Cardio-Pulmonary and Cerebral Resuscitation Lecture 1
-
Upload
emma-parks -
Category
Documents
-
view
72 -
download
2
description
Transcript of Cardio-Pulmonary and Cerebral Resuscitation Lecture 1
Cardio-Pulmonary and Cardio-Pulmonary and Cerebral ResuscitationCerebral Resuscitation
Lecture 1Lecture 1Department of Anesthesiology and Department of Anesthesiology and
Intensive CareIntensive CareThe The head of a departmenthead of a department: I.Titov, DrPh.: I.Titov, DrPh.
The theme of lecture N 1The theme of lecture N 1
1.1. Cardiopulmonary resuscitation. Cardiopulmonary resuscitation. Symptoms of clinical deathSymptoms of clinical death. Safar’s triple . Safar’s triple manoeuvre. Breathing.manoeuvre. Breathing.
2.2. Cardiopulmonary resuscitation. Chest Cardiopulmonary resuscitation. Chest compression. Complications of the CPR.compression. Complications of the CPR.
Part II. Cardiopulmonary Part II. Cardiopulmonary resuscitationresuscitation
LifeLife
For normal functioning all cells of the body For normal functioning all cells of the body require oxygen. If oxygen is not provided, require oxygen. If oxygen is not provided, death of organism appears within death of organism appears within 4..5 4..5 minutesminutes. .
BrainBrain is the tissue most susceptible to is the tissue most susceptible to anoxia (absence of oxygen). anoxia (absence of oxygen).
Part II. Cardiopulmonary Part II. Cardiopulmonary resuscitationresuscitation
Process of the deathProcess of the death
Is not a momentary but stepwise process, which can take certain Is not a momentary but stepwise process, which can take certain
time. time.
FiveFive steps of the death: steps of the death:
– Preagony Preagony
– Terminal pauseTerminal pause
– AgonyAgony
– Clinical death Clinical death (reversible injury)(reversible injury)
– Biological deathBiological death (irreversible injury)(irreversible injury)
Part II. Cardiopulmonary Part II. Cardiopulmonary resuscitationresuscitation
Agony Agony isis a staa stagege which preced which precedee to the death. to the death.
Function of vital organs is severFunction of vital organs is severee disturbed, and disturbed, and
conditions required for survival of organism conditions required for survival of organism
cannot be met. cannot be met.
UnconsciousnessUnconsciousness
Blood pressure is undetectableBlood pressure is undetectable
No pulse on arteriesNo pulse on arteries
Clinical death: Clinical death: circulation stops completely and that circulation stops completely and that
leads to the cessation of breathing and nervous leads to the cessation of breathing and nervous
system activity.system activity.
Part II. Cardiopulmonary Part II. Cardiopulmonary resuscitationresuscitation
Symptoms of clinical deathSymptoms of clinical death
No pulse on arteriesNo pulse on arteries (carotid or (carotid or femoral)femoral)Change of skin colour Change of skin colour UnconsciousnessUnconsciousnessGasping, cessation of breathingGasping, cessation of breathingDilatation of eye pupils Dilatation of eye pupils
Duration of clinical death is 3(5) minutesDuration of clinical death is 3(5) minutes
Part II. Cardiopulmonary Part II. Cardiopulmonary resuscitationresuscitation
Biological death Biological death is irreversible condition. Metabolism is irreversible condition. Metabolism
and functioning of vital organs has completely and functioning of vital organs has completely
ceasedceased. Organ damage is as extensive that . Organ damage is as extensive that
resuscitation of the body is impossible.resuscitation of the body is impossible.
