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LIFE SUPPORT
Cardio Pulmonary Arrest
Cardio Pulmonary Arrest is the sudden cessation of breathing and circulation in a patient who is not expected to die.
Why do people arrest?
Etiology depends upon age Child (up to 8)
Most of the time have respiratory problem (hypoxia) unless child is known case of congenital heart disease
Why do people arrest?
Adults most of the time have cardiac problem Exceptions
History of trauma History of drowning History of drug intoxication
BLS Basic Life Support
Diagnosis
The victims are unresponsive. Their skin is ashen Respiration is agonal or absent No pulses are present in large artery The success of CPR is directly related to how soon it begins (within 3 minutes)
Speed is important
CPR should be started within 3 minutes of arrest Defibrillation should be done with in 10 minutes of vf Increase in mortality by 8% with the delay of each minute in defibrillation
Initial Steps
Verify Cardiopulmonary Arrest
Check unresponsiveness - Shake the Patient - may be sleeping Check the airway Check breathing Palpate carotid or brachial pulses
Call for help and ask for monitor and defibrilator position the patient supine
CHILDREN
PHONE FAST
RESUSITATE FOR 2 MINUTS THEN CALL FOR HELP
PALPATE BRACIAL PULSE 1 J/Kg Wt SHOCK
SOME ONE FOUND UNRESPONSIVE
Look for carotid pulse
Latreal to thyroid notch If absent start chest compressions
Palpate right costal margin upwards reach up to xiphiod process Start chest compressions 4cm above xiphi Rate should be 100 per minute
Basic memory aid ABCD
A irway B reathing support C irculation support D efibrillation (when appropriate)
Airway Management
CLEAR AIR WAY
EXTEND NECK CHIN LIFT
Insert an airway
Breathing support
Mouth to Mask ventilation
Cardiac Massage
Compression : Ventilation ratio
If one person is doing CPR ratio of chest Compression and breathing should be two to fifteen (2 : 15) If two persons are doing CPR then ratio should one to five (1:5)
Two rescuer resuscitation
Choking at Food
Hemlich maneuver
Advanced Life Support
Attach Monitor As Soon As Available
Three possibilities on monitor Ventricular Fibrillation Asystole Pulse-less electric activity (PEA)
Ventricular Fibrillation Algorithm VENTRICULAR FIBRILATION PERICARDIAL THUMB DEFIBRILATION WITH 200J DEFIBRILATION WITH 300J DEFIBRILATION WITH 360J PASS ENDO TRACIAL TUBE PASS IV LINE ADRENALINE I Mg IV PUSH REPEAT EVERY 3TO 5 MINUTES
CAN BE GIVEN IN ETT DEFIBRILATION WITH 360 J ANTARRHYTHMICS AMIODARONE
MAGNESIUM
RESUME ATTEMPTS TO DEFIBRILATE
Defibrillation
Bag-valve mask ventilation
Look for breathing
Listen feel and hear Give two puffs of mouth to mouth breathing Take deep breath hold it Pinch nose of victim Make complete seal with your mouth expire with full force No leakage chest of victim should rise
Asystoly Algorithm ASYSTOLY PASS ETT TAKE IV LINE TRANSCUTANIOUS PACING ADRENALINE I Mg IV PUSH REPEAT 3 -5 Min CAN BE GIVEN IN ETT ATOPINE I Mg IV PUSH REPEAT 3-5 Min ASYSTOLE PERSISTS CEASE CPR ?
Pulse less Electric Activity Algorithm PEE ETT IV LINE ASSES FOR OCCULT BLOOD FLOW DIAGNOSE AND CORRECT CAUSES ADRENALINE1MG IV PUSH ATROPINE IMG IV PUSH
Causes of PEA
Hypoxia Hypovolemia Hyper-hypokalemia Hypothermia Hydrogen ions acidosis
Tablets Tension pneumothorax Tamponade Thrombosis pulmonary Thrombosis coronary
Some rhythm strips
Multiple VPCs
Ventricular tachycardia
Narrow complex tachycardia
?
Summary-BLS
Patients who are not expected to die can be revitalized by prompt CPR Basic life support is done with bare hands Call for help Follow basic mnemonic ABC
Airway clearance Breath into patient Cardiac massage for circulation support
Summary- ALS
When the help arrives, attach monitors Follow appropriate algorithm
Defibrillate if VF Pass endotracheal tube and ventilate with bag Establish IV access for drugs (remember drugs can be given via endotracheal tube) Give adrenaline to asystole patients Try finding the cause of PEA and reverse it as appropriate
Antidotes Release pressure from pleura/pericardium Give fluids to hypovolemic patients
Cardio Pulmonary Arrest
Cardio Pulmonary Arrest is the sudden cessation of breathing and circulation in a patient who is not expected to die.
