CPR.pptx

CPR
- DEFINITION
- INDICATION / CONTRAINDICATION
- STEPS
- MEDICINE
- ADVANCES

1. CPR (Basic Life Support / Advanced Cardiac Life Support) By , Krishna V Gandhi Rollno.10 Final Year MSC (N) - MSN SVBCON

2. OBJECTIVES To define CPR(ACLS/BLS). To understand Indication and Contraindication. To brief purpose of CPR. To explain Pathophysiology. To recognize the arrest. To demonstrate the procedure of CPR. To enlist the criteria's to stop CPR. To explain AED. To learn use of medicine in ACLS. To understand Simplified BLS and ACLS. To describe the New CPR devices used.

3. What does CPR stands for? C = Cardio (heart) P = Pulmonary (lungs) R = Resuscitation (recover) • Cardio pulmonary resuscitation is a series of steps used to establish artificial ventilation and circulation in the patient who is not breathing and has no pulse.

4. Basic life support Basic life support consist of a series of action and skills performed by the rescuer based on assessment findings. Take rapid decision because irreversible brain damage may occur within 4mins of cardiac arrest.

5. DEFINITION Cardio pulmonary resuscitation (CPR) is a technique of basic life support for the purpose of oxygenation to the heart, lungs and brain until and unless the appropriate medical treatment can come and restore the normal cardiopulmonary function.

6. DEFINITION Basic life support is a specific level of pre hospital medical care provided by trained responders, including emergency medical technicians in the absence of advanced medical care BLS generally does not include the use of drug/ invasive procedures / skills and can be contrasted with the provision of ACLS. CPR provided in the field by the time for higher medical responders to arrive and provide ACLS.

7. PURPOSE Restore cardiopulmonary functioning. • Prevent irreversible brain damage from anoxia. INDICATION • Cardiac arrest • Respiratory arrest • Combination of both

8. CONTRAINDICATION The only absolute  contraindication  to  CPR  is a do-not-resuscitate (DNR) order or other advanced directive indicating a person's desire to not be resuscitated in the event of cardiac arrest. A relative  contraindication  to performing  CPR  is if a clinician justifiably feels that the intervention would be medically futile.

9. COMPLICATION  1. RIB FRACTURES 2. FRACTURE STERNUM 3. RIB SEPARATION 4. PNEUMOTHORAX 5. HEMOTHORAX 6. LUNG CONTUSIONS 7. LIVER LACERATIONS

10. BLS CONSISTS OF THE FOLLOWING SEQUENCE OF ACTIONS: Make sure the victim, any by standers and you are safe; Check the victim for a response. Gentle shake his shoulder and ask loudly “ARE YOU ALL RIGHT???” No breathing No pulse felt within 10seconds.

11. If he responds; Leave him in the position in which you find him provided there is no further danger Try to find out what is wrong with him/her and get help if needed. Reassess him regularly. If he doesn't responds; Shout for help Turn the victim supine aligned position/stable side position.

12. RECOGNITION OF ARREST • First step is to Ensure scene safety • Check for response • Shout for help/activate resuscitation team at the time or after checking pulse and breathing • Activation of AED/emergency equipment's either by one rescuer or person sent by rescuer must occur as soon as possible after checking pulse and breathing (ideally should be done simultaneously) • Immediately begin CPR and use AED/defib when available

13. AVPU ASSESSMENT

14. Check breathing? Inspecting the chest rise of patient while palpating carotid pulse (saves time) 5 SECOND AND NOT MORE THAN 10 SEC

15. LOOK, LISTEN AND FEEL Lay rescuer can check by keeping our fingers in front of nostrils/keeping ears close to nose to check if any blow of expired air is present or not.  If a pulse is felt give one more rescue breath, every 5 to 6 sec and recheck the pulse every 2min. If no pulse are felt initiates CAB

16. POSITION ON BACK All body rolled over at the same time. Always be aware of head and spinal cord injuries. Support neck and spinal column laying patient in supine on hard surface. Hard surface allow effective compression of the sternum

17. CHEST COMPRESSION Interlock finger and arms straight, elbow locking helps maintain straight arms.  Use your upper body weight to compress.  Position of hand is midline of the nipple OR two finger above the xiphoid process of sternum

18. 100 compression / minute to max. 120/min Depth = 2inches / 5cm for adult 30 CHEST COMPRESSION FOLLOWED WITH 2 VENTILATION   In the presence of 2 rescuers chest compressions must not be interrupted for ventilation

19. CHILD CONSIDERATION DEPTH=1.5INCHES ONE RESCUER = 30:2 TWO RESCUER = 15:2

20. Chest compressions must be continued for 2 minutes before reassessment of cardiac rhythm. ► Golden rules: • Ensure high quality chest compressions: rate, depth, recoil. • Plan actions before interrupting CPR. • MINIMIZE interruption of chest compressions. • Early defibrillation of shockable rhythm.

