cpr for adults
DESCRIPTION
Cpr for adultsTRANSCRIPT
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CPR FOR ADULTS
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Plan
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Definition/Aim of Cardiopulmonary Resuscitation (CPR)
Treatment of VF / Pulseless VT
Treatment of non-VF/VT rhythm
Potential reversible causes of cardiac arrest
Airway, IV Access, Drugs
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Cardiopulmonary Resuscitation(CPR) - Definition
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Emergent medical applications that are performed for a livingwhose respiratory and circulation functions have been stopped
in an immediate and unexpected status
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To provide adequate amount of oxygenated blood
for vital organs
Cardiopulmonary Resuscitation(CPR) - Aim
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Cardiopulmonary Arrest (CPR)
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Causes: Airway obstruction
Respiratory distress
Cardiac abnormalities
ACUTE MYOCARDIAL INFARCTON
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CPR – ILCOR (International Liaison Committee On 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)
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CPR Basic Life Support
Advanced Life Support
Prolonged Life Support
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CPR Basic Life Support
Advanced Life Support
Prolonged Life Support
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CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/Pulseless VT)
Non-shockable
(PEA/Asystole)
1 Shock150-360 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 andcontact• Attempt / verify:
IV accessairway and oxygen
• Give uninterruptedcompressions when airway secure• Give adrenaline every 3-5 min• Consider: amiodarone,
atropine,magnesium
Immediately resume
CPR 30:2
for 2 min
Adult ALSAlgorithm
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CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/Pulseless VT)
Non-shockable
(PEA/Asystole)
1 Shock150-360 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 andcontact• Attempt / verify:
IV accessairway and oxygen
• Give uninterruptedcompressions when airway
secure• Give adrenaline every 3-5 min• Consider: amiodarone,
magnesium
Immediately resume
CPR 30:2
for 2 min
Adult ALSAlgorithm
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Open Airway Look for signs of life
…. to confirm cardiac arrest
Patient response
Open airway
Check for normal breathing
(caution agonal breathing)
Check circulation
Monitoring
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CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/Pulseless VT)
Non-shockable
(PEA/Asystole)
1 Shock150-360 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 andcontact• Attempt / verify:
IV accessairway and oxygen
• Give uninterruptedcompressions when airway
secure• Give adrenaline every 3-5 min• Consider: amiodarone,
magnesium
Immediately resume
CPR 30:2
for 2 min
Adult ALSAlgorithm
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Open Airway Look for signs of life
Call Resuscitation Team
Cardiac arrest confirmed
CPR 30:2Until defibrillator / monitor attached
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Chest Compression
30:2
Compressions
Centre of chest
5-6 cm depth
100-120 min-1
Uninterrupted compressions when airway secured
Avoid
Provider fatigue
Interruptions
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CPR 30:2
Until defibrillator/monitor attached
Assess
Rhythm
Shockable
(VF/Pulseless VT)
Non-shockable
(PEA/Asystole)
1 Shock150-360 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 andcontact• Attempt / verify:
IV accessairway and oxygen
• Give uninterruptedcompressions when airway
secure• Give adrenaline every 3-5 min• Consider: amiodarone, atropine,
magnesium
Immediately resume
CPR 30:2
for 2 min
Adult ALSAlgorithm
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Adult ALSAlgorithm
Open Airway Look for signs of life
Call Resuscitation Team
CPR 30:2Until defibrillator/monitor attached
AssessRhythm
Shockable(VF/Pulseless VT)
Non-shockable(PEA/Asystole)
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Adult ALSAlgorithm
Open Airway Look for signs of life
Call Resuscitation Team
CPR 30:2Until defibrillator/monitor attached
AssessRhythm
Shockable(VF/Pulseless VT)
Non-shockable(PEA/Asystole)
CARDİAC ARREST RHYTHMS
1. Ventricular Fibrillation (VF)2. Pulseless Ventricular Tachicardia (VF)3. Asystole4. Pulseless Electrical Activity (PEA)
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Shockable (VF)
Irregular waveform
No recognisable QRS complexes
Random frequency and amplitude
Uncoordinated electrical activity
Coarse /fine
Exclude artifact
movement
electrical interference
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Monomorphic VT
broad complex rhythm
rapid rate
constant QRS morphology
Polymorphic VT
torsade de pointes
Shockable (VT)
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Precordial Thump
Rapid treatment of a witnessed and monitored VF/VT cardiac arrest
Used if defibrillator not immediately available?
