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CPR
CPR
CPR
Cardiopulmonary resuscitation (CPR) is a series of life saving actions that improve the chance of survival following cardiac arrest
Background Cardiac arrest continues to be an all-too-common cause of premature death, and small incremental improvements in survival can translate into thousands of lives saved every year.
Immediate recognition of cardiac arrest and activation of the emergency response system Early CPR with an emphasis on chest compressions Rapid defibrillation Effective advanced life support Integrated post cardiac arrest care
Pulse check
The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally. The healthcare provider should take no more than 10 seconds to check for a pulse and, if the rescuer does not definitely feel a pulse within that time period, the rescuer should start chest compressions.
Chest Compressions
Victim on a firm surface, supine position Rescuer kneeling beside the victims chest Rescuer place the heel of one hand on the center (middle) of the victims chest (which is the lower half of the sternum) and the heel of the other hand on top of the first so that the hands are overlapped and parallel
Airway
CAB rather than ABC airway maneuvers should be performed quickly and efficiently so that interruptions in chest compressions are minimized and chest compressions should take priority in the resuscitation of an adult. head tiltchin lift maneuver jaw thrust without head extension
Rescue Breath
Deliver each rescue breath over 1 second Give a sufficient tidal volume to produce visible chest rise Use a compression to ventilation ratio of 30 chest compressions to 2 ventilations When an advanced airway is in place during 2-person CPR, give 1 breath every 6 to 8 seconds without attempting to synchronize breaths between compressions.
AED
The victims chance of survival decreases with an increasing interval between the arrest and defibrillation. cardioversion defibrillation
Hypethermia
Glucose Control
Hypoglycemia and hyperglycemia associated with worse outcomes in critically ill patients Target moderate glycemic control (144 to 180 mg/dL [8 to 10 mmol/L]) Glucose concentration within a lower range (80 to 110 mg/dL [4.4 to 6.1 mmol/L]) should not be implemented after cardiac arrest due to the increased risk of hypoglycemia
Steroids
Corticosteroids have an essential role in the physiological response to severe stress, including maintenance of vascular tone and capillary permeability No human randomized trials investigating corticosteroid use after ROSC
Seizure Management
An EEG for the diagnosis of seizure should be performed with prompt interpretation as soon as possible and should be monitored frequently or continuously in comatose patients after ROSC Thiopental and single-dose diazepam or magnesium or both given after ROSC have not improved neurological outcome in survivors The same anticonvulsant regimens for the treatment of seizures used for status epilepticus caused by other etiologies may be considered after cardiac arrest
EEG
EEG interpretation observed 24 hours after ROSC to assist with the prediction of a poor outcome in comatose survivors of cardiac arrest not treated with hypothermia
Evoked Potentials
Abnormalities in evoked potentials are associated with poor outcomes
Neuroimaging
Modalities are magnetic resonance imaging (MRI) and computed tomography (CT) of the brain detect if there any brain injury and predict functional outcome
Outcome.
Return patients to their pre arrest functional level Remain permanently unresponsive Remain permanently unable to perform independent activities
TERIMA KASIH