Evident symptoms of the death:Evident symptoms of the death:
Rigor mortisRigor mortis
Death spots on the bodyDeath spots on the body
Drop of body temperature to the level of the Drop of body temperature to the level of the surrounding surrounding
Part II. Cardiopulmonary Part II. Cardiopulmonary resuscitationresuscitation
Adult BLS sequenceAdult BLS sequenceBasic life support consists of the following actions:Basic life support consists of the following actions:1. Make sure that the victim, any bystanders, and you 1. Make sure that the victim, any bystanders, and you
are safe.are safe.2. Check the victim for a response (gently shake his 2. Check the victim for a response (gently shake his
shoulders and ask loudly, “Sir. Or Ms., are you all shoulders and ask loudly, “Sir. Or Ms., are you all right?”)right?”)
3 A. If he responds:3 A. If he responds: Leave him in the position in which you find him Leave him in the position in which you find him
provided there is no further danger.provided there is no further danger. Try to find out what is wrong with him and get help if Try to find out what is wrong with him and get help if
needed.needed. Reassess him regularly.Reassess him regularly.
Part II. Cardiopulmonary Part II. Cardiopulmonary resuscitationresuscitation
Adult BLS sequenceAdult BLS sequence3 B. If he does not respond:3 B. If he does not respond:Shout for help, call 911 (USA and Canada) Shout for help, call 911 (USA and Canada)
or 03 (Ukraine and Russian Fed)or 03 (Ukraine and Russian Fed)Turn the victim onto his back and then Turn the victim onto his back and then
open the airway using head tilt and chin lift:open the airway using head tilt and chin lift: - place your hand on his forehead and - place your hand on his forehead and
gently tilt head back.gently tilt head back.- with your fingertips under the point of the - with your fingertips under the point of the victim’s chin, lift the chin to open the victim’s chin, lift the chin to open the airway.airway.
Part II. Cardiopulmonary Part II. Cardiopulmonary resuscitationresuscitation
Adult BLS sequenceAdult BLS sequence
4. Keep the airway open, look, listen, and 4. Keep the airway open, look, listen, and feel for normal breathing.feel for normal breathing.
Look for chest movementLook for chest movement Listen at the victim’s mouth for breath Listen at the victim’s mouth for breath
sounds.sounds. Feel for air on your cheekFeel for air on your cheek
Look, listen and feelLook, listen and feel for for no moreno more than than 10 10 secsec to determine if the victim breathing to determine if the victim breathing normally. normally.
Shake and Shout
Opening the airwayOpening the airway
Head tiltHead tilt
Chin liftChin lift
If cervical spine If cervical spine injury suspected:injury suspected:– jaw thrustjaw thrust
Assess BreathingAssess Breathing
Look for chest Look for chest movementmovement
Listen for breath Listen for breath soundssounds
Feel for expired airFeel for expired air
Assess for 10 Assess for 10 seconds before seconds before deciding breathing is deciding breathing is absentabsent
Rescue breathingRescue breathing(Expired air ventilation)(Expired air ventilation)
If he is not breathing normally:If he is not breathing normally:
Ask someone to call for an Ask someone to call for an ambulance.ambulance.
Kneel by the side of the victim.Kneel by the side of the victim. Pinch the soft part of the victim’s Pinch the soft part of the victim’s
nose, using the index finger and nose, using the index finger and thumb of your hand on his thumb of your hand on his forehead.forehead.
Allows his mouth to open, but Allows his mouth to open, but maintain chin tilt.maintain chin tilt.
Take a normal breath and place Take a normal breath and place your lips around his mouth, your lips around his mouth, making sure that you have a making sure that you have a good seal. good seal.
Part II. Cardiopulmonary Part II. Cardiopulmonary resuscitationresuscitation
Blow into his mouth and look on his chest, chest Blow into his mouth and look on his chest, chest must rise; take about one second to make his must rise; take about one second to make his chest rise as in normal breathing; this is an chest rise as in normal breathing; this is an effective rescue breath.effective rescue breath.
Maintaining head tilt and chin lift, take your mouth Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest.away from the victim and watch for his chest.
