining artificial ventilation and

chest compressions designed to perfuse vital organs or restore circulation in cardiac standstill.

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Early access to get helpEarly BLS to buy time-

CPR slows down deterioration of the brain

Early defibrillation to restart heart-restores a perfusing rhythm

Early ALS to stabilise circulation

failure of circulation for 3-4mins can lead to irreversible brain damage.

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Adult BLS sequenceBasic life support consists of the following

sequence of actions:1 Make sure the victim, any bystanders,

and you are safe.

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2 Check the victim for a response.• Gently shake his shoulders and ask loudly,

‘Are you all right?’

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Shake and Shout

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3 A If he responds:

• Leave him in the position in which you find him provided there is no

further danger.• Try to find out what is wrong with him and

get help if needed.• Reassess him regularly.

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3 B If he does not respondShout for help.Turn the victim onto his back and then open the

airway using head tiltand chin lift: Place your hand on his forehead and gently tilt his

head back. With your fingertips under the point of the victim's

chin, lift thechin to open the airway.

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Opening the airwayHead tiltChin liftIf cervical spine

injury suspected: jaw thrust

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Assess BreathingLook for chest

movementListen for breath

soundsFeel for expired airAssess for 10 seconds

before deciding breathing is absent

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5 A If he is breathing normally:Turn him into the recovery position .Send or go for help, or call for an ambulance.Check for continued breathing.

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5 B If he is not breathing normally:Ask someone to call for an ambulance or, if you are

on your own, dothis yourself; you may need to leave the victim. Start

chestcompression as follows: Kneel by the side of the victim. Place the heel of one hand in the centre of the

victim’s chest. Place the heel of your other hand on top of the first

hand.

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Interlock the fingers of your hands and ensure that pressure is

not applied over the victim's ribs. Do not apply any pressure over the upper abdomen or the bottom end of the bony sternum (breastbone).

Position yourself vertically above the victim's chest and, with

your arms straight, press down on the sternum 4 - 5 cm.

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After each compression, release all the pressure on the chest

without losing contact between your hands and the sternum.

Repeat at a rate of about 100 times a minute (a little less than

2 compressions a second).Compression and release should take an equal

amount of time.

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Chest compressions

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6 A Combine chest compression with rescue breaths.

After 30 compressions open the airway again using head tilt and chin lift.

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Rescue breathing(Expired air ventilation)

Occlude victim’s noseMaintain chin liftTake a deep breathEnsure a good mouth-

to-mouth seal

Rescue breathing(Expired air ventilation)

Blow steadily (2 sec) into victim’s mouth

Watch for chest rise Maintain chin lift,

remove mouthWatch chest fall

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6 B Chest-compression-only CPR.If you are not able, or are unwilling, to give

rescue breaths, give chest compressions only.• If chest compressions only are given, these

should be continuous at a rate of 100 a minute.

• Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt resuscitation.

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7 Continue resuscitation until:•qualified help arrives and takes over,•the victim starts breathing normally, or•you become exhausted.A valid DNAR order is presented

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ALSBasic Airway Adjuncts-Oropharyngeal AirwayNasopharyngeal Airway

Advanced Airway DevicesLaryngeal Mask AirwayCombitubeEndotracheal Tube

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DEFIBRILLATIONDefinition

“The termination of fibrillation or absence of VF/VT at 5 seconds after shock delivery”

Critical mass of myocardium depolarisedNatural pacemaker tissue resumes control

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DesignPower sourceCapacitorElectrodes

TypesManualAutomatedMonophasic or Biphasic waveform

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Defibrillator waveforms

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Damped Monophasic Truncated Biphasic

Biphasic DefibrillatorsRequire less energy for defibrillation

smaller capacitors and batteries lighter and more transportable

Repeated < 200 J biphasic shocks have higher success rate for terminating VF/VT than escalating monophasic shocks

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Automated external defibrillatorsAnalyse cardiac rhythmPrepare for shock deliverySpecificity for recognition of shockable

rhythm close to 100%

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Advantages:Less training required

no need for ECG interpretation Suitable for “first-responder” defibrillationPublic access defibrillation (PAD) programs

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Attach adhesive electrodesFollow audible and visual instructionsAutomated ECG analysis - stand clear Charges automatically if shockable

rhythm +/- manual override

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Relies upon:Operator recognition of ECG rhythmOperator charging machine and delivering

shockCan be used for synchronised

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Defibrillator SafetyNever hold both paddles in one handCharge only with paddles on casualty’s chestAvoid direct or indirect contact Wipe any water from the patient’s chestRemove high-flow oxygen from zone of

defibrillation

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Manual DefribillationDiagnose VF/VT from ECG and signs of

cardiac arrestSelect correct energy levelCharge paddles on patientShout “stand clear”Visual check of areaCheck monitorDeliver shock

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