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CARDIO PULMONAL

RESUSCITATION
Oleh :
Dr Achmad Syauqi Sp An

CARDIO PULMONAL RESUSCITATION


This chapter presents

an overview
of the
American and the International Liaison Commite
on Recuscitation
( ILCOR) year 2000
recommendation
for
establishing
and
maintaining the ABCDs of
cardiopulmonary
resuscitation
:
airway,
breathing,
circulation,deffibrillation
For the health care provider, deffibrillation using
biphasic
electrical
current
works
best,
endotracheal tube (ETT) placement should be
confirmed with a qualitatife end-tidal CO2 device
bretylium is no longer reccommended but
vasopressin.

Adult Cardiac Arrest


BLS algorithm
Precordial thump if
appropriate

Attach
defribilator/monitor
Assess
rhythm
VF/VT

Attempt defribilation
x 3 as necessary

CPR 1 Minute

Chek
pulse

During CPR
-Chek elektrode /paddle position and
contact
- attempt to place, confirm, secure airway
- attempt and ferify IV access
- patient with VF/VT refractory to initial
syocks :
a. ephinephrine 1 mg IV, every 3 to 5
minutes
Or
b. Vassopressin 40 u IV ,single dose, 1
time only
-Patients with non VF/VT rhythms :
ephinephrine 1 mg IV, every 3 to 5
minutes
-Consider : buffers, antiarhytmics, pacing
- search for and correct refersible causes

Non VF/VT

CPR up to 3
minutes

CONSIDER CAUSES THAT ARE POTENTIALLY


REFERSIBLE
1.HYPOVOLEMIA
2.HYPOXIA
3.HYDROGEN ION- ACIDOSIS
4.HYPER/HYPOKALEMIA, OTHER

METABOLIK
5.HYPOTHERMIA
6. TABLETS (drug OD, accidents)
7.TAMPONADE, CARDIAC
8.TENSION PNEUMOTHORAX
9.THROMBOSIS, CORONARY (ACS)
10.
THROMBOSIS, PULMONARY (EMBOLISM)

AIRWAY
Although the A of the mnemonic
ABC stands for airway. It should also
stand for the initial assesment of the
patient, before CPR is initiated,
unresponsivenessis established and
the emergency response system
activated.

Person collapses
Possible cardiac arrest
Assess responsiveness

Begin primary
ABCD survey

B give 2 slow breaths


C assess pulse, if no pulse
C start chest compressions
D attach monitor
defibrilator when available

CPR continues
Assess rhythm
Attempt
defibrilation

CPR for
1 minute

Non VF/ VT

SECONDARY ABCD SURVEY


-Airway : attempt to place airway device
- Breathing : confirm and secure airway device
ventilation oxygenation
- Circulation : gain intravenous access , give adrenagic
agent
NON VF/VT patient
ephinephrine 1 mg IV, repeat every 3 to 5
minutes
VF/VT patients
- Vassopressin 40 u IV ,single dose, 1 time only
or
- ephinephrine 1 mg IV, repeat every 3 to 5
minutes
- Differential diagnosis

CPR up
to 3
minutes

Occlusion of the airway by the tongue


can be relieved by a head -tilt chin - lift

Or a jaw thrust

In patient with possible cervical


spine injury

Or lying down

The hands are positioned slightly above the navel and


well below the xypoid process

Summary of the recommended


basic life support techniques
INFANT (1-12
mo)

CHILD (>
12)

ADULT

Breathing rate

20 breath/min

20 breath/min 10-12
breaths/min

Pulse check

brachial

carotid

carotid

compression rate

> 100/min

100/min

100/min

Compression
methot

Two or three
fingers

Heel of one
hand

Hands
interlaced

Ventilation ratio

5:1

5:1

15 : 2

Foreign body
obstruction

Back blows and


chest thrusts

Heimlich
maneuver

Heimlich
maneuver

BREATHING
Assesment of spontaneus breathing should

immediately follow the opening of the`


establishment of the air way.
Ventilation should not be delayed for
intubations if a patent airway is
estaetablished by a jaw-thrust manuever.
Apnew is a confirmed by breath sound and
lack of airflow.

circulation
after succesful delifery of two initial
breaths,the circulation must be rapidly
assessed health care providers are advised in
the 2000 to continue to check for a pulse.
if the patient has an adequate pulse or
blood presure, breathing is continued at 10-12
breath/ min for an adult or a child older than 8
years, and 20 breaths/min for an infant or a
child up to 8 years of age. guidelines

DEFIBRILLATION
Ventricular fibrillation is found most
commonly in adults who experience
nontraumatic cardiac arest. the time
from collapse to defibrillation is the
single most important determinant of
survival. The chanches for survival
decline 7-10 for every minutes
withoud devibrilation.

Energi requirements for cardioversion and defibrilation using


monophasic damped sinusoidal wavwform shocks
FIRST
Unstable atrial fibrilation

SECON
D

THIRD

SUBSEQUE
NT

100200

100-200

100300

360

adult

50

100

200

360

child

0,51/Kg

2/kg

4/kg

4/kg

100

200

200300

360

adult

200

200-300

200360

360

child

2/kg

4/kg

4/kg

4/kg

Unstable paroxysmal atrial


tacicardia

Monomorphic ventricular
tachicardia
Ventricular vibrilation

Algoritm for treathing VF/VT


Primary
Primary ABCD
ABCD survey
survey

---A
A
--B
B
--C
C
--D
D

Focus
Focus :: basic
basic CPR
CPR and
and defibrilation
defibrilation
-- Check
responsivenees
Check responsivenees
activate
activate emergency
emergency response
response system
system
-call
for
defibrilator
call for defibrilator

AIRWAY
:: open
AIRWAY
open the
the airway
airway
BREATHING
:: provide
BREATHING
provide positive-presure
positive-presure ventilation
ventilation
CIRCULATIONS
:
give
chest
compression
CIRCULATIONS : give chest compression
DEFIIBRILATION
DEFIIBRILATION :: asses
asses for
for and
and shock
shock VF/
VF/ pulseless
pulseless VT,
VT, up
up to
to 3
3 times
times if
if necesserry
necesserry

-- ephinephrine
ephinephrine 1
1 mg
mg
IV,
IV, repeat
repeat every
every 3
3 to
to
5
minutes
5 minutes
-- Sopressin
Sopressin 40
40 U
U IV
IV ,,
single
dos
single dos

RESUME
RESUME ATTEMPS
ATTEMPS TO
TO
DEFIBRILATE
DEFIBRILATE

Rhythm after
first 3 shocks
Persistent or
reccurrent
VF/VT

Secondary ABCD survey

CONSIDER ANTIAAHYMICS

RESUME ATTEMPTS TO DEFIBRILATE

THANKS YOU