CARDIOPULMONARY RESUSCITATION

1. CARDIOPULMONARY RESUSCITATION DR J.O OLATOSI D.A,FWACS PRIMARY FMCP UPDATE - CPR LECTURE

2. CARDIAC ARREST • Sudden cessation of spontaneous and effective heart function • Diagnosis’unresponsive • Sudden deep unconsciousness • Absent major peripheral pulses • Absent spontaneous ventilation/agonal breathing Fixed dilated pupils not index for diagnosis or prognosis PRIMARY FMCP UPDATE - CPR LECTURE

3. CAUSES OF CARDIAC ARREST Airway obstruction • Blood, vomit, foreign body • Trauma • Infection, inflammation • Laryngospasm • Bronchospasm PRIMARY FMCP UPDATE - CPR LECTURE

4. Decreased respiratory drive -CNS depression • Decreased respiratory effort -neurological lesion -muscle weakness -restrictive chest defect • Pulmonary disorders -pneumothorax, lung pathology PRIMARY FMCP UPDATE - CPR LECTURE

5. Cardiac abnormalities Primary • Ischaemia • Myocardial infarction • Hypertensive heart disease • Valve disease • Drugs • Electrolyte abnormalities PRIMARY FMCP UPDATE - CPR LECTURE

6. Secondary • Asphyxia • Hypoxaemia • Blood loss • Septic shock PRIMARY FMCP UPDATE - CPR LECTURE

7. Cardiopulmonary Resuscitation A technique combining artificial ventilation and chest compressions designed to perfuse vital organs or restore circulation in cardiac standstill. PRIMARY FMCP UPDATE - CPR LECTURE

8. 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.

9. Adult BLS sequence Basic life support consists of the following sequence of actions: 1 Make sure the victim, any bystanders, and you are safe. PRIMARY FMCP UPDATE - CPR LECTURE

10. 2 Check the victim for a response. • Gently shake his shoulders and ask loudly, ‘Are you all right?’ PRIMARY FMCP UPDATE - CPR LECTURE

11. Shake and Shout PRIMARY FMCP UPDATE - CPR LECTURE

12. 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. PRIMARY FMCP UPDATE - CPR LECTURE

13. 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. PRIMARY FMCP UPDATE - CPR LECTURE

14. Opening the airway • Head tilt • Chin lift • If cervical spine injury suspected: • jaw thrust

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

16. 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. PRIMARY FMCP UPDATE - CPR LECTURE

17. 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 victim’s chest. • Place the heel of your other hand on top of the first hand. PRIMARY FMCP UPDATE - CPR LECTURE

18. 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. PRIMARY FMCP UPDATE - CPR LECTURE

19. 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. PRIMARY FMCP UPDATE - CPR LECTURE

20. Chest compressions PRIMARY FMCP UPDATE - CPR LECTURE

21. 6 A Combine chest compression with rescue breaths. • After 30 compressions open the airway again using head tilt and chin lift. PRIMARY FMCP UPDATE - CPR LECTURE

22. Rescue breathing(Expired air ventilation) • Occlude victim’s nose • Maintain chin lift • Take a deep breath • Ensure a good mouth-to-mouth seal

23. Rescue breathing(Expired air ventilation) • Blow steadily (2 sec) into victim’s mouth • Watch for chest rise • Maintain chin lift, remove mouth • Watch chest fall

24. 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. PRIMARY FMCP UPDATE - CPR LECTURE

25. 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 PRIMARY FMCP UPDATE - CPR LECTURE

26. ALS Basic Airway Adjuncts- • Oropharyngeal Airway • Nasopharyngeal Airway Advanced Airway Devices • Laryngeal Mask Airway • Combitube • Endotracheal Tube PRIMARY FMCP UPDATE - CPR LECTURE

27. 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 PRIMARY FMCP UPDATE - CPR LECTURE

28. Design • Power source • Capacitor • Electrodes Types • Manual • Automated • Monophasic or Biphasic waveform PRIMARY FMCP UPDATE - CPR LECTURE

29. Defibrillator waveforms Damped Monophasic Truncated Biphasic PRIMARY FMCP UPDATE - CPR LECTURE

30. Biphasic Defibrillators • Require less energy for defibrillation • smaller capacitors and batteries • lighter and more transportable • Repeated < 200 J biphasic shocks have higher success rate for terminating VF/VT than escalating monophasic shocks PRIMARY FMCP UPDATE - CPR LECTURE

31. Automated external defibrillators • Analyse cardiac rhythm • Prepare for shock delivery • Specificity for recognition of shockable rhythm close to 100% PRIMARY FMCP UPDATE - CPR LECTURE

32. Advantages: • Less training required • no need for ECG interpretation • Suitable for “first-responder” defibrillation • Public access defibrillation (PAD) programs PRIMARY FMCP UPDATE - CPR LECTURE

33. Attach adhesive electrodes • Follow audible and visual instructions • Automated ECG analysis - stand clear • Charges automatically if shockable rhythm • +/- manual override PRIMARY FMCP UPDATE - CPR LECTURE

34. Relies upon: • Operator recognition of ECG rhythm • Operator charging machine and delivering shock • Can be used for synchronised cardioversion PRIMARY FMCP UPDATE - CPR LECTURE

35. Defibrillator Safety • Never hold both paddles in one hand • Charge only with paddles on casualty’s chest • Avoid direct or indirect contact • Wipe any water from the patient’s chest • Remove high-flow oxygen from zone of defibrillation PRIMARY FMCP UPDATE - CPR LECTURE

36. 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 PRIMARY FMCP UPDATE - CPR LECTURE

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