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CPCR- II

CPCR- II. No role of atropine in asystole/ PEA. Other periarrest rhythms. Bradycardia Tachycardia: Narrow complex tachycardia. Wide complex tachycardia. Periarrest rythms. Adult Bradycardia with pulse. Adult Tachycardia with pulse.

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CPCR- II

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  1. CPCR- II

  2. No role of atropine in asystole/ PEA

  3. Other periarrest rhythms Bradycardia Tachycardia: Narrow complex tachycardia. Wide complex tachycardia.

  4. Periarrest rythms • Adult Bradycardia with pulse. • Adult Tachycardia with pulse.

  5. Changes with reference to management of symptomatic arrhythmias: • Adenosine : considered for diagnosing and treating stable undifferentiated regular monomorphic wide complex tachycardia. • Iv infusion of chronotropic agents : for symptomatic or unstable bradycardia. • Atropine : no longer recommended for pulseless electrical activity / asystole. • Real time monitoring & optimization of CPR using: • Mechanical parameters • Physiological parameters • ROSC is confirmed by PETCO2 values

  6. Pacing is no longer recommended for patients with asystole cardiac arrests. • In the event of bradyarrythmias not responding to atropine : pacing is indicated.

  7. Defib vs Cardioversion Defibrillation: UNSYNCHRONISED shocks, high energy, pulseless arrest, stops heart, rhythm restarts. Cardioversion: SYNCHRONISED shocks, low energy, periarrest rhythms ( SVT, VT with pulses, atrial fibrillation, atrial flutter….reentry), resets rhythm. synchronised to QRS- complex.

  8. Post cardiac arrest care: Key objectives were : • Optimizing cardio pulmonary function and vital organ perfusion after ROSC. • Transportation to an appropriate hospital or critical care unit with adequate system of care. • Identification and intervention for acute coronary syndromes. • Temperature control for neurologic recovery. • Anticipation, treatment & prevention of multiple organ dysfunction.

  9. ROSC is not the end point for successful ACLS now more emphasis is laid on post cardiac resuscitation management. For this post cardiac arrest treatment algorithm is formed.

  10. References : • Circulation . The journal of American heart association 2010. • Miller’s anaesthesia 7th edition. • Morgan’s clinical anaesthesiology 4th edition. • Cardio pulmonary resuscitation 2010. improve the quality of care. Indian journal of anaesthesia. 2010;54; (2) :91- 94. • Cardio cerebral resuscitation : is it better than CPR?. Indian journal of anesthesia 2009; 53(6) : 637 -640.

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