Cpr 2010

SANIL VARGHESE

CARDIOPULMONARY

RESUSCITATION

HISTORICAL REVIEW

• In the 19th century, Doctor H. R. Silvesterdescribed a method “The Silvester Method”.

• Holger Neilson technique was in the United States in 1911.

• In the 20th century at Johns Hopkins University where the technique of CPR was originally developed. The first effort at testing the technique was performed on a dog by Redding, Safar and JW Perason. Soon afterward, the technique was used to save the life of a child.

• Peter Safar wrote the book ABC of resuscitation in 1957.

CPR For Health Care Providers

• Adult

• Child

• Infant

Terminology

• BLS / BCLS

• ALS / ACLS

• Respiratory Arrest

• Arrest, Cardiac Arrest, Code, Code Blue

• Ventilations

5

Diagnosis of cardiac arrest

Symptoms of cardiac arrest3 absence of pulse on carotid arteries – a

pathognomonic symptom

3 respiration arrest – may be in 30 seconds after

cardiac arrest

3 enlargement of pupils – may be in 90 seconds after

cardiac arrest

Blood pressure measurement

Taking the pulse on peripheral arteries

Auscultation of cardiac tones

Loss of time !!!

AMERICAN HEART ASSOCIATION:

2010 GUIDELINES

Health Care Provider*

“PUSH HARD AND PUSH FAST”

At least 100 COMPRESSIONS / MINUTE*

Allow the chest to recoil -- equal compression and relaxation times

<10 seconds for pulse checks or rescue breaths

Compression Depth*

Adults 2”

Child/Infant 1/3 depth of chest 1.5" infant 2" child

Avoid excessive ventilations

A-B-C changed to C-A-B*

Critical element is chest compressions

Delay in A-B

Avoidance of A & B

Early defib

If alone--call and retrieve AED

Exception asphyxial arrest

AMERICAN HEART ASSOCIATION:

2010 GUIDELINES

AMERICAN HEART ASSOCIATION:

2010 GUIDELINES

• Cricoid pressure not recommended

• Advanced airway = 1 every 6-8 seconds

• Adult: 1 every 5-6 Peds: 1 every 3

• With advanced airway- no pause

AMERICAN HEART ASSOCIATION:

2010 GUIDELINES

AHA ECC Adult Chain of Survival - New

Simplified Universal

BLS algorithm

AMERICAN HEART ASSOCIATION:2010 GUIDELINES

Electrical Therapies

• Shock first vs CPR first

• No precordial thump

• CPR devices – no data for

• AED in hospital (goal to shock =< 3 mins)

• Use in infants (with or without attenuator)

AMERICAN HEART ASSOCIATION:

2010 GUIDELINES

ACLS• Simplified algorithm

• Optimized CPR quality with monitoring

• Waveform capnography (>12 mmHg)

• Atropine deleted (PEA/Asystole)

• Chronotropic drugs for brady, then pacing

• Adenosine safe for monomorphic wide tachs

• Post-cardiac arrest

AMERICAN HEART ASSOCIATION:

2010 GUIDELINES

AMERICAN HEART ASSOCIATIONCAPNOGRAPHY

AMERICAN HEART ASSOCIATION:

2010 GUIDELINES

Post-Cardiac Arrest – ROSC

• Therapeutic Hypothermia

– Remain comatose

– 32-34 degree C (all ages) (89.6-93.2 F)

– 12-24 hours

• PCI

• O2 sat ≥94% & PETCO 35-40

AMERICAN HEART ASSOCIATION:

2010 GUIDELINES

• Asthma

• Anaphylaxis

• Pregnancy

• Morbid obesity

• PE

• Electrolyte imbalance

• Toxins

Special Resuscitation Situations

• Hypothermia

• Avalanche

• Drowning

• Electric shock/lightening

• PCI

• Cardiac tamponade

• Cardiac surgery

AMERICAN HEART ASSOCIATION:

2010 GUIDELINES

Acute Coronary Syndromes

• Out of hospital 12-lead

• Triage to PCI

• Oxygen – > 94 % is the goal (capno)

• Morphine – use with caution in UA/non-STEMI

AMERICAN HEART ASSOCIATION:

2010 GUIDELINES

Stroke

• Stroke-prepared hospitals

• Triage to stroke centers

• TPA up to 4.5 hours

18

C. CirculationRestore the circulation, that is

start external cardiac massage

Hand Position

• At the nipple line

• Off the zyphoid process

2 fingers = infant

1 hand = child

2 hands = adult

20

A (Airway)

ensure open

airway

21

Open the airway using a head

tilt lifting of chin. Do not tilt the

head too far back

Check the pulse on

carotid artery using

fingers of the other hand

22

B (Breathing)

Tilt the head back

and listen for. If

not breathing

normally, pinch

nose and cover

the mouth with

yours and blow

until you see the

chest rise.

VENTRICULAR FIBRILLATION OR PULSELESS TACHYCARDIA

23

Witnessed Unwitnessed

Precordial thump

Check pulse, if none:

Begin CPR

Defibrillate with 200 joules

Defibrillate with 200-300 joules

Establish IV access, intubate

Adrenaline 1 mg push

Defibrillate with 360 joules

Lidocaine 1 mg/kg IV, ET

Defibrillate with 360 joules

24

Operations in case of asystole

Asystole

• Start CPR

• IV line

• Adrenaline:IV 1 mg, each 3-5 min.

-or

- intratracheal 2 - 2.5 mg

- in the absence of effect increase

the dose

-Atropine 1 mg push (repeated once

in 5 min)

•Na Bicarbonate 1 Eq/kg IV

•Consider pacing

25

Drugs used in CPR

• Atropine – can be injected bolus, max 3 mg to

block vagal tone, which plays significant role in

some cases of cardiac arrest

• Adrenaline – large doses have been

withdrawn from the algorithm. The

recommended dose is 1 mg in each 3-5 min.

• Vasopresine – in some cases 40 U can

replace adrenaline

• Amiodarone - should be included in algorithm

• Lidocaine – should be used only in ventricular

fibrillation

Public Access Defibrillation -PAD

• Casinos

• Airports

• City buildings

• Senior centers

• Gated communities

Complications of Compressions

• fractured ribs

• fractured sternum

• lacerated lungs

• lacerated liver, blood vessels, etc,.

2010 AHA GUIDELINESRecommendations

Component Adults Children Infants

Recognition Unresponsive (for all ages)

No breathing or no normalbreathing (ie, only gasping)

No breathing or only gasping

No pulse palpated within 10 seconds for all ages (HCP only)

CPR sequence C-A-B

Compression rate At least 100/min

Compression depth

At least 2 inches (5 cm)

At least 2 inches (5 cm)

About 1. inches (4 cm)

Recommendations

Component Adults Children Infants

Chest wall recoil Allow complete recoil between compressionsHCPs rotate compressors every 2 minutes

Compression interruptions

Minimize interruptions in chest compressionsAttempt to limit interrruptions to <10 seconds

Airway Head tilt–chin lift (HCP suspected trauma: jaw thrust)

Compression-to-ventilationratio (until advancedairway placed)

30:21 or 2 rescuers

30:2Single rescuer

15:22 HCP rescuers

Ventilations: when rescueruntrained or trained andnot proficient

Compressions only

Ventilations with advancedairway (HCP)

1 breath every 6-8 seconds (8-10 breaths/min)

Asynchronous with chest compressionsAbout 1 second per breath

Visible chest rise

Defibrillation Attach and use AED as soon as available. Minimize interruptions in chest compressions before and after shock;resume CPR beginning with compressions immediately after each shock.

Thank you