21. AIRWAY A patent airway is essential to facilitate proper ventilation and oxygenation. Loss of consciousness often results in airway obstruction due to loss of tone in the muscle of the airway and falling back of the tongue

22. Head tilt chin lift one hand is placed on the forehead and the other on the chin the head is tilted upwards to cause anterior displacement of the tongue.

23. Jaw thrust maneuver

24. Sweep out sweep out foreign body in the mouth by index finger in unconscious pt only. This is NOT advised in a conscious or convulsing patient

25. Heimlich maneuver I f the patient is conscious or the foreign body cannot be removed by a finger sweep. It is done while the patient is standing up or lying down. This is a subdiaphragmatic abdominal thrust that elevates the diaphragm expelling a blast of air from the lungs that displaces the foreign body. In infants his can be done by a series of blows on he back and chest thrusts.

26. BREATHING Breathe for the person Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened. With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-to- mouth breathing and cover the person's mouth with yours, making a seal.

27. Mouth To Mouth Breathing With the airway held open, pinch the nostrils closed, take a deep breath and seal your lips over he patients mouth. Blow steadily into the patients mouth watching the chest rise as if the patient was taking a deep breath.

28. Mouth To Nose Breathing S eal the mouth shut and breathe steadily though the nose. used in infants and small children.

29. Pocket mask ventilation

30. Bag – Valve Mask ventilation Position yourself directly above patient’s head Use the E- C hand position (first rescuer) Make “C” with thumb and index finger of one hand. When we use 3 fingers, it forms “E” Chest rise is checked while squeezing the bag to give breaths to the patient. Depress the bag about half way to deliver the between 400-700ml of volume to make the chest rise. Give a smooth & effortless ventilation that last for 1 second.

31. This barrier helps to protect from patient blood, vomitus, saliva and the breath the air that the patient exhale. When using the pocket mask, make sure the use one of the patient size.

32. WHEN TO STOP CPR? Once started continue CPR for 30 compression followed with 2 ventilation You see the sign of return of spontaneous circulation (ROCS) such as patient movement or breathing An AED is ready to analyze the patient heart rhythm Other trained rescuer takes over and relieve you from compression/ventilation responsibilities Presented with DNR order Alone and exhausted The scene becomes unsafe

33. RECOVERY POSITION The modified HAINES (High Arm In Endangered Spine) position used for situations in which the patient is suspected to spinal injury Do the following: Kneel at the side of the patient and roll the patient towards the rescuer. Place the top leg on the other with both knee in a bent position. Align the arm of top with the upper body.

34. IF THE PATIENT IS INFANT: Carefully position the infant face down along the forearm Support the infant head and neck with your other hand while keeping the infant mouth and nose clear Keep the head and neck slightly lower than the chest

35. Automated External Defibrillator AED are a portable type of external defibrillator that automatically diagnose the ventricular fibrillation in a patient. Automatic refers to the ability to autonomously analyze the patients condition. AED is provided with self-adhesive electrodes instead of hand held paddles.

36. Using a AED Turn it on Patient chest is clearly exposed and dry Remove any medicine patch if found with a gloved hand Remove undergarment that may be in the way the pads needed to be adhered to the skin Apply the appropriate size pad Position of pad : 1 - Right clavicle 2 – Left mid axillary line few inches below the left armpit

37. Plug in the connector and push the analyze button if necessary. Tell everyone to “CLEAR”, ensure no one is touching the patient during the analysis / shock. Deliver shock by pressing shock button. Observe AED analysis and prepare for a shock to be delivered if advised. After shock delivery immediately start compression and perform about 2minutes of CPR.

38. TYPES OF AED

39. PRINCIPLES OF AED The discharge resistance which the patient represents as purely ohmic resistance of 50 to 100Ω approximately for a typical electrode size of 80cm This particular waveform Fig is called „ Lown ‟ waveform. The pulse width of this waveform is generally 10 ms. Energy storage capacitor is charged at relatively slow rate from AC line. Energy stored in capacitor is then delivered at a relatively rapid rate to chest of the patient. Simple arrangement involve the discharge of capacitor energy through the patient's own resistance.

40. MEDICINE ADRENALINE Sympathomimetic drug Action – alpha and beta adrenergic action having approximately equal activity on both receptors. Dose – IV bolus of 1mg followed by 10-20 cc NS , 3 dose in 15mins Positive Inotrope and Positive Chronotropic Precaution – should not be infused with alkaline solution. - can exacerbate ischemia and induce ventricular ectopy.

