CARDIOPULMONARY RESUSCITATION

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CARDIOPULMONARY RESUSCITATION

• DR J.O OLATOSI D.A,FWACS

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CARDIAC ARREST

• Sudden cessation of spontaneous and effective
  heart function
• Diagnosisunresponsive
• Sudden deep unconsciousness
• Absent major peripheral pulses
• Absent spontaneous ventilation/agonal breathing
• Fixed dilated pupils not index for diagnosis
  or prognosis

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CAUSES OF CARDIAC ARREST

• Airway obstruction
• Blood, vomit, foreign body
• Trauma
• Infection, inflammation
• Laryngospasm
• Bronchospasm

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• Decreased respiratory drive
• -CNS depression
• Decreased respiratory effort
• -neurological lesion
• -muscle weakness
• -restrictive chest defect
• Pulmonary disorders
• -pneumothorax, lung pathology

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Cardiac abnormalities

• Primary
• Ischaemia
• Myocardial infarction
• Hypertensive heart disease
• Valve disease
• Drugs
• Electrolyte abnormalities

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• Secondary
• Asphyxia
• Hypoxaemia
• Blood loss
• Septic shock

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Cardiopulmonary Resuscitation

• A technique combining artificial ventilation and
  chest compressions designed to perfuse vital
  organs or restore circulation in cardiac
  standstill.

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• Early access to get help
• Early BLS to buy time-CPR slows down
  deterioration of the brain
• Early defibrillation to restart heart-restores a
  perfusing rhythm
• Early ALS to stabilise circulation
• failure of circulation for 3-4mins can lead to
  irreversible brain damage.

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Adult BLS sequence

• Basic life support consists of the following
  sequence of actions
• 1 Make sure the victim, any bystanders, and you
  are safe.

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• 2 Check the victim for a response.
• Gently shake his shoulders and ask loudly, Are
  you all right?

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3 A If he responds

• Leave him in the position in which you find him
  provided there is no
• further danger.
• Try to find out what is wrong with him and get
  help if needed.
• Reassess him regularly.

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3 B If he does not respond

• Shout for help.
• Turn the victim onto his back and then open the
  airway using head tilt
• and chin lift
• Place your hand on his forehead and gently tilt
  his head back.
• With your fingertips under the point of the
  victim's chin, lift the
• chin to open the airway.

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Opening the airway

• Head tilt
• Chin lift
• If cervical spine injury suspected
• jaw thrust

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Assess Breathing

• Look for chest movement
• Listen for breath sounds
• Feel for expired air
• Assess for 10 seconds before deciding breathing
  is absent

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5 A If he is breathing normally

• Turn him into the recovery position .
• Send or go for help, or call for an ambulance.
• Check for continued breathing.

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5 B If he is not breathing normally

• Ask someone to call for an ambulance or, if you
  are on your own, do
• this yourself you may need to leave the victim.
  Start chest
• compression as follows
• Kneel by the side of the victim.
• Place the heel of one hand in the centre of the
  victims chest.
• Place the heel of your other hand on top of the
  first hand.

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• Interlock the fingers of your hands and ensure
  that pressure is
• not applied over the victim's ribs. Do not apply
  any pressure over the upper abdomen or the bottom
  end of the bony sternum (breastbone).
• Position yourself vertically above the victim's
  chest and, with
• your arms straight, press down on the sternum 4 -
  5 cm.

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• After each compression, release all the pressure
  on the chest
• without losing contact between your hands and the
  sternum.
• Repeat at a rate of about 100 times a minute (a
  little less than
• 2 compressions a second).
• Compression and release should take an equal
  amount of time.

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• Chest compressions

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6 A Combine chest compression with rescue
breaths.

• After 30 compressions open the airway again using
  head tilt and chin lift.

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Rescue breathing(Expired air ventilation)

• Occlude victims nose
• Maintain chin lift
• Take a deep breath
• Ensure a good mouth-to-mouth seal

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Rescue breathing(Expired air ventilation)

• Blow steadily (2 sec) into victims mouth
• Watch for chest rise
• Maintain chin lift, remove mouth
• Watch chest fall

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6 B Chest-compression-only CPR.

• If you are not able, or are unwilling, to give
  rescue breaths, give chest compressions only.
• If chest compressions only are given, these
  should be continuous at a rate of 100 a minute.
• Stop to recheck the victim only if he starts
  breathing normally otherwise do not interrupt
  resuscitation.

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7 Continue resuscitation until

• qualified help arrives and takes over,
• the victim starts breathing normally, or
• you become exhausted.
• A valid DNAR order is presented

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ALS

• Basic Airway Adjuncts-
• Oropharyngeal Airway
• Nasopharyngeal Airway
• Advanced Airway Devices
• Laryngeal Mask Airway
• Combitube
• Endotracheal Tube

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DEFIBRILLATION

• Definition
• The termination of fibrillation or absence of
  VF/VT at 5 seconds after shock delivery
• Critical mass of myocardium depolarised
• Natural pacemaker tissue resumes control

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• Design
• Power source
• Capacitor
• Electrodes
• Types
• Manual
• Automated
• Monophasic or Biphasic waveform

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Defibrillator waveforms
Damped Monophasic
Truncated Biphasic
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Biphasic Defibrillators

• Require less energy for defibrillation
• smaller capacitors and batteries
• lighter and more transportable
• Repeated lt 200 J biphasic shocks have higher
  success rate for terminating VF/VT than
  escalating monophasic shocks

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Automated external defibrillators

• Analyse cardiac rhythm
• Prepare for shock delivery
• Specificity for recognition of shockable rhythm
  close to 100

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• Advantages
• Less training required
• no need for ECG interpretation
• Suitable for first-responder defibrillation
• Public access defibrillation (PAD) programs

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• Attach adhesive electrodes
• Follow audible and visual instructions
• Automated ECG analysis - stand clear
• Charges automatically if shockable rhythm
• /- manual override

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• Relies upon
• Operator recognition of ECG rhythm
• Operator charging machine and delivering shock
• Can be used for synchronised cardioversion

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Defibrillator Safety

• Never hold both paddles in one hand
• Charge only with paddles on casualtys chest
• Avoid direct or indirect contact
• Wipe any water from the patients chest
• Remove high-flow oxygen from zone of
  defibrillation

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Manual Defribillation

• Diagnose VF/VT from ECG and signs of cardiac
  arrest
• Select correct energy level
• Charge paddles on patient
• Shout stand clear
• Visual check of area
• Check monitor
• Deliver shock

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