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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.

The brain depends totally on oxygen and is the organ least able to withstand hypoxia. Degree of preexisting hypoxia of the cells. The whether circulatory or respiratory arrest occurs first. 3.1. . 2.

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

9. 4. Hyperthermia 10. 8. Stimulation of the heart. 6. Hyperkalemia. Hyparcapnia. Hypothermia.1. 7. Coronary occlusion. Overdosage. Low cardiac output. Hypoxia and vagal stimulation. 3. Acidosis . 2. 5.

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or tumor. muscular dystrophy. or anesthetics. mucous plugs.narcotics. hypercapnia. head trauma. 3. solid material. tranquilizers. Airway obstruction by vomitus. CNS depression: caused by stroke. or muscle relaxant drugs. 2. laryngeal or bronchial spasm.1. secretions. blood. barbiturates. myasthenia. . foreign body. Neuromuscular failure secondary to poliomyelitis.

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.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 patients with a history of arrhythmias. congestive heart failure. heart block. electrolyte imbalance . myocarditis . or dehydration.  During or following heart surgery. In geriatric or pediatric patients.  In massive hemorrhage. digitalis toxicity. . myocardial infarction.

 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 . Underlying condition must be corrected.The initial goal of therapy is BRAIN oxygenation The second goal is restoration of circulation.

Breathing. Breathing. ICU . Drug (Defibrillation). Fluid. Drug (Defibrillation ) Advanced life support (ALS): Airway.Basic Life support (BLS): Airway. Circulation. ECG. Circulation. Gauge.

In a witnessed cardiac arrest (when treatment can be initiated within 1 min of the onset of arrest). circulation. C.ABCD steps A. the ABCD sequence should include use of a precordial thump. D. breathing. drugs and definitive therapy. . B. airway.

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 .

4. 2. 3. Ratio Comp : Vent  30 : 2 .External Cardiac Compression 1. vertically downward 4-5 cm Push hard push fast 100 x/min.

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Cardiac Compression .

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 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). and (4) VF tends to deteriorate to asystole within a few minutes. (3) The probability of successful defibrillation diminishes rapidly over time. (2) the treatment for VF is electrical defibrillation. (1) .

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 Defibrillation  delivery of current through the chest and to the heart to depolarize myocardial cells and eliminate VF.  Defibrillation (shock success) is typically defined as termination of VF for at least 5 seconds following the shock.  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.

use the same or higher energy . 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.

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

 These low-energy shocks if delivered as unsynchronized are likely to induce VF. Shock delivery that is timed (synchronized) with the QRS complex. the patient’s rhythm is irregular). . use high-energy unsynchronized shocks.  If cardioversion is needed and it is impossible to synchronize a shock (eg.  The energy (shock dose) used is lower than that used for unsynchronized shocks (defibrillation).

 Ventricular tachycardia  Ventricular tachycardia with a pulse responds well to cardioversion using initial monophasic energies of 200 J.  Use biphasic energy levels of 120—150 J for the initial shock.  Give stepwise increases if the first shock fails to achieve sinus rhythm. .

Electrode Position .

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antiarrhythmics and other drugs. 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. .

 Beta-adrenergic actions. which increases coronary and cerebral perfusion pressures. . . vasoconstrictive effects  systemic vasoconstriction. (inotropic.the primary sympathomimetic agent for the management of cardiac arrest for 40 years. Adrenaline .  Alpha-adrenergic actions. 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 3—5 min of CPR. via the tracheal tube.  Adrenaline is preferred in the treatment of anaphylaxis. Absorption via the tracheal route is highly variable.  When intravascular (intravenous or intra-osseous) access is delayed or cannot be achieved. the initial intravenous dose of adrenaline is 1 mg. diluted to 10 ml with sterile water. During cardiac arrest. give 2—3 mg.  Dose.  Adrenaline is second-line treatment for cardiogenic shock. .

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

 Indications. use a central venous catheter if one is in situ but.  refractory VF/VT  haemodynamically stable ventricular tachycardia (VT) and other resistant tachyarrhythmias  Dose.if not. use a large peripheral vein and a generous flush. 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. Consider an initial intravenous dose of 300 mg amiodarone.

 Indications.  Dose.5 mg/kg) for VF/pulseless VT refractory to three shocks.  The total dose should not exceed 3 mg/kg during the first hour. Lidocaine is indicated in refractory VF/VT (when amiodarone is unavailable).  Give an additional bolus of 50 mg if necessary. . an initial dose of 100 mg (1—1.

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

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

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 CPR must be continued until  Cardiopulmonary system is stabilized  The patient is pronounced death  Alone rescuer is physically unable to continue .