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15563CPR
15563CPR
RESUSCITATION (CPR)
By
L/O/G/
Ahmed hassanein
A.
O Professor of anesthesia, ICU and pain management
1
What does CPR stands for?
• C = Cardio (heart)
• P = Pulmonary (lungs)
• R = Resuscitation (recover)
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DEFINITION
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• Cardio pulmonary resuscitation is a series
of steps used to establish artificial
ventilation and circulation in the patient
who is not breathing and has no pulse.
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PURPOSE
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INDICATION
• Cardiac arrest
• Respiratory arrest
• Combination of both
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Causes of cardiac arrest
Hypoxia
Hypotension
Hypothermia
H acidosis
Hypokalemia
hypoglycemia
Causes of cardiac arrest
Tamponad cardiac
Tension pneumothorax
Thromboembolism(pulmonary, coronary)
Toxicity( local anesth., digoxin,….)
Diagnosis of cardiac
arrest
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Diagnosis of cardiac arrest
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0
HOW CPR WORKS:
The air we breathe in, travels to our lungs were
oxygen is picked up by our blood and then
pumped by the heart to our tissue and organs.
When a person experiences cardiac arrest-
whether due to heart failure in adults or the elderly
or an injury such as near drowning, or severe
trauma in a child-the heart goes from a normal
arrhythmic pattern called ventricular fibrillation,
and eventually ceases to beat altogether.
This prevents oxygen from circulating throughout
the body, rapidly killing cells and tissue.
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• Inessence, cardio (heart) pulmonary(lung)
resuscitation (revive, revitalize) serves as an
artificial heartbeat and an artificial respirator.
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EQUIPMENTS
• A hard flat surface.
• Airway equipment.
• Suction equipment.
• Intravenous equipment.
Phases Steps
F=
fibrillation
Phase-3 Prolonged life Post resuscitation care
support
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4
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CHAIN OF SURVIVAL
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1) EARLY RECOGNITION
Assessment is of crucial importance. It
includes :
1) Unresponsiveness
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2) No breathing or no normal breathing (i.e,
only gasping)
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3) No pulse felt within 10 seconds.
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2) CPR Sequence
Compression
Airway
Breathing
(A) Chest compressions (cardiac
massage)
The human brain cannot survive more than
3 minutes with lack of circulation. So
chest compressions must be started
immediately for any patient with absent
central pulsations.
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TECHNIQUE OF CHEST COMPRESSION
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• The other hand is placed over the hand on the sternum.
• Shoulders should be positioned directly over the hands
with the elbows locked straight and arms extended. Use
your upper body weight to compress.
• Sternum must be depressed atleast 5 cm in adults, and
2-4 cm in children, 1-2 cm in infants .
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3
PUSH HARD AND PUSH FAST
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RATE OF COMPRESSIONS
Must be performed in a rate of 100-120
30 2 26
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Chest compressions in infants (0-12
months)
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1.RIB FRACTURES
2.FRACTURE STERNUM
3.RIB SEPARATION
4.PNEUMOTHORAX
5.HEMOTHORAX
6.LUNG CONTUSIONS
7.LIVER LACERATIONS
8.FAT EMBOLI
9.HIV, HEPATITIS 10.INFECTIONS
Airway
2) Jaw thrust:
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Breathing: Breathe for the person
Assessment of restoration
ofbreathing and circulation
Contraction of pupil
Improved color of the skin
Free movement of the chest wall
Swallowing attempts
Struggling movements
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•Struggling movements
•Improved color
•Return of or strong pulse
•Return of systemic blood pressure
When to terminate BLS
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ALS includes:
CHEST COMPRESSION
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1) Face Mask
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2) Oropharyngeal airway
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3) Nasopharyngeal airway
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5) Endotracheal tube
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6) Combitube
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BREATHING
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• Expired air
= 16% O2
• Ambu Bag + O2 +
Reservoir bag = 85%
O2
3) DEFIBRILLATION
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• Alternatively antero-
posterior position
may be used: one
paddle is placed in
the left infrascapular
region while the other
is placed in the left
5th-6th intercostal
space anterior
axillary line.
•
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► Adrenaline:
-Given as a vasopressor α-1 effect (not as an
inotrope).
-Dose: 1 mg (0.01 mg/kg) IV every 4 minutes
(alternating cycles) while continuing CPR.
-Given:
1) Immediately in non-shockable rhythm (non-VT/VF).
2) In VF or VT given after the 3rd shock.
-Repeated: in alternate cycles (every 4 minutes).
-Once adrenaline → ALWAYS adrenaline.
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Amiodarone:
- Dose: 300 mg IV bolus (5 mg/kg).
- Given: in shockable rhythm after the 3rd
shock.
- If unavailable give lidocaine 100 mg IV
(1-1.5 mg/kg).
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- Dose: 2 g IV.
- Given:
1- VF / VT with hypomagnesemia. 2-
Torsade de pointes.
3- Digoxin toxicity.
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► Calcium:
– Dose: 10 ml of 10% Calcium chloride IV.
– Indications: PEA caused by: hyperkalemia,
hypocalcemia, hypermagnesemia, and overdose of
calcium channel blockers.
– Do NOT give calcium solutions and NaHCO3
simultaneously by the same route.
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► IV Fluids:
► Thrombolytics:
• Fibrinolytic therapy is considered when cardiac
arrest is caused by proven or suspected acute
pulmonary embolism.
its complications:
1Increases CO2 load:
2Inhibits release of O2 to tissues. 3- Impairs
myocardial contractility. 4- Causes
hypernatremia.
5- Adrenaline works better in acidic medium.
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Atropine:
• Control of seizure
• Temperature control
• Treatment of hyperpyrexia
• Treatment of hypothermia
• Blood glucose level
Managing the Cardiac
Arrest TeaM
►During cardiac arrest the
team leader should allocate and assign the various roles
and tasks to the team members.
Assign one person for each of the following roles:
– Airway management & ventilation (Eg.bag & mask.
Intubation).
– Chest compressions
– .
– IV drug administration.
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THANK YOU