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Cardiopulmonary Resuscitation

Dr. Dino Irawan, SpAn., MM


SMF Anestesiologi dan Unit Perawatan Intensif
RSUD Arifin Ahmad / FK Universitas Riau
Objective:
• Identification phases of resuscitation
• Algorythm of CPR initiation
• Airway management
• Breathing support
• Circulation Support
• Drug s and fluids



Introduction
1961 : Safar devided CPR into 3 phases
• Phase I :
Basic Life Support, goals of this phase action ( ABC)
Emergency Oxygenation
• Phase II :
Advanced Life Support, goals of this phase action (DEF)
Restoration of spontaneous circulation and stabilization of the
cardiopulmonary system
• Phase III :
Prolonged Life Support, goals ( GHI) Post resuscitative brain
oriented and intensive care

Awake? / No
Breath ? / No

Airway management
Breath ?/No

Breathing Support 2x
Carotid Pulse / No

Circulation support
Airway management:
The most common site of airway obstruction in comatouse
patients :
• relaxed tongue , when patients head is in flexed or mid
position
•Foreign matter : vomitus, blood
•stimulation in stuporous or lightly comatose patients
Laryngospasm is usually caused by upper airway
• could be complete or partial obstruction, in complete
obstrc (if not corrected) leads to apnea and cardiac arrest
within 5 – 10 minute , in partial obstrc must be corrected
promptly can result in brain damage or even cardiac arrest
Recognition of Airway obtruction ;
•Can not hear and feel of air flow at the mouth
and nose for complete airway obstruction
• When patients still breathing inspiratory
retraction of intercostal and supraclavicular
• Partial airway obstruction : snoring, crowing,
gurgling, wheezing
• Hypercarbia : somnolence
• Hypoxemia : sympathetic stimulation
Manual clearing of the airway:
•The crossed finger maneuver
•Finger behind teeth manuever
•Tongue jaw lift manuever

Clearing the airway by suction

Technique for foreign body clearing
If the victim is conscious ,
• encourage to expel by coughing and spitting it out
•Apply abdominal thrust s or back blows

If the victim is unconscious
• Apply back blows or abdominal thrust in horizontal
position



Positioning to open the airway
• Head tilt
• Neck lift
• Chin lift
• Jaw thrust
Open the airway using equipment
• Oropharyngeal airway
• Nasopharyngeal airway
• Endotracheal intubation
• Cricothyroidotomy and Tracheostomy
H
Chin Lift Neck Lift




Breathing support
- Without equipment
Mouth to mouth and Mouth to nose
- Mouth to ventilation
- Bag Valve Mask with oxygen
Giving positive pressure during inspiration and
spontaneous expiration

Mouth to mouth or mouth to nose
ventilation
Exhalation consist of 16 - 18 % of
oxygen

Recognition of cardiac arrest
unconsciousness, apnea or gasping,
death like appearance(cyanosis, or
pallor), absence of pulse in large arteries
( carotid or femoral )

Circulation Support
Cardiac arrest :
• Primary : Ventricular fibrillation, asystole
caused by myocardial infarction
• Secondary : exsanguination, asphyxia
The most common caused of cardiac arrest :
Ventricular fibrillation
Closed chest cardiac compressions
External cardiac compression (C) in
combination with airway control ( A ) ,
breathing support (B) Made it possible to
promptly initiate attempts at reversal of
clinical death
The aims of cardiac compression : Initiate
artificial circulation

1 operator dan 2 operator pada pasien yang belum
terintubasi
Pada pasien yang telah terintubasi : kompresi 80-100/mnt
ventilasi 12-15/mnt
Monitoring the effectiveness of CPR
• Cheking whether the spontaneously
pulse has returned at first after 1 minute
CPR, and every 2 – 5 minute there after
• Intermittently palpating the carotid
pulse
Emergency management of hemorrhage
• Control of external hemorrhage without
surgical measures, by elevation and
compression
•Positioning of conscious patients in horizontal
with leg elevated
•ABC resuscitation initiation in unconscious
patients

Drugs and Fluids
•Routes for drugs and fluid :
• Peripheral intravenous route for the
administration of drugs and fluids should be
establish as quicly as possible after the initiation
of CPR without interrupting CPR
Drugs
Epinephrine ( Adrenaline ) may help restore
spontaneous circulation in cardiac arrest of
1 – 2 minute duration
Alpha and beta receptor activity
Alpha receptor activity is the most important in
cardiac arrest
Vasoconstriction, diastolic pressure raises, improve
myocardial and cerebral blood flow
LMA

• LMA Classic
• LMA Unique
• LMA Proseal
• LMA Fastrach
• LMA Flexible