Cardio-pulmonary Cerebral Resuscitation (CPR) Prof. M. H. Mumtaz Prof. M. H. Mumtaz
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Cardio-pulmonary Cerebral Resuscitation
(CPR)
Prof. M. H. MumtazProf. M. H. Mumtaz
PHASES
IBasic Life
Support (BLS)(ABC)
IIIProlonged Life Support (PLS)
(GHI)
IIAdvanced Life Support (ALS)
(DEF)
B L S
Tilt Head.
Lift Neck.
Support Chin.
A. AIRWAY
If Unconscious ?
B L S
Lung Inflation.– Mouth to Mouth.– Mouth to Nose.– Mouth to Tube.– Bag-wash.
B. BREATHE
If not breathing ?If not breathing ?
C. CIRCULATE
One Operator
Two Operators
B L SB L S
Cause
Nervous System.
Myocardium.
Sympathetic
Parasympathetic
Phase TwoAdvanced Life Support
(Restoration of Spontaneous Circulation)
Adrenaline. Alkali. Fluids.
D. DRUGS & FLUIDS
E. EKG
VentricularFibrillation
Asystole
BizarreComplexe
F. FIBRILLATION TREATMENT
Ext Defibrillation.
Lignocain.
Biochemical Changes
METABOLIC ACIDOSIS
Anaerobic Metabolism Myocardial Cont.
Actions of Catech.
Threshold for VF.
Restoration of N. Beat.
S. Vasodilatation.
Pul. Vasoconstriction.
Potassium.
Bicarbonate.
Biochemical Changes
H-CO3 + H+ H2CO3 CO2 + H2O
ECFK+
Lungs KidneyH +
ICF
Correction Bicarbonate Therapy: (CO2 Producing) H-CO3 + H+ H2CO3 CO2 + H2O
Carbonate Therapy: (Non CO2 Producing)
– Routine Indications Base Deficit > 10 Meq/L PH < 7.20 HCO3 < 14 Mmol/L
Meq HCO3 = Base Deficit X wt. (kg) X .3
Correction Problems
– A. Alkalosis. - K+
- O2 Dissociation - Left Shift.
- Depression of Myocard.– B. Sodium Over Load.
Oxygenation Ventilation.
Total Oxygen at Arrest1500-1600 mls
Lungs = 370 mls.Tissues = 60 mls.Muscles = 240 mls.Blood = 800-1000 mls.
(Arterial = 280-300)Venous Capillary = 600-700
Critical Survival Time
A M O U N T R E Q U I R E D / M I NF O R M E T . = 2 5 0 m l s
C R I T I C A L S U R V I V A L T I M E
1 0 0 0 T O 1 5 0 0= = 4 - 6 m i n
2 5 0
Requirement
Drugs Atropine. Adrenaline. Calcium. Glucagon . Isoprenalin. Dopamine. Debutamine. Lignocaine.
Equipment Trained Doctor . Laryngoscope. Tube (ETT). Ambu Resuscitation. Defibrillator with Oscilloscope.
Emergency-Fluid Resuscitation
Primary volume therapy
“Fill from inside out”
ICS
VesselISS
insideout
A New Concept
Small Volume Hyperosmolar Saline
Colloid Resuscitation
4 ml/kg - 7.2-7.5% NaCl/Colloid
interstitium interstitium
Shock Small-volume hyperosmolar resuscitation
endothelial cell
Flow Flowerythrocyted d
Physiological & Basic Mechanisms
Plasma osmolality= 285-295 mosmol/kg. 7.2% NaCl = 2400 mosmol/kg. End bolus infusion = 460 mosmol/kg.
(4 ml/kg).– Ttransmembrane osmotic gradient. – Endogenous fluid mobilization. (most pronounced in capillary districts) – Plasma volume.– Hydraulic resistance.– Tissue perfusion.
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