1. Cardiorespiratory Arrest

8/13/2019 1. Cardiorespiratory Arrest

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Cardiorespiratory arrestis thesudden, unexpected cessation ofrespiration and functional circulation.


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CPCR Principle

4 6 minutes

CPCRDuring respiratory and cardiac arrest, CPCR may be successful

if performed before biological death of vital tissue develops.


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1. Degree of preexisting hypoxia of the cells.

2. The brain depends totally on oxygen and is

the organ least able to withstand hypoxia.

3. The whether circulatory or respiratory arrestoccurs first.


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A.Cardiac asystole.B.Ventricular fibrillation or Pulseless VT

Electrical defibrillation is required toreestablish spontaneous and effectivecardiac electrical activity.

C.Electromechanical dissociation

circulatory collapse that occurs despitesatisfactory electrical complexes on the ECG


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1. Low cardiac output.

2. Hyparcapnia.

3. Hyperkalemia.

4. Hypoxia and vagal stimulation.5. Stimulation of the heart.

6. Coronary occlusion.

7. Overdosage.

8. Hypothermia.

9. Hyperthermia

10. Acidosis


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1. Airway obstructionby vomitus, foreign body,blood, secretions, solid material, mucous plugs,laryngeal or bronchial spasm, or tumor.

2. CNS depression: caused by stroke, head trauma,hypercapnia, barbiturates,narcotics, tranquilizers,or anesthetics.

3. Neuromuscular failure secondary topoliomyelitis, muscular dystrophy, myasthenia, ormuscle relaxant drugs.


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Flail chestPneumothoraxMassive atelectasis

Acute pulmonary embolismCongestive heart failureOverwhelming pneumonia

Gram-negative septicemiaLung burnsCarbon monoxide poisoning

Massive blood loss.


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In geriatric or pediatric patients. In patients with a history of

arrhythmias, heart block, digitalistoxicity, myocarditis , myocardialinfarction, congestive heart failure,electrolyte imbalance , or dehydration.

In massive hemorrhage.During or following heart surgery.


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The initial goal of therapy is BRAIN oxygenation

The second goal is restoration of circulation.

Underlying condition must be corrected.

CPCR is not indicated for all patients.Natural death in the aged or in the terminalstages of a chronic illness

CPCR should be performed in cases of reversibleunexpected death


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Basic Life support (BLS):Airway, Breathing,Circulation, Drug (Defibrillation )

Advanced life support (ALS):Airway, Breathing, Circulation, Drug (Defibrillation),ECG, Fluid, Gauge, ICU


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ABCD stepsA, airway.B, breathing.

C, circulation.D, drugs and definitive therapy.

In a witnessed cardiac arrest (when treatment can beinitiated within 1 min of the onset of arrest), theABCD sequence should include use of a precordialthump.


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Precord ial Thum b


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OPEN AIRWAY

BREATHE

CHECK BREATHING

Shake and shout

Head tilt / Chin lift

Look, listen and feel

2 effective breaths

CHECK

RESPONSIVENESS

If breathing:

recovery position

Adult Basic Life Support


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CIRCULATION PRESENT

Continue Rescue Breathing

NO CIRCULATION

Compress Chest

Check circulationEvery minute

100 per minute15:2 ratio

Send or go for help as soon as poss ib le

according to gu idelines

ASSESS

10 secs only Signs of a circulation


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1. vertically downward4-5 cm2. Push hard push fast3. 100 x/min.4. Ratio Comp : Vent30 : 2

External Cardiac Compression


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Cardiac Compression


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Defibrillate up to 3 times

Epinephrine several

dose optionsAntiarrhythmic agents

Lidocaine

Bretylium

Magnesium Procainamide

Ventricular fibrillation


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Search for reversible causes and treat

Epinephrine Atropine for absolute or relative bradicardia


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Epinephrine

AtropineConsider transcutaneous pacing

Search for reversible causes andtreat if possible


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Atropine

Dopamine Epinephrine

Transcutaneous pacing

Transvenous pacing


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Immediate cardioversion

Premedicate when possible

Synchronized setting


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Narrow-complex

Adenosine

Verapamil Diltiazem

-blockers

Digoxin Synchronized cardioversion


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Wide-complex

Lidocaine Procainamide

Bretylium

Consider adenosine

Synchronized cardioversion


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It is critical to survival from sudden cardiac arrest(SCA) for several reasons:

(1) the most frequent initial rhythm in witnessedis ventricular fibrillation (VF),

(2) the treatment for VF is electrical defibrillation,

(3) The probability of successful defibrillationdiminishes rapidly over time, and

(4) VF tends to deteriorate to asystole within a fewminutes.


