cardiopulmonary resuscitation by Centre CPR OLomouc

Transcription

1 cardiopulmonary resuscitation by Centre CPR OLomouc

2 Epidemiology of cardiac arrest Europe- 40% from total death up to 75 y incidence out of hospital 38/ inh. survival out of hospital 5 13 % survival in-hospital CPR up to 20 %

3 Part 5: Adult Basic Life Support by Robert A. Berg, Robin Hemphill, Benjamin S. Abella, Tom P. Aufderheide, Diana M. Cave, Mary Fran Hazinski, E. Brooke Lerner, Thomas D. Rea, Michael R. Sayre, and Robert A. Swor Circulation Volume 122(18 suppl 3):S685-S705 November 2, 2010 Copyright American Heart Association

4 Simplified adult BLS algorithm. check : -consciousness (ask him -pulse (palpation of the great arteries -breathing ( look-listen-feel Faculty hospital Olomouc: everybody is able to start with CPR urgent phone 2666!! in the town emergency 155 Berg R et al. Circulation 2010;122:S685-S705 Copyright American Heart Association

5 Airways a) Head tilting and chin lifting to oper the airway Look- for chest movement listen at the patient s mouth feel for breathing (10s) normal -unsatisfactory - absent

6 Airway interventions(basic)

7 Extraglotic aids for open airway Head tilt chin lift Jaw thrust Suction Oral airways Nasal airways Laryngeal tube intubation

8 Cardiac arest -kneel by the side -your heel of one hand in the centre of p. chest (lower half of the sternum) -Place the heel of your other hand on top of the first - push 5cm and release quickly -100/min -combine with breathing 30:2 1person 5:1 2person -recheck pulse and breathing after 2 min

9 CPR of children under 1 y of age (!) start with 5 breathing cycle cardiac massage : ventilation 3 : 1 frequency of compression 120 /min centre of the chest with 2 fingers max. do 1/3 of the chest no Heimlich maneouvre by asfyxia

10 Basic, AED No reaction open airway CPR 30 : 2 until AED attached Call for any help or CPR team Call for AED, CPR team shock advised AED assesses the cardiac rhytm No shock advised 1 shock Immediatelly continue 2 min CPR 30 : 2 Immediatelly continue 2 min CPR 30 : 2 Continue until the victim starts to wake up, to move, open eyes and breathe normally

11 BLS healthcare provider algorithm. Berg R et al. Circulation 2010;122:S685-S705

12 Automated external defibrillator - AED

13 Electrode pads location wrong OK

14 Advanced Life Support (ALS) continues from basic CPR specialized, differentiated full range at ICU, anestesiology unit, URGENT ambulance

15 biphasic J, monophasic 360J or AED ALS algorithm

16 New in advanced resuscitation (ALS) looking for risk patient for circulation/cardia arrest Minimalisation of interrupted cardiac massage not recommended :Intratracheal medicine administration (except children Atropin precordial strike Recommended : Intraoseal = parenteral medicine administration Echocardiography during CPR not preferential early intubation Capnography during CPR Oxygen titration (SpO2 v 94-98%) Therapeutic hypothermia=standard of the postcpr care=prevention Emphasis on PCI (coronary intervention prognosis of CPR still unclear

17 Asystolia terminal rythm type possibility for cardiac pacing/external, internal (JIP, KARIM, emergency) by question ASY x VF = massage Adrenalin 1 mg po 3 5 min i.v./i.o PEA (pulseless activity) often associated with reversible reasons Adrenalin 1 mg po 3 5 min i.v./i.o.

18 Ventricular fibrillation chaotic elektromechanic ventricular activity breakable by early defibrillation(aed,biphasic J, monophasic 360J) repeated by 2 min unsuccesfull= adrenalin 1mg every 3-5min

19 Adrenalin 1 ml =1 mg Indication: asystolia, persistent VF or pulseless VT after 3 unsuccesfull defillations, anafylaktic shock Dosage in adults during CPR every 3 5 min 1 mg (1ml possible even unadulterated+ flushing) i.v./i.o. Children CPR 1 mg disolve in fysiol.sol 10 ml (1ml= 0,1 mg adrenalin) 0,01mg/kg i.v. ~ 0,1ml/kg = 1ml/10kg adulterated solution i.v./i.o no iv i.o. access: intratracheal 0,1mg/kg always in 5 ml fysiol.sol. 1/1 Newborn: µg/kg mg i.v., intratracheal µg/kg ANAFYLAKTIC shock Adults and children since 12 y: 0,5 mg i.m., repeated after 5min, better in small boluses po 0,01 ml i.v./i.o. children : 6 12 y: 0,3 mg intramuscular, repeated after 5 min children under 6y : 0,15 mg intramuscular, repeated after 5 min

20 Other drugs used by CPR Amiodaron inj. Indikace: persistent ventricular fibrillation or tachycardia after 3.defibrillation Dosage: First bolus300 mg, further150 mg iv or continuing by infusion, lze navázat 900mg/den in G 5 % solution Magnézium (10 % nebo 20 %), magnesium sulphuricum Indication: hypomagnesemia under 0.6 mmol/l, arrhytmia supra-, ventricular torsades de pointes, intoxication by digitalis Dosage: Torsades de pointes: 10 ml 20 % MgSO 4 intravenous nebo intraosseal slowly by 10 min No: Atropin not recommended by ASYSTOLia!!!