Take another normal breath and blow into the Take another normal breath and blow into the victim’s mouth once more to give a total of two victim’s mouth once more to give a total of two effective rescue breaths. effective rescue breaths.
Give each rescue breath over 1 sec rather than 2 Give each rescue breath over 1 sec rather than 2 sec.sec.
Assess CirculationAssess CirculationCheck the victim’s pulse.Check the victim’s pulse.
A. If pulse on the carotid artery is not palpable – A. If pulse on the carotid artery is not palpable – begin chest compression.begin chest compression.
Place the heel of one hand in the centre of the Place the heel of one hand in the centre of the victim’s chest.victim’s chest.
Place the heel of your other hand on the top of the Place the heel of your other hand on the top of the first hand.first hand.
Interlock the fingers of your hands and ensure that Interlock the fingers of your hands and ensure that pressure is not applied over the victim’s ribs. Do pressure is not applied over the victim’s ribs. Do not apply any pressure over the upper abdomen not apply any pressure over the upper abdomen or the bottom end of the bony sternum or the bottom end of the bony sternum (breastbone).(breastbone).
Part II. Cardiopulmonary Part II. Cardiopulmonary resuscitationresuscitation
– 3030 compressions compressions : 2 breaths for: 2 breaths for
1-person 1-person CPRCPR
2-person 2-person CPRCPR
Part II. Cardiopulmonary Part II. Cardiopulmonary resuscitationresuscitation
Chest Chest compressions:compressions:
Depress sternum Depress sternum 4-5 cm4-5 cm
Rate: 100 per Rate: 100 per minuteminute
PRECORDIALPRECORDIAL BLOWBLOW
IndicationsIndications::
Confirmed Confirmed of of blood circulation blood circulation stopstop
Continue resuscitation until:Continue resuscitation until:
Qualified help arrives and takes Qualified help arrives and takes overover
The victim shows signs of lifeThe victim shows signs of life
You become exhaustedYou become exhausted
Airway management and Airway management and ventilationventilation
Basic airway management and Basic airway management and ventilationventilation
The laryngeal mask airway and The laryngeal mask airway and CombitubeCombitube
Advanced techniques of airway Advanced techniques of airway managementmanagement
Basic mechanical ventilationBasic mechanical ventilation
Safar’s triple Safar’s triple manoeuvremanoeuvre
Open mouthOpen mouth
Head Tilt and Head Tilt and Chin LiftChin Lift
Jaw ThrustJaw Thrust
SUCTIONSUCTION
Ventilation by mouth through a Ventilation by mouth through a maskmask
AdvantagesAdvantages::
Allows to avoid direct contact Allows to avoid direct contact
Reduces probability Reduces probability of of infectedinfected
Allows to raiseAllows to raise O2O2
RestrictionsRestrictions::
Tightness maintenanceTightness maintenance
Stomach inflatingStomach inflating
Bag-valve-maskBag-valve-mask
Ventilation by means of bag АVentilation by means of bag Аmbumbu
AdvantagesAdvantages
Direct contact allows to Direct contact allows to avoidavoid
Allows to increase Allows to increase concentration О2concentration О2 - - toto 85 % 85 %
Can be used with an Can be used with an obverse mask, obverse mask, LLММ, , Combitube, Combitube, endotrachealendotracheal tubetube
RestrictionsRestrictions At use with an obverse At use with an obverse maskmask::Risk of inadequate Risk of inadequate ventilationventilationRisk of inflating of a Risk of inflating of a stomachstomach 4 hands are necessary 4 hands are necessary for optimum usefor optimum use
Installation Installation LLММ
LaryngealLaryngeal mask mask
AdvantagesAdvantagesSpeed and simplicity of Speed and simplicity of installationinstallation
Presence of the different Presence of the different sizessizes
