You are on page 1of 51

A.M.

TAKDIR MUSBA

EMERGENCY AND TRAUMATOLOGY , 2010

Cardiorespiratory arrest is the

sudden, unexpected cessation of respiration and functional circulation.

CPCR Principle

4 6 minutes

CPCR
During respiratory and cardiac arrest, CPCR may be successful if performed before biological death of vital tissue develops.

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 arrest occurs first.

A. Cardiac asystole. B. Ventricular fibrillation or Pulseless VT Electrical defibrillation is required to reestablish spontaneous and effective cardiac electrical activity. C. Electromechanical dissociation circulatory collapse that occurs despite satisfactory electrical complexes on the ECG

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

1. Airway obstruction by 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 to poliomyelitis, muscular dystrophy, myasthenia, or muscle relaxant drugs.

Flail chest Pneumothorax Massive atelectasis Acute pulmonary embolism Congestive heart failure Overwhelming pneumonia Gram-negative septicemia Lung burns Carbon monoxide poisoning Massive blood loss.

In geriatric or pediatric patients. In patients with a history of

arrhythmias, heart block, digitalis toxicity, myocarditis , myocardial infarction, congestive heart failure, electrolyte imbalance , or dehydration. In massive hemorrhage. During or following heart surgery.

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 terminal stages of a chronic illness CPCR should be performed in cases of reversible unexpected death

Basic Life support (BLS):


Airway, Breathing, Circulation, Drug (Defibrillation )

Advanced life support (ALS):


Airway, Breathing, Circulation, Drug (Defibrillation), ECG, Fluid, Gauge, ICU

ABCD steps A, airway. B, breathing. C, circulation. D, drugs and definitive therapy.


In a witnessed cardiac arrest (when treatment can be initiated within 1 min of the onset of arrest), the ABCD sequence should include use of a precordial thump.

Precordial Thumb

Adult Basic Life Support

CHECK RESPONSIVENESS

Shake and shout

OPEN AIRWAY

Head tilt / Chin lift

If breathing: recovery position

CHECK BREATHING

Look, listen and feel

BREATHE

2 effective breaths

ASSESS 10 secs only

Signs of a circulation

CIRCULATION PRESENT Continue Rescue Breathing

NO CIRCULATION Compress Chest

Check circulation Every minute

100 per minute 15:2 ratio

Send or go for help as soon as possible according to guidelines

External Cardiac Compression

1. 2. 3. 4.

vertically downward 4-5 cm Push hard push fast 100 x/min. Ratio Comp : Vent 30 : 2

Cardiac Compression

Defibrillate up to 3 times

Ventricular fibrillation

Epinephrine several

dose options Antiarrhythmic agents


Lidocaine Bretylium Magnesium Procainamide

Search for reversible causes and treat

Epinephrine
Atropine for absolute or relative bradicardia

Epinephrine
Atropine

Consider transcutaneous pacing


Search for reversible causes and

treat if possible

Atropine Dopamine Epinephrine Transcutaneous pacing Transvenous pacing

Immediate cardioversion
Premedicate when possible Synchronized setting

Narrow-complex

Adenosine

Verapamil
Diltiazem -blockers

Digoxin
Synchronized cardioversion

Wide-complex Lidocaine Procainamide Bretylium Consider adenosine Synchronized cardioversion

It is critical to survival from sudden cardiac arrest (SCA) for several reasons:

the most frequent initial rhythm in witnessed is ventricular fibrillation (VF), (2) the treatment for VF is electrical defibrillation, (3) The probability of successful defibrillation diminishes rapidly over time, and (4) VF tends to deteriorate to asystole within a few minutes.
(1)

Defibrillation delivery of current through the chest

and to the heart to depolarize myocardial cells and eliminate VF. The energy settings for defibrillators are designed to provide the lowest effective energy needed to terminate VF. Electrophysiologic event that occurs in 300 to 500 milliseconds after shock delivery. Defibrillation (shock success) is typically defined as termination of VF for at least 5 seconds following the shock.

Biphasic defibrillator (initial shock) : selected energies of 150 J to 200 J

(biphasic truncated exponential waveform) or 120 J (rectilinear biphasic waveform). For second and subsequent shocks, use the same or higher energy

Monophasic defibrillator : select a

dose of 360 J for all shocks. If VF is initially terminated by a shock but then recurs later in the arrest, deliver subsequent shocks at the previously successful energy level.

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 as unsynchronized are likely to induce VF. If cardioversion is needed and it is impossible to synchronize a shock (eg, the patients rhythm is irregular), use high-energy unsynchronized shocks.

Ventricular tachycardia
Ventricular tachycardia with a pulse responds

well to cardioversion using initial monophasic energies of 200 J. Use biphasic energy levels of 120150 J for the initial shock. Give stepwise increases if the first shock fails to achieve sinus rhythm.

Electrode Position

Drugs should be considered only after initial

shocks have been delivered (if indicated) and chest compressions and ventilation have been started. Three groups of drugs relevant to the management of cardiac arrest (2005 Consensus Conference): vasopressors, antiarrhythmics and other drugs.

Adrenaline - the primary sympathomimetic agent

for the management of cardiac arrest for 40 years. Alpha-adrenergic actions, vasoconstrictive effects systemic vasoconstriction, which increases coronary and cerebral perfusion pressures. Beta-adrenergic actions, (inotropic, chronotropic) may increase coronary and cerebral blood flow. .

Indications Adrenaline is the first drug used in cardiac arrest of any

aetiology: it is included in the ALS algorithm for use every 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 of adrenaline is 1 mg. When intravascular (intravenous or intra-osseous) access is delayed or cannot be achieved, give 23 mg, diluted to 10 ml with sterile water, via the tracheal tube. Absorption via the tracheal route is highly variable.

Amiodarone is a membranestabilising anti-

arrhythmic drug that increases the duration of the action potential and refractory period in atrial and ventricular myocardium. Atrioventricular conduction is slowed, and a similar effect is seen with accessory pathways. Amiodarone has a mild negative inotropic action and causes peripheral vasodilation through noncompetitive alpha-blocking effects.

Indications. refractory VF/VT haemodynamically stable ventricular tachycardia (VT) and other resistant tachyarrhythmias Dose. Consider an initial intravenous dose of 300

mg amiodarone, diluted in 5% dextrose to a volume of 20 ml (or from a pre-filled syringe), if VF/VT persists after the third shock. Amiodarone can cause thrombophlebitis when injected into a peripheral vein; use a central venous catheter if one is in situ but,if not, use a large peripheral vein and a generous flush.

Indications. Lidocaine is indicated in

refractory VF/VT (when amiodarone is unavailable). Dose. an initial dose of 100 mg (11.5 mg/kg) for VF/pulseless VT refractory to three shocks. Give an additional bolus of 50 mg if necessary. The total dose should not exceed 3 mg/kg during the first hour.

Atropine. antagonises the action of the

parasympathetic neurotransmitter acetylcholine at muscarinic receptors. Blocks the effect of the vagus nerve on both the sinoatrial (SA) node and the atrioventricular (AV) node, increasing sinus automaticity and facilitating AV node conduction.

is indicated in: asystole

pulseless electrical activity (PEA) with a

rate <60/min. sinus, atrial, or nodal bradycardia when the haemodynamic condition of the patient is unstable. The recommended adult dose of atropine for asystole or PEA with a rate <60 /min is 3 mg i.v. in a single bolus.

CPR must be continued until

Cardiopulmonary system is stabilized


The patient is pronounced death Alone rescuer is physically unable to

continue

You might also like