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Defibrillationdelivery of current through the chestand to the heart to depolarize myocardial cells andeliminate VF.

The energy settings for defibrillators are designed toprovide the lowest effective energy needed toterminate VF.

Electrophysiologic event that occurs in 300 to 500milliseconds after shock delivery.

Defibrillation (shock success) is typically defined astermination of VF for at least 5 seconds following theshock.


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Biphasic defibrillator (initial shock) :

selected energies of 150 J to 200 J

(biphasic truncated exponentialwaveform) or

120 J (rectilinear biphasic waveform).

For second and subsequent shocks, usethe same or higher energy


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Monophasic defibrillator : select adose of 360 J for all shocks.

If VF is initially terminated by ashock but then recurs later in the

arrest, deliver subsequent shocks atthe previously successful energylevel.


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Shock delivery that is timed (synchronized)with the QRS complex.

The energy (shock dose) used is lower than

that used for unsynchronized shocks(defibrillation).

These low-energy shocks if delivered asunsynchronized are likely to induce VF.

If cardioversion is needed and it is impossibleto synchronize a shock (eg, the patientsrhythm is irregular), use high-energy

unsynchronized shocks.


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Electrode Position


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Adrenaline - the primary sympathomimetic agentfor the management of cardiac arrest for 40 years.

Alpha-adrenergic actions,vasoconstrictive effectssystemic vasoconstriction, which increasescoronary and cerebral perfusion pressures.

Beta-adrenergic actions,(inotropic,

chronotropic) may increase coronary and cerebralblood flow.

.


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Indications Adrenaline is the first drug used in cardiac arrest of any

aetiology: it is included in the ALS algorithm for useevery 35 min of CPR.

Adrenaline is preferred in the treatment of anaphylaxis. Adrenaline is second-line treatment for cardiogenic

shock.

Dose. During cardiac arrest, the initial intravenous dose ofadrenaline is 1 mg.

When intravascular (intravenous or intra-osseous) accessis delayed or cannot be achieved, give 23 mg, diluted to10 ml with sterile water, via the tracheal tube. Absorptionvia the tracheal route is highly variable.


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Amiodarone is a membranestabilising anti-arrhythmic drug that increases the duration of the

action potential and refractory period in atrial andventricular myocardium.

Atrioventricular conduction is slowed, and asimilar effect is seen with accessory pathways.

Amiodarone has a mild negative inotropic actionand causes peripheral vasodilation through non-competitive alpha-blocking effects.


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Indications. refractory VF/VT haemodynamically stable ventricular tachycardia (VT)

and other resistant tachyarrhythmias

Dose. Consider an initial intravenous dose of 300mg amiodarone, diluted in 5% dextrose to a

volume of 20 ml (or from a pre-filled syringe), ifVF/VT persists after the third shock.

Amiodarone can cause thrombophlebitis wheninjected into a peripheral vein; use a central

venous catheter if one is in situ but,if not, use alarge peripheral vein and a generous flush.


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Indications. Lidocaine is indicated inrefractory VF/VT (when amiodarone isunavailable).

Dose. an initial dose of 100 mg (11.5mg/kg) for VF/pulseless VT refractory tothree shocks.

Give an additional bolus of 50 mg ifnecessary.

The total dose should not exceed 3 mg/kgduring the first hour.


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Atropine. antagonises the action of theparasympathetic neurotransmitter

acetylcholine at muscarinic receptors.Blocks the effect of the vagus nerve on

both the sinoatrial (SA) node and the

atrioventricular (AV) node, increasingsinus automaticity and facilitating AVnode conduction.


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is indicated in: asystole

pulseless electrical activity (PEA) with a

rate


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CPR must be continued until Cardiopulmonary system is stabilized

The patient is pronounced death

Alone rescuer is physically unable tocontinue


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1. Cardiorespiratory Arrest

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