More effective ventilation in More effective ventilation in comparison with an comparison with an obverse maskobverse mask
Allows to avoid Allows to avoid laryngoscopylaryngoscopy
RestrictionsRestrictionsDoes not protect from Does not protect from aspirationaspirationDoes not approach in Does not approach in situations when high situations when high pressure use on a breath pressure use on a breath is requiredis requiredIt is impossible It is impossible to to aspirate fromaspirate from bottom bottom BPBP
Choice of an air line of the suitableChoice of an air line of the suitable
sizesize
Simple adaptations for maintenance Simple adaptations for maintenance of BPof BP
Installation Installation of pharyngo-oralof pharyngo-oral an air an air lineline
Installation Installation of pharyngonasalof pharyngonasal an air line an air line
CombitubeCombitube AdvantagesAdvantages
Speed and simplicity of Speed and simplicity of installationinstallation
Allows to avoid Allows to avoid laryngoscopylaryngoscopy
It is possible to use, It is possible to use, when pressure upon a when pressure upon a breath the highbreath the high
RestrictionsRestrictionsIt is accessible only 2 sizesIt is accessible only 2 sizes
There is a risk of ventilation There is a risk of ventilation through a gastric gleamthrough a gastric gleam
Damage of cuffs at installationDamage of cuffs at installation
Trauma in an installation timeTrauma in an installation time
Only for disposable useOnly for disposable use
Ventilation by means of Ventilation by means of CombitubeCombitube
Intubation ofIntubation of ttracheasracheas Attempt Attempt of intubationof intubation::
Preoxygenation ofPreoxygenation of the patient the patient30 30 seconds on each attemptseconds on each attemptSpend a tube through a vocal crack under the Spend a tube through a vocal crack under the control of direct sightcontrol of direct sightAt any doubts or complexitiesAt any doubts or complexities, , reoxygenationreoxygenation the the patient before the subsequent attemptspatient before the subsequent attemptsPatients are harmed by unsuccessful attempts Patients are harmed by unsuccessful attempts of oxygenation, instead of of oxygenation, instead of intubationintubation!!
Installation Installation of endotracheal of endotracheal tubetube
Intubation of tracheaIntubation of trachea
AdvantagesAdvantages
Allows to increase Allows to increase PO2PO2 to to 100 %100 %
Isolates Isolates BPBP, preventing , preventing of aspirationof aspiration
Allows Allows aspirated of BPaspirated of BP
Alternative way for Alternative way for introductionintroduction of medicine of medicine
RestrictionsRestrictionsTraining and Training and experience are experience are absolutely necessaryabsolutely necessaryUnfortunate attempt, Unfortunate attempt, esophageal intubationesophageal intubationRisk of deterioration of Risk of deterioration of damage back and a damage back and a brain during brain during laryngoscopelaryngoscope
Confirmation of correct position Confirmation of correct position of ETTof ETT in a trachea in a trachea
Direct visualisation during Direct visualisation during laryngoscopelaryngoscopeAuscultationAuscultation::– With two sidesWith two sides,, on average on average axillary'saxillary's lines lines– Over Over epigastriumepigastrium
Symmetric movements Symmetric movements of thoraxof thorax during during ventilationventilation
Pressure on Pressure on cricoidcricoid cartilage on purpose cartilage on purpose of of occlusionocclusion a gullet about a gullet about cervical department of a cervical department of a backbonebackbone
Sellick”s manoeuvreSellick”s manoeuvre
Sellick”s manoeuvreSellick”s manoeuvre
AdvantagesAdvantagesDDecrease ecrease of rof risk isk of of aspirationaspiration and and regurgitationregurgitation
