Transcript Causes of stopped circulation

CARDIO PULMO (CEREBRAL)
RESUSCITATION
Jozef Firment
Judita Capková
Department of
Anaesthesiology & Intensive Medicine
Šafárik University Faculty of Medicine, Košice
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 Basic life support A,B,C - to buy time for
 Advanced life support A,B,C,D,E –
to restore circulation
1961: Peter Safar
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Most frequent causes
of out-of-hospital cardiac
arrest CA
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Most common causes of
cardiac arrest CA
• 1. place
IHD...Myocardial
infarction (80%)
Ventricular fibrilation
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Most common causes of
cardiac arrest CA
• 1. place
IHD...Myocardial
infarction
• Hypertension
Electrical defibrillation –
Valvular
disease,..
only• effective
treatment
for VF
•
• Trauma
• Poisoning
• Drowning
Ventricular fibrilation
• Hypotermia...
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Most common causes of
cardiac arrest CA
• 1. place
IHD...Myocardial
infarction (80%)
• Hypertension
• Valvular disease,..
•
• Trauma
• Poisoning
• Drowning
Ventricular fibrilation
• Hypotermia...
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Cause of CA in
• Trauma
• Drowning
• Drug overdose
• Children
Asphyxia
Rescue breaths are critical for
resuscitation
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• In- hospital arrests are due tu PEA or
asystole (60-70%)
- early recognition of pp at risk may
prevent arrest – „Medical Emergency
Teams“
• Overall survival to hospital discharge is
10%
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THE CHAIN OF SURVIVAL
Early
access
to
emergency
services
up to 4 min
up to 8 min
Early
BLS
to
buy
time
Early
defibrillation
to reverse
VF
Early
advanced
care
to
stabilise
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Open Airway:
Cervical spine injury
• Jaw thrust (no for lay rescuer) or chin lift
with manual inline stabilisation
of head and neck by an assistant
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AGONAL BREATHING
• Occurs shortly after the heart stops
in up to 40% of cardiac arrests
• Described as barely, heavy, noisy or
gasping breathing
• Recognise as a sign of cardiac arrest
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EXTERNAL
CHEST
COMPRESSIONS
one rescuer
30:2
f : 100-120/min.
5-6 cm
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The quality of cc is frequently
suboptimal
Effective chest compressions
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Continous chest compression - only
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Only 1 in 4 patients in CA
recieves bystander CPR
• transmission of infection:
- tuberculosis, SARS, H1N1 –
small number,
- HIV – never reported
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Protective devices:
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Continous chest compression - only
• If layman is not able or is unwilling to
perform mouth to mouth breathing
• Chest compressions f: 100/min
without stopping
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Basic life support C,A,B
• Continue chest compressions and
rescue breathing:
- victim starts breathing normally
(signs of life)
- Medical emergency service arrives
- you become exhausted
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 Basic life support C,A,B
 Advanced life support
C, A, B, Drugs, ECG, Fibrilation
treatment - defibrilation...
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In hospital CPRAdvanced life support
 One person starts 30:2
others call resuscitation team
+ defibrillator, r. equipments (airway, ambu bag,
adrenalin,..)
 only one person: leaves the patient,
calls resuscitation team
starts 30:2
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VENTILATION MANAGEMENT
ALS –In-hospital CPR
A and B:
• Oral/nasal airway
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VENTILATION MANAGEMENT
ALS –In-hospital CPR
A and B:
• Oral/nasal airway
• Tracheal intubation : f: 10/min , Fi02 = 1,0
(reservoir bag), VT(tidal volume) 6-7 ml/kg,
(chest compressions and ventilations continue
uninterupted)
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Laryngeal mask,
laryngeal tube
Oe-Trach Combitube
Oe
90%
Trach
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Campbell
B:
adults:
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- “ children
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- “ -
O2
l/min
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FiO2
%
85-100
4
5
>40
85-100
2
>40
BAG WITH OXYGEN SUPPLY
VT x f
1000 x
dtto
300 x
dtto
Inlet O2
10 - 13 l/min
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Advanced life support
Self-inflating bag-mask + oropharyngeal airway :
CC:V= 30:2
Hyperventilation
reduces cerebral
blood flow
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The quality of chest compressions is
frequently suboptimal
team leader should
change CPR providers every 2 minutes
(5x cc:v 30:2)
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Hearth rhytms associated with CA:
Ventricular fibrillation
Asystole
Ventricular tachycardia
Electro-mechanical
disociation (EMD)
Pulseless ventricular
activity (PVA)
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DEFIBRILLATION
• Paddle positions (sternum, apex),
no over the breast tissue
• Self- adhesive pads (sparks!!)
- the best
• Biphasic defibrilators:
1. 150-200J
2. 150-360J,....