41. AMIODARONE ANTI ARRYTHMETIC drug MAIN USE IN ACLS VF/pulseless VT VT with pulse Tachycardia rate control Action – Effect on Na+ , K+, Ca++ channels, alpha & beta adrenergic blocking property, Class 3 antiarrhythmic agent. Has direct action in isolated myocardial preparation to decrease delayed slow outward k+ current and in higher doses additionally decrease fast & slow inward current due to Na++ & ca++ respectively. Dosage: In VF/VT : 300 mg bolus followed by 1MG/MIN for first 6 hours then 0.5mg / hr for next 18hrs Additional 150 mg bolus can be given for break through arrhythmic upto a load of approx 2g/24hr Can be loaded orally (800 - 1600 mg daily)

42. FOR CARDIAC ARREST Initial: 1.0 mg (1:10000) IV or 2 to 2.5 mg (1:1000) Maintain: 0.1 to 0.5 mcg/kg/min Titrate to desire blood pressure 0.3-0.5 mg IM Repeat every 5 mins as needed FOR ANAPHLAXIS

43. Adverse effect: Hypotension Bradycardia causes QT prolongation Exacerbation of CHF Phlebitis Hepatitis / Neuropathy

44. LIDOCAINE It can be used in ACLS when aminodarone is not available. Mechanism : It suppresses autonomaticity of conduction tissue in heart by increasing the electrical stimulation threshold of the ventricles, Purkinjin fibre & cause spontaneous depolarization of ventricles during diastole by direct action on the tissue. DOSAGE: 1 to 1.5 mg/kg : Dose I 0.5 to 0.75 Mg/kg : Dose II at 5-10min interval max upto 3mg/kg.

45. ATROPINE Anticholinergic, Antispasmodic Agents. 0.5 mg IV/IO every 3 to 5 minutes Max Dose: 3 mg Minimum dose 0.5 mg MAIN USE IN ACLS: Symptomatic Bradycardia, Specific Toxins/overdose (e.g. organophosphates) Cardiac and BP monitoring Do not use in glaucoma or tachyarrhythmias

46. DOPAMINE  Inotropic Agents. MAIN USE IN ACLS : SHOCK/CHF 2 to 20 mcg/kg/min Titrate to desired blood pressure Fluid resuscitation first Cardiac and BP monitoring

47. MAGNESIUM SULFATE Antidysrhythmics Cardiac Arrest: 1 to 2 gm diluted in 10 mL D5W IVP If not Cardiac Arrest: 1 to 2 gm IV over 5 to 60 min Maintain: 0.5 to 1 gm/ hr IV Cardiac and BP monitoring Rapid bolus can cause hypotension and bradycardia Use with caution in renal failure Calcium chloride can reverse hypermagnesemia

48. PROCAINAMIDE Used in the management and treatment of ventricular arrhythmias, supraventricular arrhythmias, atrial flutter, atrial fibrillation. Class  1A antiarrhythmic agent. 20 to 50 mg/min IV until rhythm improves, hypotension occurs, QRS widens by 50% MAX dose: 17 mg/kg Drip = 1 to 2 gm in 250 to 500 mL at 1 to 4 mg/min

49. NEWER INNOVATION New CPR Devices : Manual o Cardiopump o CPR RsQ assist o CPR PRO cradle o Lifebelt o Lifestick • Electric o Autopulse o Lifeline ARM o LUCAS • Pneumatic o Thumper o Lifestat o Hydraulic-pneumatic band

50. CARDIOPUMP • Handheld device • Piston having a suction cup that sticks to patient’s chest • Manual form of CPR device • Operator operates the device by hand • Alternate compression with active decompression increases venous return by decreasing intrathoracic pressure and increases overall flow

51. Light and compact • It has a handle which provides support for active compression during CPR • Manual device, operated by rescuer CPR RsQ ASSIST

52. • Manual device • Have to be operated by rescuer • Can be used for compression only because there is no decompression CPR PRO CRADLE

53. • Manual device • For compression only, no decompression • A provided levarage is pushed against the chest LIFE BELT

54. • Dual handled rigid bar with two short pistons with adhesive pads • This cyclic compressions doubles the flow and allows to decrease depth of compression and decrease injury to sternum and ribs LIFE STICK

55. • Electrically operated • Consists of a load distributing band and a backboard • The band is placed around the chest and tightened and loosened by the motor • It has a fixed compression rate of 80/min because it has a greater effect on hemodynamics at lower compression rates AUTOPULSE

56.  • Electrically operated • Piston mounted on a removable frame placed around the chest • The frame is fixed on a rigid backboard • It provides alternate compression with active decompression by a suction cup that forces thorax back to its uncompressed volume (recoil) L UCAS

57. Pneumatically operated • It has piston mounted on a arm fixed on a supporting column • Rigid backboard • It gives compressions with the rate of 100 compressions per min THUMPER

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59. SUMMARY : SIMPLIFIED BLS ACLS