Cardiopulmonary Resuscitation- CPR.pptx

Cardiopulmonary Resuscitation aim to rescue both respiratory arrest and cardiac arrest

1. Cardiopulmonary Resuscitation (CPR) S a m s o n P e t e r M v a n d a l

2. Introduction CPR is needed for patient whose breathing or heart has stopped Ventilations are given to oxygenate blood when breathing is inadequate or has stopped If heart has stopped, chest compressions are given to circulate blood to vital organs Ventilation combined with chest compressions is called cardiopulmonary resuscitation (CPR) CPR is commonly given to patients in cardiac arrest as a result of heart attack

3. CAUSES OF CARDIAC ARREST

4. Causes of cardiac arrest 2. Cardiac causes 1. Extra cardiac causes All cases leading to the progressive decline of contractility, conductivity disorders, mechanical factors All cases accompanied with hypoxia

5. Causes of circulation arrest Cardiac Ischemic heart disease (myocardial infarction) Arrhythmias of different origin and character Cardiac tamponade Pulmonary artery thromboembolism Ruptured aneurysm of aorta Extracardiac/Non cardiac airway obstruction acute respiratory failure shock embolisms of different origin drug overdose poisoning 6

6. 7 INDICATIONS FOR CPR Symptoms of cardiac arrest Absence of pulse on carotid arteries Respiration arrest measurement  Taking the pulse on peripheral arteries  Auscultation of cardiac tones Taking BP Loss of time !!!

7. CPR cont… When Not to Perform CPR Patient obviously dead or clear signs of prolonged death, such as rigor mortis How long to resuscitate ? CPR can be continued for 30 minutes if the time to onset of CPR is less than 6 minutes, but if there is a delay to onset of CPR longer than 6 minutes, CPR should be terminated after 15 minutes.

8. FACTS ABOUT CPR 75% of all cardiac arrests happen in people's homes. CPR doubles a person's chance of survival from sudden cardiac arrest. There has never been a case of HIV transmitted by mouth-to-mouth CPR. Approximately 15% of patients are discharged neurologically intact

9. Facts cont… CPR provides a flow of oxygenated blood to the brain and heart and keeps these organs alive until defibrillation can shock the heart into a normal rhythm. If CPR is started within 4 minutes of collapse and defibrillation provided within 10 minutes, a person has a 40% chance of survival.

10. 11 Main stages of resuscitation A (Airway) Look in oropharynx for swelling, secretions or other object causing obstruction Noisy or abnormal breathing sounds Inability to speak or change in voice External evidence of trauma or compressive masses B (Breathing) Assess for the presence of breathing If present assess for adequacy Look for trachea deviation Decreased or absence of breath sounds NB.Current resuscitation guideline follow the sequence of CABDE not ABCDE

11. 12 A (Airway)  ensure an open airway

12. C (Circulation) Rapid assessment and management of C problems is the most important aspect for CPR Feel for a central pulse for no more than 10 seconds If present look for sign of circulatory compromise A pulse that is weak and either too fast or too slow Hypotension Evidency of poor peripheral perfusion Evidence of poor organ perfusion

13. Intervention on C Management on C problems depends on whether cardiac arrest is present or not Patients in cardiac arrest needs CPR and rapid access to AED or defibrillator Patient with shock need rapid assessment and correction of the underlying cause. The tool for circulation management includes Chest compression AED Defibrillator IV access for drugs and fluids Devices and Drugs aimed at the underlying cause

14. 15 Check the pulse on carotid artery using fingers of the other hand for 5-10 seconds If pulse is absent start CPR at once and get AED

15. 16 2 Mechanisms explaining the restoration of circulation by external cardiac massage Cardiac pump Thoracic pump

16. 17 Cardiac pump during the cardiac massage Blood pumping is assured by the compression of heart between sternum and spine Between compressions thoracic cage is expanding and heart is filled with blood

17. 18 Thoracic pump at the cardiac massage Blood circulation is restored due to the change in intra thoracic pressure During the chest compression blood is directed from the pulmonary circulation to the systemic circulation. Cardiac valves function as in normal cardiac cycle.

18. General technique of CPR Verify Scene safety Shake victim’s shoulders and shout "are you okay?" If unresponsive, not breathing, and no pulse Place victim flat on his/her back on a hard surface. Call for help Start CPR

19. General technique cont… Find the correct hand position (At the breast born) Two hands for adults One or 2 hands for child Two fingers for infant

20. General technique cont… Begin CPR cycle 30:2 for adult 15:2 for children Quality of CPR Compress chest hard and fast at a rate of 100 compressions/minute Adult = 1 1/2 to 2 inches deep Infant/child = 1/3 to 1/2 inches depth Release completely between compressions

21. General technique cont… If AED/defibrillator available Check rhythm If shock able rhythm administer 1 shock Immediately return CPR for 2 minutes then reassess rhythm If non -shockable rhythm Immediately CPR for 2 minutes then reassess rhythm

22. Placing pocket mask or BVM 1. Give 2 ventilations, each lasting 1 second 2. Determine victim has no pulse

23. Put hand(s) in correct position for chest compressions

24. Give 30 chest compressions at rate of 100 per minute Then give 2 ventilations

25. Continue CPR until: Patient begins to move You are too exhausted to continue If patient starts moving, check for adequate breathing If patient is breathing adequately, put patient in recovery position and monitor breathing CPR cont…

26. Chest Compressions Alert Be careful with your hand position Do not give compressions over bottom tip of breastbone

27. Chest Compressions Alert When compressing, keep elbows straight and hands in contact with patient’s chest at all times

28. Chest Compressions Alert Compress chest hard and fast, but let chest recoil completely between compressions. Minimize amount of time used giving ventilations between sets of compressions.

