(Resuscitation in ICU) lecture of resuscitation.pptx

This lecture talk about resuscitation in ICU

1. Resuscitation in ICU Dr . Hanan Beshr

2. EARLY RECOGNITION PREVENTS : Cardiac arrests and deaths Admissions to ICU Inappropraite resuscitation attempts

3. THE ABCDE appraoch to the deteriorating patients : A irway B reathing C irculation D isability E xposure

4. Airway The aim of the airway assessment is to establish and maintain patent airway . The patient’s can be clear (if the patient is talking . Partially obstructed ( if air entry is diminished and often noisy) or completely obstructed ( if there are no breath sounds at the mouth or nose)

5. AIRWAY Causes of airway obstruction : CNS depression Blood Vomit Foteign body Trauma Infection e.g., Diphtheria Inflammation laryngospasm Bronchospasm

6. Assessing the airway Talking Difficulty breathing, distressed, chocking Shortness of breath Noisy breathing ( Stridor , wheeze, Gurgling) See-saw respiratory pattern, accessory muscles

7. search Note : What are the accessory muscle s that used in respiratory distress ?

8. Treatment of airway obstruction Airway opening : Head tilt, chin lift and jaw thrust If suspected cervical spine injury : manual inline stabilization Maintain opening by simple adjuncts: S upraglottic airway devices : Oropharyngeal airways Nasopharyngeal airways Laryngeal mask airways Infraglottic airway devices : Endotracheal intubation

9. HEAD TILT- CHIN LEFT \ JAW THRUST

10. MANUAL IN LINE STABILIZATION

11. OROPHARYNGEAL AIRWAY

12. LARYNGEAL MASK

13. NASOPHARYNGEAL AIRWAY

14. SIZING OF OROPHARYNGEAL AIRWAY

15. ENDOTRACHEAL TUBE

16. Causes of breathing problems : Decreased respiratory drive : CNS depression Decreased respiratory effort : - Muscle weakness Nerve damage Restrictive chest defect Pain from fractured ribs lungs disorders Pneumothorax , Hemothorax ,Infection ,Acute exacerbation COPD ,Asthma , pulmonary embolus, ARDS

17. RECOGNITION OF BREATHING PROBLEMS 1 . Look - Respiratory distress , accessory muscle , cyanosis , respiratory rate , chest deformity , conscious level 2 . Listen - Noisy breathing , breath sounds 3 . Feel - Expansion , percussion Note : For 10 seconds

18. obstructed airway A patient who is chocking typically has a panicked , confused or surprised facial expression . They may run about, flail their arms or try to get another’s attension The patient may palce one or both hands on their throat. This act of clutching the thraot is commonly referred to as the universal sign of chocking

19. obstructed airway

20. obstructed airwy Encourage coughing forcefully If the patient cannot breath or has a weak or ineffective cough perform abdominal thrust or back blows

21. DISABILITY AVPU or GCS A : Alert V : Response to verbal stimuli P : Response to painful stimuli U : Unresponsive Pupils

22. AFTER YOU FINISH: Investigation Consutation of specialists Continuous assessment

23. Exposure Remove clothes to enable examination e.g., ijuries, bleeding, rashes Avoid heat loss Maintain dignity

24. Causes of circulation problems : PRIMARY Acute coronary syndromes Arrythmias Hypertensive heart dieases Valve diseases Drugs Inheritted cardiac diseases Electrolyte\acid base abnormalities SECONDARY Asphyxia , Hypoxemia , blood loss , hypothermia , septic shock

25. recognition of circulation problems: look at the patient : Pulse : Tachycardia , bradycardia Peripheral perfusion : Capillary refill time Blood pressure : Hypotension Organ perfusion : Chest pain , mental status , urine output Bleeding , fluid losses

26. TRETMENT OF CIRCULATORY PROBLEMS : Airway, breathing Oxygen if needed IV\IO access , take bloods Treat the cause Fluid challenge

27. Cardiac arrest 1. Recogntion an ativation of emergncy response system at the hospital 2. Immediate high-quality CPR 3. Rapid defibrillation 4. Basic and advanced emergency medical survices 5. Advanced life suport and postarrest care

28. CPR for adults Conduct a rapid assessment : Check for responsiveness Open the airway and simultaneously check for breathing and carotid pulse for at least 5 seconds but no more than 10 sec . If no pulse no breath, begin CPR

29. CHEST COMPRESSION 30:2 Compressions: Center of the chest 5-6 cm depth 2 per second (100-120 chest compression\min) maintain high quality compressions with minimal interuption Continous compresssion once airway secured Switch compression provider every 2 min to avoid fatigue Allow complete chest recoil.

30. Reverseble causes of cardiac arrest Seminar for the next lecture Seminar