LIFE SUPPORT

Cardio Pulmonary Arrest

Cardio Pulmonary Arrest is the sudden cessation of breathing and circulation in a patient who is not expected to die.

Why do people arrest?
 

Etiology depends upon age Child (up to 8)

Most of the time have respiratory problem (hypoxia) unless child is known case of congenital heart disease

Why do people arrest?

Adults most of the time have cardiac problem Exceptions
  

History of trauma History of drowning History of drug intoxication

BLS  Basic Life Support

Diagnosis
    

The victims are unresponsive. Their skin is ashen Respiration is agonal or absent No pulses are present in large artery The success of CPR is directly related to how soon it begins (within 3 minutes)

Speed is important

CPR should be started within 3 minutes of arrest Defibrillation should be done with in 10 minutes of vf Increase in mortality by 8% with the delay of each minute in defibrillation

Initial Steps

Verify Cardiopulmonary Arrest
   

Check unresponsiveness - Shake the Patient - may be sleeping Check the airway Check breathing Palpate carotid or brachial pulses

Call for help and ask for monitor and defibrilator position the patient supine

CHILDREN

PHONE FAST

RESUSITATE FOR 2 MINUTS THEN CALL FOR HELP

 

PALPATE BRACIAL PULSE 1 J/Kg Wt SHOCK

SOME ONE FOUND UNRESPONSIVE

Look for carotid pulse
 

Latreal to thyroid notch If absent start chest compressions

Palpate right costal margin upwards reach up to xiphiod process Start chest compressions 4cm above xiphi Rate should be 100 per minute

Basic memory aid  ABCD
   

A irway B reathing support C irculation support D efibrillation (when appropriate)

Airway Management

CLEAR AIR WAY
 

EXTEND NECK CHIN LIFT

Insert an airway

Breathing support

Mouth to Mask ventilation

Cardiac Massage

Compression : Ventilation ratio

If one person is doing CPR ratio of chest Compression and breathing should be two to fifteen (2 : 15) If two persons are doing CPR then ratio should one to five (1:5)

Two rescuer resuscitation

Choking at Food

Hemlich maneuver

Advanced Life Support

Attach Monitor As Soon As Available

Three possibilities on monitor
Ventricular Fibrillation  Asystole  Pulse-less electric activity (PEA)

Ventricular Fibrillation Algorithm
VENTRICULAR FIBRILATION PERICARDIAL THUMB DEFIBRILATION WITH 200J DEFIBRILATION WITH 300J DEFIBRILATION WITH 360J PASS ENDO TRACIAL TUBE PASS IV LINE
ADRENALINE I Mg IV PUSH REPEAT EVERY 3TO 5 MINUTES

CAN BE GIVEN IN ETT DEFIBRILATION WITH 360 J ANTARRHYTHMICS AMIODARONE MAGNESIUM

RESUME ATTEMPTS TO DEFIBRILATE

Defibrillation

Bag-valve mask ventilation

Look for breathing
 

 

Listen feel and hear Give two puffs of mouth to mouth breathing Take deep breath hold it Pinch nose of victim Make complete seal with your mouth expire with full force No leakage chest of victim should rise

Asystoly Algorithm
ASYSTOLY PASS ETT TAKE IV LINE TRANSCUTANIOUS PACING ADRENALINE I Mg IV PUSH REPEAT 3 -5 Min CAN BE GIVEN IN ETT ATOPINE I Mg IV PUSH REPEAT 3-5 Min ASYSTOLE PERSISTS CEASE CPR ?

Pulse less Electric Activity Algorithm
PEE ETT IV LINE ASSES FOR OCCULT BLOOD FLOW DIAGNOSE AND CORRECT CAUSES ADRENALINE1MG IV PUSH ATROPINE IMG IV PUSH

Causes of PEA
      Hypoxia  Hypovolemia Hyper-hypokalemia  Hypothermia  Hydrogen ions acidosis 

Tablets Tension pneumothorax Tamponade Thrombosis pulmonary Thrombosis coronary

Some rhythm strips

Multiple VPCs

Ventricular tachycardia

Narrow complex tachycardia

?

Summary-BLS

 

Patients who are not expected to die can be revitalized by prompt CPR Basic life support is done with bare hands Call for help Follow basic mnemonic ABC
  

Airway clearance Breath into patient Cardiac massage for circulation support

Summary- ALS
 

When the help arrives, attach monitors Follow appropriate algorithm
    

Defibrillate if VF Pass endotracheal tube and ventilate with bag Establish IV access for drugs (remember drugs can be given via endotracheal tube) Give adrenaline to asystole patients Try finding the cause of PEA and reverse it as appropriate
  

Antidotes Release pressure from pleura/pericardium Give fluids to hypovolemic patients