29. Problems with CPR Technique CPR often ineffective because of poor technique Compressions not delivered steadily and constantly during resuscitation efforts Often compressions are too shallow, resulting in ineffective blood flow Compressions may be given at too fast a rate Only good-quality CPR improves chances of survival

30. Chest Compressions Infant or child being given rescue breaths or oxygen may have a pulse but still inadequate perfusion If pulse < 60 beats/minute and infant or child has signs of poor perfusion, provide CPR

31. Two-Rescuer CPR for Adults and Children Minimizes time between rescue breaths and compressions CPR becomes more effective Reduces rescuer fatigue

32. Two-Rescuer CPR Performed in cycles of 30:2 for adult (15:2 for infant or child) One rescuer provides breaths, second rescuer gives chest compressions Rescuers switch positions every 2 minutes Change done after full CPR cycle Accomplish change in < 5 seconds

33. Two-Rescuer CPR continued If defibrillation present, one rescuer gives CPR while the other sets up unit If unit advises CPR, rescuers give CPR together Third rescuer can apply cricoid pressure

34. Transitioning from One-Rescuer CPR to Two-Rescuer CPR Second rescuer moves into position on other side to prepare to take over chest compressions First rescuer completes a cycle of compressions and ventilations While first rescuer pauses to check for a pulse, second rescuer finds correct hand position for compressions

35. Transitioning from One-Rescuer CPR to Two-Rescuer CPR When first rescuer says, “No pulse, continue CPR,” second rescuer begins chest compressions and first rescuer then gives only ventilations

36. Skill For CPR in Adult or Child (Two Rescuers)

37. Rescuer 1 checks ABCs. Rescuer 2 locates site for chest compressions.

38. If no pulse, rescuer 2 gives 30 chest compressions for adult (15 for child) at rate of 100/minute.

39. Rescuer 1 gives 2 recue breaths.

40. Continue cycles of 30:2 for adults (15:2 for child). After 5 cycles (~ 2 minutes) switch positions.

41. Adult or Child Two-Rescuer CPR Continued Continue CPR until: Patient moves Advanced help arrives and takes over If patient starts breathing and has pulse, put in recovery position and monitor ABCs If AED brought to scene, start AED sequence

42. Two-Rescuer CPR: Infants Uses different hand position Place thumbs of both hands on sternum while fingers encircle chest Compress breastbone with both thumbs while squeezing chest with fingers Same rate and depth as usual

43. Skills for CPR Infants (Two Rescuers)

44. Rescuer 1 checks ABCs. Rescuer 2 locates site for chest compressions.

45. If no pulse, rescuer 2 gives 15 chest compressions.

46. Rescuer 1 gives 2 breaths.

47. Infant Two-Rescuer CPR Continued Continue cycles of 15:2 for ~ 2 minutes then switch roles Continue CPR until: Infant moves Advanced help arrives and takes over If infant starts breathing, hold in recovery position and monitor ABCs

48. CPR 30:2 Attach defibrillator/Monitor Minimize interruption Assess rhythm Immediately resume CPR for 2 Min Minimize interruptions       Non shockable PEA/Asystole Immediately resume CPR for 2 Min Minimize Interruption Immediate post cardiac arrest treatment Use ABCDE approach Controlled oxygenation and ventilation 12-Lead ECG Treat precipitating cause   Call for Help Shockable (VF/Pulseless)/T Return of spontaneous circulation 1 Shock Unresponsive patient  

49. During CPR Ensure high quality CPR rate, depth and recoil Plan intervention before interrupting CPR Give oxygen Consider advanced airway and capnography Continuous chest compressions when advanced air in place Vascular access (IV,IO) Give adrenaline every 3-5 min Correct reversible causes

50. Reversible causes Hypoxia Hypovolaemia Hypo/Hyperkalaemia Hypothermia Thrombosis-pulmonary or coronary Tamponade-cardiac Toxins Tension PTX

51. Reasons to Stop CPR Patient revives. You are so exhausted you can not continue.

52. Complications of Compressions Fractured ribs Fractured sternum Lacerated lungs Lacerated liver, blood vessels, etc.,,

53. 54 Drugs used in CPR Atropine Can be injected bolus Plays significant role in some cases of cardiac arrest Increases heart rate Adrenaline Large doses have been withdrawn from the algorithm. The recommended dose is 1 mg in each 3-5 min Increases heart rate and blood pressure

54. Drugs cont… Lidocaine Low doses as local anesthetics, high dose as anti-arrhythmic

55. THE END