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Adult Bcls
Adult Bcls
MOUTH TO MOUTH
BREATHING : MOUTH TO MASK
Breathing : AMBU BAG
Automated External Defibrillator
Electrode Placement
4 pad positions
• anterolateral,
• anteroposterior,
• anterior-left infrascapular, and
• anterior-rightinfrascapular
R
COARSE VF H
Y
T
FINE VF H
M
S
SHOCKABLE
A
R
R
E PULSELESS
S ELECTRICAL
ACTIVITY
T
R
H
ASYSTOLE
Y
T
H
M
S
NON-SHOCKABLE
Management of Cardiac
Arrest
CARDIAC ARREST
NON SHOCKABLE RHYTHM ( PEA/ ASYSTOLE )
SHOCK
CPR in PREGNANT FEMALES
Monitoring During CPR
Physiologic parameters
• Monitoring of PETCO2 (35 to 40 mmHg)
• Coronary perfusion pressure (CPP) (15mmHg)
• Central venous oxygen saturation (ScvO2)
(30ml/kg)
To keep MAP>65mm Hg
Targeted Temperature Management
• comatose adult patients with ROSC after cardiac arrest & in-
hospital cardiac arrest should have TTM for “nonshockable”)
• Core Temperature Measurement If Comatose
• Induce therapeutic Hypothermia ( if no contraindications)
• Surface or endovascular cooling
• Cold IV fluid Bolus 30 mL/kg
• Selecting & maintaining a constant temperature of 32°C–34°C×24
hours
• After 24 hours, Slow rewarming 0.25°C/hr
• to actively prevent fever in comatose patients after TTM
• routine prehospital cooling of patients after ROSC with rapid
infusion of cold intravenous fluids is NOT recommended
• An EEG for the diagnosis of seizure should be promptly
performed and interpreted, and then should be monitored
frequently or continuously in comatose patients after
ROSC.
• The same anticonvulsant regimens for the treatment of
status epilepticus caused by other etiologies may be
considered after cardiac arrest
Prognostication After Cardiac Arrest
• The earliest time to prognosticate a poor neurologic outcome
using clinical examination in patients not treated with TTM is 72
hours after cardiac arrest, but this time can be even longer after
cardiac arrest if the residual effect of sedation or paralysis is
suspected to confound the clinical examination
SINUS BRADYCARDIA
1ST DEGREE
2ND DEGREE A
MOBIZ TYPE-1 V
(WENCKEBACH
PHENOMENON) B
L
2ND DEGEREE O
MOBIZ TYPE-2 C
K
3RD DEGREE
COMPLETE HEART
BLOCK
CAUSES
• HYPOXIA
• HYPOTENSION
• ACIDOSIS
• ELECTROLYTE IMBALANCE(HYPERKALEMIA)
• DRUGS ( β-BLOCKER, CCB, DIGOXIN)/ TOXINS
• INCREASED VAGAL TONE
• INTRINSIC SA/AV NODAL DISEASE
• CONGENITAL HEART/ CONDUCTION DEFECT
• CARDIOMYOPATHY/MYOCARDITIS/MI
• ACUTE RHEUMATIC FEVER (1st Degree AV Block)
ADULT TACHYCARDIA WITH A PULSE
ALGORHYTHM
TACHYCARDIA : RECOGNITION
SIGNS/SYMPTOMS ECG
• NONSPECIFIC & Differ acc to Age of • HR > FASTER for Age
the Child A.NARROW COMPLEX(≤0.09sec)
• Palpitation 1. ST (MC) HR
• Light-headed ness/ syncope 2. SVT( MC tacchyarrythmia cardio-
• Respiratory distress vascular compromise in Infancy)
• Shock 3. ATRIAL FLUTTER
• Altered mental status B. WIDE COMPLEX ( ≥0.09sec)
• Sudden collapse with rapid ,weak 1. VT
pulse 2. SVT with Aberrant Conduction
SINUS TACHYCARDIA
N
A
SUPRAVENTRICULAR R
TACHYCARDIA R
O
W
ATRIAL FLUTTER
VT MONOMORPHIC
W
I
D
E
VT POLYMORPHIC
ACUTE CORONARY SYNDROME ALGORHYTHM
Acute Coronary Syndrome
a constellation of symptoms related to obstruction of coronary arteries with acute
chest pain being the most common symptom in addition to nausea, vomiting,
diaphoresis etc.
Chest pain concerned for ACS is often radiating to the left arm or angle of the jaw,
pressure-like in character, and associated with nausea and sweating. Chest pain is
often categorized into typical and atypical angina.
CLINICAL FEATURES
Acute coronary syndrome
• Based on ECG and cardiac enzymes, ACS is classified into:
– STEMI: ST elevation, elevated cardiac enzymes
– NSTEMI: ST depression, T-wave inversion, elevated cardiac enzymes
– Unstable Angina: Non specific ECG changes, normal cardiac
enzymes
Universal Definition of Myocardial Infarction
• The term acute myocardial infarction (MI) should be used when there is evidence of
myocardial necrosis in a clinical setting consistent with acute myocardial ischemia.
Under these conditions, any one of the following criteria meets the diagnosis for MI
• Detection of a rise and/or fall of cardiac biomarker values (preferably cardiac troponin
[cTn]) with at least one value above the 99th percentile upper reference limit (URL)
and with at least one of the following:
• • Symptoms of ischemia
• • New or presumed new significant ST-segment T-wave (ST-T) changes or new left
bundle branch block (LBBB)
• • Development of pathologic Q waves in the electrocardiogram (ECG)
• • Imaging evidence of new loss of viable myocardium or new regional wall motion
abnormality
• • Identification of an intracoronary thrombus by angiography or autopsy
Classification of Myocardial Infarction
• Type I: Spontaneous Myocardial Infarction
• Type 2: Myocardial Infarction Secondary to an Ischemic
Imbalance
• Type 3: Myocardial Infarction Resulting in Death When
Biomarker Values Are Unavailable
• Type 4a: Myocardial Infarction Related to Percutaneous
Coronary Intervention (PCI)
• Type 4b: Myocardial Infarction Related to Stent Thrombosis
• Type 5: Myocardial Infarction Related to Coronary Artery
Bypass Grafting (CABG)
ECG
STEMI:
Q waves , ST elevations, hyper acute T waves; followed by T wave inversions.
Clinically significant ST segment elevations:
> than 1 mm (0.1 mV) in at least two anatomical contiguous leads
or 2 mm (0.2 mV) in two contiguous precordial leads (V2 and V3)
Thrombosis in Myocardial Infarction (TIMI) score is a seven item tool that helps stratify patients with potential
ACSs in the ED. Patients with a score of 0 to 2 have a 2% to 9% 30-day risk of death, myocardial infarction, or
revascularization. Patients with higher scoreshave higher risks
DRUGS IN STEMI
DRUGS IN NSTEMI
REFERENCES
• AHA 2015 GUIDELINES : BLS & ACLS
• TINTINALLI’S 8TH EDITION
• HARRISON’S 19TH
• BRAUNWALD’S 10TH
Action in time can save a life!!!
THANK YOU