Cpr for adults

Cpr for adults

1. CPR FOR ADULTS
1

2. 2

4. Plan
4
Definition/Aimof CardiopulmonaryResuscitation(CPR)
Treatment of VF / PulselessVT
Treatment of non-VF/VT rhythm
Potential reversible causes of cardiac arrest
Airway, IV Access, Drugs

5. CardiopulmonaryResuscitation
(CPR) -Definition
5
Emergentmedicalapplicationsthatareperformedfora living
whoserespiratoryandcirculationfunctionshavebeenstopped
in an immediateandunexpectedstatus

6. 6
Toprovideadequateamountof oxygenatedblood
forvitalorgans
CardiopulmonaryResuscitation
(CPR) -Aim

7. 7

8. CardiopulmonaryArrest(CPR)
8
Causes:
Airwayobstruction
Respiratorydistress
Cardiacabnormalities
ACUTE MYOCARDIAL
INFARCTON

9. 9
CPR –ILCOR (InternationalLiaisonCommitteeOn Resuscitation)
American Heart Association (AHA)
European Resuscitation Council (ERC)
Heart and Stroke Foundation of Canada (HSFC)
Australian Resuscitation Council (ARC)
Resuscitation Councils of Southern Africa (RCSA)
Council of Latin America for Resuscitation (CLAR)

10. 10
CPR
Basic Life Support
Advanced Life Support
Prolonged Life Support

11. 11
CPR
Basic Life Support
Advanced Life Support
Prolonged Life Support

12. 12
CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/Pulseless VT)
Non-shockable
(PEA/Asystole)
1 Shock
150-360 J biphasic
or 360 J monophasic
Open Airway
Look for signs of life
Immediately resume
CPR 30:2
for 2 min
Call
Resuscitation
Team
During CPR:
•Correct reversible causes
•Check electrode position and
contact
•Attempt / verify:
IV access
airway and oxygen
•Give uninterrupted
compressions when airway
secure
•Give adrenaline every 3-5 min
•Consider:amiodarone,
atropine,
magnesium
Immediately resume
CPR 30:2
for 2 min
AdultALS
Algorithm

13. 13
CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/Pulseless VT)
Non-shockable
(PEA/Asystole)
1 Shock
150-360 J biphasic
or 360 J monophasic
Open Airway
Look for signs of life
Immediately resume
CPR 30:2
for 2 min
Call
Resuscitation
Team
During CPR:
•Correct reversible causes
•Check electrode position and
contact
•Attempt / verify:
IV access
airway and oxygen
•Give uninterrupted
compressions when airway
secure
•Give adrenaline every 3-5 min
•Consider: amiodarone,
magnesium
Immediately resume
CPR 30:2
for 2 min
AdultALS
Algorithm

14. 14
Open Airway
Look for signs of life
…. to confirm cardiac arrest
Patient response
Open airway
Check for normal breathing
(caution agonalbreathing)
Check circulation
Monitoring

15. 15
CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/Pulseless VT)
Non-shockable
(PEA/Asystole)
1 Shock
150-360 J biphasic
or 360 J monophasic
Open Airway
Look for signs of life
Immediately resume
CPR 30:2
for 2 min
Call
Resuscitation
Team
During CPR:
•Correct reversible causes
•Check electrode position and
contact
•Attempt / verify:
IV access
airway and oxygen
•Give uninterrupted
compressions when airway
secure
•Give adrenaline every 3-5 min
•Consider: amiodarone,
magnesium
Immediately resume
CPR 30:2
for 2 min
Adult ALS
Algorithm

16. 16
Open Airway
Look for signs of life
Call
Resuscitation
Team
Cardiac arrest confirmed
CPR 30:2
Until defibrillator /
monitor attached

17. 17
Chest Compression
30:2
Compressions
Centre of chest
5-6cm depth
100-120min
-1
Uninterrupted
compressions when
airway secured
Avoid
Provider fatigue
Interruptions

18. 18
CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/Pulseless VT)
Non-shockable
(PEA/Asystole)
1 Shock
150-360 J biphasic
or 360 J monophasic
Open Airway
Look for signs of life
Immediately resume
CPR 30:2
for 2 min
Call
Resuscitation
Team
During CPR:
•Correct reversible causes
•Check electrode position and
contact
•Attempt / verify:
IV access
airway and oxygen
•Give uninterrupted
compressions when airway
secure
•Give adrenaline every 3-5 min
•Consider: amiodarone,
atropine,
magnesium
Immediately resume
CPR 30:2
for 2 min
Adult ALS
Algorithm

19. 19
Adult ALS
Algorithm
Open Airway
Look for signs of life
Call
Resuscitation
Team
CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/PulselessVT)
Non-shockable
(PEA/Asystole)

20. 20
Adult ALS
Algorithm
Open Airway
Look for signs of life
Call
Resuscitation
Team
CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/PulselessVT)
Non-shockable
(PEA/Asystole)
CARDİAC ARREST RHYTHMS
1.VentricularFibrillation(VF)
2.PulselessVentricularTachicardia(VF)
3.Asystole
4.PulselessElectricalActivity(PEA)

21. 21
Shockable(VF)
Irregular waveform
No recognisable QRS
complexes
Random frequency and
amplitude
Uncoordinated electrical activity
Coarse /fine
Exclude artifact
movement
electrical interference

22. Monomorphic VT
broad complex rhythm
rapid rate
constant QRS morphology
Polymorphic VT
torsade de pointes
Shockable(VT)

23. Precordial Thump
Rapid treatment of a
witnessed and monitored
VF/VT cardiac arrest
Used if defibrillator not
immediately available
?