Why do people arrest?
Etiology depends upon age Child (up to 8)
Most of the time have respiratory problem (hypoxia) unless child is known case of congenital heart disease
Why do people arrest?
Adults most of the time have cardiac problem Exceptions
History of trauma History of drowning History of drug intoxication
BLS Basic Life Support
Diagnosis
The victims are unresponsive. Their skin is ashen Respiration is agonal or absent No pulses are present in large artery The success of CPR is directly related to how soon it begins (within 3 minutes)
Speed is important
CPR should be started within 3 minutes of arrest Defibrillation should be done with in 10 minutes of vf Increase in mortality by 8% with the delay of each minute in defibrillation
Initial Steps
Verify Cardiopulmonary Arrest
Check unresponsiveness - Shake the Patient - may be sleeping Check the airway Check breathing Palpate carotid or brachial pulses
Call for help and ask for monitor and defibrilator position the patient supine
CHILDREN
PHONE FAST
RESUSITATE FOR 2 MINUTS THEN CALL FOR HELP
PALPATE BRACIAL PULSE 1 J/Kg Wt SHOCK
SOME ONE FOUND UNRESPONSIVE
Look for carotid pulse
Latreal to thyroid notch If absent start chest compressions
Palpate right costal margin upwards reach up to xiphiod process Start chest compressions 4cm above xiphi Rate should be 100 per minute
Basic memory aid ABCD
A irway B reathing support C irculation support D efibrillation (when appropriate)
Airway Management
CLEAR AIR WAY
EXTEND NECK CHIN LIFT
Insert an airway
Breathing support
Mouth to Mask ventilation
Cardiac Massage
Compression : Ventilation ratio
If one person is doing CPR ratio of chest Compression and breathing should be two to fifteen (2 : 15) If two persons are doing CPR then ratio should one to five (1:5)
Two rescuer resuscitation
Choking at Food
Hemlich maneuver
Advanced Life Support
Attach Monitor As Soon As Available
Three possibilities on monitor Ventricular Fibrillation Asystole Pulse-less electric activity (PEA)
Ventricular Fibrillation Algorithm VENTRICULAR FIBRILATION PERICARDIAL THUMB DEFIBRILATION WITH 200J DEFIBRILATION WITH 300J DEFIBRILATION WITH 360J PASS ENDO TRACIAL TUBE PASS IV LINE ADRENALINE I Mg IV PUSH REPEAT EVERY 3TO 5 MINUTES
CAN BE GIVEN IN ETT DEFIBRILATION WITH 360 J ANTARRHYTHMICS AMIODARONE
MAGNESIUM
RESUME ATTEMPTS TO DEFIBRILATE
Defibrillation
Bag-valve mask ventilation
Look for breathing
Listen feel and hear Give two puffs of mouth to mouth breathing Take deep breath hold it Pinch nose of victim Make complete seal with your mouth expire with full force No leakage chest of victim should rise
Asystoly Algorithm ASYSTOLY PASS ETT TAKE IV LINE TRANSCUTANIOUS PACING ADRENALINE I Mg IV PUSH REPEAT 3 -5 Min CAN BE GIVEN IN ETT ATOPINE I Mg IV PUSH REPEAT 3-5 Min ASYSTOLE PERSISTS CEASE CPR ?
Pulse less Electric Activity Algorithm PEE ETT IV LINE ASSES FOR OCCULT BLOOD FLOW DIAGNOSE AND CORRECT CAUSES ADRENALINE1MG IV PUSH ATROPINE IMG IV PUSH
Causes of PEA
Hypoxia Hypovolemia Hyper-hypokalemia Hypothermia Hydrogen ions acidosis
Tablets Tension pneumothorax Tamponade Thrombosis pulmonary Thrombosis coronary
Some rhythm strips
Multiple VPCs
Ventricular tachycardia
Narrow complex tachycardia
?
Summary-BLS
Patients who are not expected to die can be revitalized by prompt CPR Basic life support is done with bare hands Call for help Follow basic mnemonic ABC
Airway clearance Breath into patient Cardiac massage for circulation support
Summary- ALS
When the help arrives, attach monitors Follow appropriate algorithm
Defibrillate if VF Pass endotracheal tube and ventilate with bag Establish IV access for drugs (remember drugs can be given via endotracheal tube) Give adrenaline to asystole patients Try finding the cause of PEA and reverse it as appropriate
Antidotes Release pressure from pleura/pericardium Give fluids to hypovolemic patients