• CPR for 2 min (5 x 30:2)
after shock
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DEFIBRILLATION
• Check the rhythm
(organised QRS complexes:
regular + narrow- feeling for a pulse)
• After the third shock give:
adrenalin 1mg every 3-5 min. iv
amiodaron 300mg iv
• Time between CC and shock delivery
< 5s
– coronary perfusion pressure falls
substantially
• Signs of life return :normal breathing,
movement, coughing, puls
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A precordial thump
• Generates a small electrical shock
• In witnessed and monitored
VF/VT arrests if a defibrillator is not
immediately available
•The ulnar edge of fist
the lower half of sternum
from a height of 20 cm
•Converting VT to sinus rhytm
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LIFE-THREATENING CARDIAC
RHYTHM DISTURBANCES
Cardiac arrest (asystole)
Fine VF will not be shocked successfully
Pulseless electrical activity (PEA, EMD)myocardial contractions are too weak to produce pulse or blood
pressure
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POTENTIALLY
REVERSIBLE CAUSES
(5 H’s & 5 T’s):
•
•
•
•
Hypoxia
Hypovolemia
Hypothermia
Hyper/hypoK+and
metabolic
disorders
• H+ ions (acidosis)
• Tension
pneumothorax
• Tamponade
• Toxic/therap.
disturbances
• Thrombosis coronary
• Thrombosis
pulmonary
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POTENTIALLY REVERSIBLE CAUSES
(5 H’s & 5 T’s):
• Hypoxia – ventilation with 100% oxygen
• Hypovolemia (haemorrhage-trauma, GIT
bleeding,rupture of an aortic aneurysm- fluid
( saline or Hartman´s solution + urgent
surgery)
• Hypothermia (in drowning incident)
• Hyper/hypoK+and metabolic disorders
(detected by biochemical tests, renal failure)
• H+ ions (acidosis) - bicarbonate
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POTENTIALLY REVERSIBLE
CAUSES
•
•
•
•
•
(5 H’s & 5 T’s):
Tension pneumothorax- needle
thoracocentesis and chest drain
Tamponade – needle pericardiocentesis
Toxic substances – appropriate
antidotes
Thrombosis coronary - thrombolysis
Thrombosis pulmonary – trombolytic
drug
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Thoracocentesis
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Needle pericardiocentesis
Cardiac tamponade:
- difficult to diagnose
- penetrating chest
trauma – is suggestive
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Thrombosis pulmonary and
coronary
• thrombolysis
• percutaneous coronary
intervention -PCI
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DRUGS USED CPR
1. Adrenaline (EPINEPHRINE)
1 mg á 3’- 5 ’
(EVERY SECOND LOOP(5x CV 30:2) OF THE
ALGORYTHM)
alpha adrenergic actions cause vasoconstriction,
increases myocardial and cerebral perfusion pressure
2. Bicarbonate
50ml 8,4%
-pH < 7.1, BE < -10
-hyperkalaemia
-tricyclic antidepressant overdose
& equipment
• (defibrilator)
• oxygen
• Ambu bag
• face mask
• F1/1
• infusion set
• plastic IV cannula
3. Amiodarone 300 mg after a third unsuccessful
defibrillation in VF/VT...150 mg (inf. 900mg/24h)
lidocaine 1 mg/kg- alternative
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DRUG DELIVERY ROUTES
• Intravenous (central, peripheral
+ 20 ml sol. F 1/1 + elevate 10-20 s)
• Intraosseal – effective concentrations of
drugs is achieved very quickly
• Tracheal (2-3x more dose + 10 ml water)
(adrenaline, lidocaine, atropine)
• NEVER IM nor SC !!!
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EZ-IO AD Proximal Tibial Access
Intraosseous Infusion System
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Automatický intraoseálny
injektor
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Post – resuscitation care
• Stable cardiac rhythm, normal
haemodynamic function (thrombolysis,
percutaneous coronary intervention)
• Intubation, ventilation, sedation
• Therapeutical hypothermia
• Comatose adults after out-of-hospital VF cardiac arrest
were cooled to 32-34 oC for 12-24 h.
• Improved neurological outcome
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• www.erc.edu
• www.resus.org. uk
• Resuscitation (in october 2010)
• http://www.lf.upjs.sk/kaim/pregradualne
_vzdelavanie.html
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Thank you!
[email protected]
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Open chest CPR
• better coronary perfusion
• Trauma, after cardiothoracic surgery,
when chest or abdomen is already open
PROTOCOL FOR CPCR
INTERPRETATION
„Utstein in-hospital“
TIME
~
~
~
~
~
disaster call
start CPCR
emerg. team arrival
onset of circulation
living out
+ provided activities...
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HODNOTENIE VÝSLEDKOV
KPCR
• Kritériom krátkodobého výsledku KPCR
je obnovenie krvného obehu
• Kritériom dlhodobého výsledku KPCR je
návrat neurologických a psychických
schopností pacienta
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Ectopic rhythm
Normal SR
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2
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Rhythm
disorders at AMI
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Thrombus
development
Acute MI
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LIFE-THREATENING CARDIAC
RHYTHM DISTURBANCES
1. Ventricular fibrillation,
pulseless ventricular
tachycardia
2. Cardiac arrest (asystole)
3. Pulseless electrical activity
(PEA, EMD)
= circulatoty arrest
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European resuscitation counscil
• Európske guidelines týkajúce sa
resuscitácie boli publikované
Európskou radou pre resuscitáciu
(ERC) v International Journal
Resuscitation v novembri 2010.
• www. erc.edu, www.resus.org.uk
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