It can be applied at It can be applied at intubationintubation,, and also and also ventilation by means of ventilation by means of an obverse mask and an obverse mask and LMLM
LacksLacks
Can complicate Can complicate intubationintubation
Can complicate Can complicate ventilation by means ventilation by means of an obverse mask of an obverse mask or or LMLM
Avoid at active Avoid at active vomitingvomiting
CricothireotomyCricothireotomy
IndicationsIndicationsImpossibility of maintenanceImpossibility of maintenance passableness passableness oof f BPBP in in another wayanother way
ComplicationsComplicationsDisplacement Displacement of cannulaof cannula– EmphysemaEmphysema– BleedingBleeding– Gullet punchingGullet punching
HypoventilationHypoventilation
DEFIBRILLATIONDEFIBRILLATION
Rhythm of a stop of blood Rhythm of a stop of blood circulationcirculation
Fibrillation Fibrillation of ventriclesof ventricles
Ventricle'sVentricle's tachycardia «without pulse» tachycardia «without pulse»
AsystoleAsystole
Electro-mechanical Electro-mechanical dissociationdissociation ( (EMDEMD))
AsystoleAsystole
There is no activity There is no activity of ventricles of ventricles ((complex complex QRS)QRS)
Activity of auricles Activity of auricles (wave(wave P) P) can becan be
Seldom straight lineSeldom straight line
Possibility Possibility of sof small wavemall waves ofs of VFVF
The mechanism The mechanism of of DEFIBRILLATIONDEFIBRILLATION
DefinitionDefinition– ““The termination of fibrillation or absence The termination of fibrillation or absence
VF/VT VF/VT in in 5 5 seconds after the seconds after the discharge”discharge”
DepolarizedDepolarized all weight of a myocardium all weight of a myocardium
Natural Natural pacemekerpacemeker renew job renew job
Automatic external Automatic external DEFIBRILLATORDEFIBRILLATOR
Analyze a Analyze a heart heart rhythmrhythmMake the Make the dischargedischargeSpecificity in Specificity in recognition of the recognition of the rhythm rhythm in in subject which subject which is is defibrillationdefibrillation comes comes nearer to nearer to 100 %100 %
Automatic external Automatic external DEFIBRILLATORDEFIBRILLATOR
Attach sticky electrodesAttach sticky electrodesFollow the sound and Follow the sound and visual instructionvisual instructionThe automatic analysis of The automatic analysis of an electrocardiograman electrocardiogram - - do do not touch the patientnot touch the patient The automatic The automatic dischargedischarge at a corresponding at a corresponding rhythmrhythm+/-+/-a manual overloada manual overload
Manual Manual DEFIBRILLATIONDEFIBRILLATION
It is based onIt is based on::
The rhythm is recognised The rhythm is recognised by the operatorby the operator
The operator puts the The operator puts the dischargedischarge
It can be used for It can be used for synchronised synchronised cardioversioncardioversion
Safety Safety of defibrillation of defibrillation
Never hold both electrodes in one handNever hold both electrodes in one hand
Charge only when electrodes on a breast Charge only when electrodes on a breast of the victimof the victim
Avoid direct or indirect contactAvoid direct or indirect contact
Wipe dry a breast of the patientWipe dry a breast of the patient
Remove oxygen from a zone Remove oxygen from a zone of of defibrillation defibrillation
Manual Manual DEFIBRILLATION (1)DEFIBRILLATION (1)Diagnostics Diagnostics VFVF//VTVT andand signs of a stop of blood signs of a stop of blood circulationcirculationChoice of suitable energy of Choice of suitable energy of the the dischargedischargeTo load condensers To load condensers (electrodes on the patient)(electrodes on the patient)The commandThe command “ “all to departall to depart””Visual check of a zone Visual check of a zone of of defibrillationdefibrillationTo check up the monitorTo check up the monitorThe The dischargedischarge