24. 1
st
shock
150 -200 J biphasic
360 J monophasic
Assess
Rhythm
Shockable
(VF/Pulseless VT)
1 Shock
150-360 J biphasic
or 360 J monophasic
Immediately resume
CPR 30:2
for 2 min

25. Defibrillation Energies
Vary with manufacturer
Check local equipment
If unsure, deliver 200 J (do not delay shock)

26. Deliver 2
nd
shock
Deliver 3
rd
shock
CPR for 2 min
If VF/VT persists
CPR for 2 min
Deliver 4
th
shock
Adrenalin,1mg iV
Amiodaron, 300 mg
2
nd
and subsequent shocks
Max. (270-360J)biphasic
360 J monophasic
Minimise delays between CPR
and shocks (< 10 s)

27. After delivery of shock
Continue CPR for another 2 min
stop CPR only if patient shows signs of life
After 2 min, assess rhythm:
If organised electrical activity, check for signs of life:
if ROSC start post resuscitation care
if no ROSC go to non VF/VT algorithm
If asystole, go to non VF/VT algorithm

28. Asystole
Pulseless Electrical
Activity (PEA)
Assess
Rhythm
Non-shockable
(PEA/Asystole)
Immediately resume
CPR 30:2
for 2 min

29. Absent ventricular (QRS) activity
Atrial activity (P waves) may persist
Rarelya straight line trace
Treat fine VF as asystole
Non-shockable
(Asystole)

30. Asystole
During CPR:
check leads are attached
adrenaline 1 mg IV every 3 –5 min

31. Clinical features of cardiac arrest
ECG normally associated with an output
Non-shockable
(PEA)

32. Pulseless Electrical Activity
(PEA)
Exclude/treat reversible causes
Adrenaline 1 mg IV every 3-5 min

33. During CPR:
Correct reversible causes
Check electrode position and contact
Attempt / verify:
-IV access
-Airwayand oxygen
Give uninterrupted compressions when airway
secure
Give adrenaline every 3-5 min
Consider: amiodarone, magnesium

34. Potential reversible causes:
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia& metabolic disorders
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis (coronary or pulmonary)
4H
4T

35. Airway and Ventilation
Secure airway:
tracheal tube
supraglottic airway device
e.g. LMA
Once airway secured, if possible, do not
interrupt chest compressions for ventilation
Avoid hyperventilation

36. Intravenous Access
Peripheral versus central veins

37. Intraosseous Access
TRACHEAL ACCESSx

38. Drugs
Adrenaline
Amiodarone
Magnesium
Thrombolytics
Sodium bicarbonate
O
2

39. Adrenaline
Actions:
agonistarterial vasoconstriction
systemic vascular resistance
cerebral and coronary blood flow
agonistheart rate
force of contraction
myocardial O
2demand
(may increase ischaemia)

40. Adrenaline
Indications:
During cardiac arrest
VF/VT –give after3
rd
shock
Non VF/VT –give immediately
Repeat every 3-5 min
1 mg IV
Cautious use after ROSC

41. Amiodarone
Actions:
Lengthens duration of action potential
Prolongs QT interval
Mild negative inotrope -may cause
hypotension

42. Amiodarone
Indications:
Shock refractory VF/VT
300 mg IV
Give after 3
rd
shock
If unavailable give lidocaine 1.5mg/kgIV

43. Atropine
Actions:
Blocks effects of vagus nerve
Increases sinus node automaticity
Increases atrioventricular conduction

44. Atropine
Indications:
Peri-arrest
Symptomatic sinus, atrial or nodal bradycardia
500 mcg IV increments to 3 mg

45. Magnesium
Hypomagnesaemia often co-exists with
hypokalaemia
Actions:
Depresses neurological and myocardial
function
A physiological calcium blocker

46. Magnesium
Indications:
VF / VT with hypomagnesaemia
Torsade de pointes
Atrial fibrillation
Digoxin toxicity
Dose:
cardiac arrest 2 g (8 mmol) IV bolus
peri-arrest 2 g (8 mmol) IV over 10 min

47. Thrombolytic Drugs
Actions:
Dissolves thrombus
Improves cerebral blood flow
Has a role in coronary thrombosis and
pulmonary embolism

48. Thrombolytic Drugs
Indications:
Cardiac arrest caused by suspected pulmonary
embolus
Can take up to 60 min to have effect
Dose:
Tenecteplase500-600 mcg kg
-1
IV over 10 sec
Alteplase(rt-PA) 10 mg IV over 1-2 min followed
by IV infusion of 90 mg over 2 h

49. Sodium Bicarbonate
Actions:
Alkalinising agent (increases pH)
Butcan:
increase carbon dioxide load
inhibit release of oxygen to tissues
impair myocardial contractility
cause hypernatraemia

50. Sodium Bicarbonate
Indications:
Life-threatening hyperkalaemia
Tricyclic overdose
Severe metabolic acidosis (pH < 7.1)
Dose:
50 ml 8.4% sodium bicarbonate IV

51. Summary
•ALS algorhythm provides a standardised approach to
cardiac arrest treatment
•Shockable rhythms (VF/pulseless VT)
•Non-shockable rhythms (Asystole, PEA)
•Reversible reasons of cardiac arrest (4H,4T)

52. LAST WORDS
Drugs role in cardiac arrest becomes after
effective chest compression, effective ventilation
with high oxygen concentration and defibrillation

53. 53
THANK
YOU…
Dr. Sule AKIN

54. 54
THANK
YOU…
Dr. Sule AKIN