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Cardiopulmonary resuscitation

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Information about Cardiopulmonary resuscitation
Science-Technology

Published on December 7, 2008

Author: ravimohanv

Source: authorstream.com

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Cardiopulmonary resuscitation : Cardiopulmonary resuscitation Dr.V.Ravimohan What I learned in the ILS training http://www.mrcogexam.net Chain of survival : Chain of survival Early recognition and call for help Early cardiopulmonary resuscitation (CPR) Early defibrillation Post resuscitation care Early recognition : Early recognition Most in-hospital cardiac arrests are not sudden or unpredictable events Hypoxia or hypotension are either not noticed by staff ,or are recognised but treated poorly. 2 systems early warning scores calling criteria “cardiac arrest team” “Medical emergency team” Medical emergency team calling criteria : Medical emergency team calling criteria Airway obstruction : Airway obstruction Treatment Remove any obstruction unless contraindicated turn the patient to a side Simple airway opening manoeuvres head tilt, jaw thrust or chin lift (remember to give oxygen) Oropharyngeal airway or nasal airway Elective tracheal intubation Tracheostomy Always remember to give oxygen Breathing problems : Breathing problems Causes Poor respiratory drive-CNS depression Poor respiratory effort-muscle weakness/nerve damage Lung disorders Breathing problems : Breathing problems Recognition Irritability, confusion, lethargy and depressed consciousness(from hypoxia and hypercapnia) High respiratory effort(>30/min) Pulse oxymetry Non invasive measure of oxygenation but not a measure of ventilation Blood gas analysis Circulation problems : Circulation problems Causes Primary heart problemsarrythmia secondary to ischaemia Secondary heart problems severe anaemia, hypothermia Acute coronary syndromes : Acute coronary syndromes Unstable angina Non ST segment elevation MI ST segment elevation MI Treatment O2 high concentration Aspirin 300 mg Nitro-glycerine S/L Morphine ABCDE approach : ABCDE approach A-airway B-breathing C-circulation D-disability E-Exposure Airway Obstruction : Airway Obstruction Airway obstruction-”sea-saw” respirations complete no breath sounds at the mouth or nose Incomplete noisy clear the airway Give O2 10 l/min Breathing : Breathing General signs of respiratory distress Use of accessory muscles of respiration Sweating Cyanosis Respiratory rate Pulse oxymeter Trachea Percuss listen Circulation : Circulation Colour & temperature of limbs Capillary fill time Finger tip held at the heart level Normal fill time is less than 2 seconds Pulse volume low – poor cardiac output high(bounding)-sepsis B.P low diastolic blood pressure arterial vasodilatation anaphylaxis or sepsis narrow pulse pressure-(normal 35-45 mmHg) arterial vasoconstrictionhypovolaemia/cardiogenic shock Disability : Disability AVPU A-Alert V-responds to vocal stimuli P-responds to painful stimuli U-unresponsive to all stimuli Measure blood glucose to exclude hypoglycaemia Exposure : Exposure Exposure to examine the patient properly Minimise heat loss Respect dignity “collapsed patients” : “collapsed patients” Ensure personal safety Check for patient response “are you alright?” If patient responds”ABCDE approach” If patient doesn’t respondcall for help Airway Breathing-”look” “feel” “hear” for not more than 10 secs Pulse : Pulse Checking for pulse-can be difficult even for the trained staff If unsure about the pulse don’t start delaying CPR If there is pulse Still call for help Give O2 Ventilate lungs check for circulation ever 10 seconds Attach monitoring IV access If there is no pulse or signs of life : If there is no pulse or signs of life Call for help 30 chest compression:2 ventilation 100 compressions/min compression depth 4-5 cm Once the defibrillator arrives apply electrodes to patient and analyse rhythm Minimise interruptions to chest compressions Advanced life support cardiac rhythm : Advanced life support cardiac rhythm 2 groups of cardiac rhythm Shock able rhythm Ventricular fibrillation Pulse less ventricular tachycardia Non shock able rhythm Asytole Pulse less electrical activity Shock able Rhythm : Shock able Rhythm 3 possibilities : 3 possibilities VT/VF persists : VT/VF persists VF/VT still persists : VF/VT still persists Some tips : Some tips Lidocaine 100mg IV is an alternative for amidarone but isn’t an option if amidarone is already given If there is doubt about whether a rhythm is Asystole or very fine AF don’t defibrillate Very fine VF is unlikely to respond to shock Precordial Thump : Precordial Thump May be useful in VF/VT cardiac arrest which was witnessed and monitored sudden collapse Ulnar edge of a tightly clenched fist From height of about 20 cm Thumb is most likely to be successful in converting VT to sinus rhythm PULSELESS ELECTRICAL ACTIVITY : PULSELESS ELECTRICAL ACTIVITY Definition: organised electrical activity in the absence of any palpable pulses. Treatment for PEA : Treatment for PEA If VT/VF persists : If VT/VF persists Follow shock able side of algorithm Treatment for asystole and slow PEA(rate <60 min-1) : Treatment for asystole and slow PEA(rate <60 min-1) During CPR : During CPR Reversible causes : Reversible causes 4 H : 4 H 4T : 4T CPR in a pregnant patient : CPR in a pregnant patient Left lateral tilt(15-30 degrees) of patient Periarrest caesarean section should begin within 4 minutes Sterile preparation is not necessary Moving the patient to operating theatre isn’t necessary

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