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1st shock 150 - 200 J biphasic 360 J monophasic
AssessRhythm
Shockable
(VF/Pulseless VT)
1 Shock150-360 J biphasic
or 360 J monophasic
Immediately resumeCPR 30:2 for 2 min
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Defibrillation Energies
Vary with manufacturer
Check local equipment
If unsure, deliver 200 J (do not delay shock)
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Deliver 2nd shock
Deliver 3rd shock
CPR for 2 min
If VF/VT persists
CPR for 2 min
Deliver 4th shock
Adrenalin, 1mg iVAmiodaron, 300 mg
2nd and subsequent shocks
Max. (270-360J) biphasic
360 J monophasic
Minimise delays between CPR
and shocks (< 10 s)
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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
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AsystolePulseless Electrical Activity (PEA)
AssessRhythm
Non-shockable(PEA/Asystole)
Immediately resume
CPR 30:2 for 2 min
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Absent ventricular (QRS) activity
Atrial activity (P waves) may persist
Rarely a straight line trace
Treat fine VF as asystole
Non-shockable(Asystole)
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AsystoleDuring CPR:
check leads are attached
adrenaline 1 mg IV every 3 – 5 min
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Clinical features of cardiac arrest
ECG normally associated with an output
Non-shockable(PEA)
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Pulseless Electrical Activity(PEA)
Exclude/treat reversible causes
Adrenaline 1 mg IV every 3-5 min
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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
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Potential reversible causes: Hypoxia Hypovolaemia Hypo/hyperkalaemia & metabolic disorders Hypothermia
Tension pneumothorax Tamponade, cardiac Toxins Thrombosis (coronary or pulmonary)
4H
4T
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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
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Intravenous Access
Peripheral versus central veins
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Intraosseous Access
TRACHEAL ACCESSx
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Drugs
Adrenaline
Amiodarone
Magnesium
Thrombolytics
Sodium bicarbonate
O2
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AdrenalineActions:
agonist arterial vasoconstriction
systemic vascular resistance
cerebral and coronary blood flow
agonist heart rate
force of contraction
myocardial O2 demand
(may increase ischaemia)
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Adrenaline
Indications:
During cardiac arrest VF/VT – give after 3rd shock
Non VF/VT – give immediately
Repeat every 3-5 min
1 mg IV
Cautious use after ROSC
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Amiodarone
Actions:
Lengthens duration of action potential
Prolongs QT interval
Mild negative inotrope - may cause hypotension
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AmiodaroneIndications: Shock refractory VF/VT
300 mg IV
Give after 3rd shock
If unavailable give lidocaine 1.5mg/kg IV
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Atropine
Actions:
Blocks effects of vagus nerve
Increases sinus node automaticity
Increases atrioventricular conduction
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AtropineIndications:
Peri-arrest Symptomatic sinus, atrial or nodal bradycardia
500 mcg IV increments to 3 mg
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Magnesium
Hypomagnesaemia often co-exists with hypokalaemia
Actions:
Depresses neurological and myocardial function
A physiological calcium blocker
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MagnesiumIndications:
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
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Thrombolytic Drugs
Actions:
Dissolves thrombus
Improves cerebral blood flow
Has a role in coronary thrombosis and pulmonary embolism
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Thrombolytic Drugs
Indications: Cardiac arrest caused by suspected pulmonary
embolus Can take up to 60 min to have effect
Dose: Tenecteplase 500-600 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
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Sodium Bicarbonate
Actions:
Alkalinising agent (increases pH)
But can:
increase carbon dioxide load
inhibit release of oxygen to tissues
impair myocardial contractility
cause hypernatraemia
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Sodium Bicarbonate
Indications:
Life-threatening hyperkalaemia
Tricyclic overdose
Severe metabolic acidosis (pH < 7.1)
Dose: 50 ml 8.4% sodium bicarbonate IV
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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)
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LAST WORDS
Drugs role in cardiac arrest becomes after effective chest compression, effective ventilation with high oxygen concentration and defibrillation
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THANK
YOU…
Dr. Sule AKIN
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THANK
YOU…
Dr. Sule AKIN