Manual Manual DEFIBRILLATION (2)DEFIBRILLATION (2)
Repeatedly to estimate a rhythmRepeatedly to estimate a rhythmTo hold electrodes on a breast between To hold electrodes on a breast between dischargesdischargesTo increase energyTo increase energy– The assistant makesThe assistant makes, , oror– To place an electrode on To place an electrode on defibrillatordefibrillator and to and to
choose energy level independentlychoose energy level independently
Not to spendNot to spend BLS BLS between between dischargedischarges if s if there is no long delaythere is no long delay
The conclusionThe conclusion
DefibrillationDefibrillation it is unique effective at it is unique effective at restoration of circulation at patients with restoration of circulation at patients with VFVF or or VTVT without pulse without pulseDefibrillationDefibrillation should it is spent quickly, should it is spent quickly, effectively and safelyeffectively and safelyNew technologies increase possibilities of New technologies increase possibilities of equipment and simplify useequipment and simplify use
Introduction of medicines inIntroduction of medicines in
ttime ime of of СРСРRR
The central venous accessThe central venous access
Internal jugular veinInternal jugular vein
SubclavianSubclavian veinvein
Complications Complications of catheterizationof catheterization the central veinsthe central veins
Artery punctureArtery punctureHematomaHematomaHemothoraxHemothoraxPneumothoraxPneumothoraxAir Air embolismembolismDamage of surrounding fabricsDamage of surrounding fabricsААrrhythmiasrrhythmias
IntatrachealIntatracheal introductinintroductin of medicines of medicines
Preparations whichPreparations which cancan it is entered into it is entered into a tracheaa trachea::
AdrenalineAdrenaline
LidocaineLidocaine
AtropineAtropine
NaloxoniNaloxoni
Preparations whichPreparations which cannotcannot be entered into be entered into a trachea:a trachea:
AmiodaroniAmiodaroni
Sodium bicarbonateSodium bicarbonate
CalciumCalcium
AdrenalineAdrenaline
IndicationsIndications::
Any rhythm at a blood circulation stopAny rhythm at a blood circulation stop
BradycardiaBradycardia
Special circumstancesSpecial circumstances::
Anaphylactic shockAnaphylactic shock
AdrenalineAdrenalineDoseDose::
1 mg I\V1 mg I\V inin 10 1:10,000 (1 ml 1:1,000) every 2-3 10 1:10,000 (1 ml 1:1,000) every 2-3 minmin at resuscitationat resuscitation2-3 mg2-3 mg throwthrow EEТТТТ
2–10 mkg min2–10 mkg min-1-1 at at bbradycardia resistant to radycardia resistant to atropineatropine0.50.5 ml 1:1,000 iml 1:1,000 i//m, 3-5 ml 1:10,000 im, 3-5 ml 1:10,000 i//vvat anaphylactic shockat anaphylactic shock, , in din depending on weightepending on weight
AdrenalineAdrenaline
ActionAction::
aa-agonist-agonist:: - - arterial arterial vasoconstriction vasoconstriction ОПССОПСС a cerebral and coronary blood-groovea cerebral and coronary blood-groove
bb-agonist-agonist ↑↑ HC HC ↑↑ forces of forces of heartheart reductions reductions requirements of a myocardium for oxygen requirements of a myocardium for oxygen ((can can strengthen an ischemiastrengthen an ischemia))
AtropineAtropine
IndicationsIndications::
AsystoleAsystoleBradycardia Bradycardia EMD (F of HCEMD (F of HC < 60 in min)< 60 in min)
AtropineAtropine
ActionAction ::Blockade of effects of nervBlockade of effects of nervus vagusus vagusSStrengthening trengthening of aof automatism utomatism of sinoatrial of sinoatrial nodenodeIncrease А-В of conductivityIncrease А-В of conductivity
AtropineAtropine
DoseDose ::
Asystole / EMD (F of HCAsystole / EMD (F of HC < 60 in min)< 60 in min)– 3 mg3 mg ii//v, uv, unitarynitary– 6 mg6 mg throwthrow EEТТТТ
BradycardiaBradycardia– 0.50.5 mgmg ii//v, tv, to repeat at necessity, maximum o repeat at necessity, maximum 3 mg 3 mg
AmiodaroniAmiodaroni
IndicationsIndications ::
RefractoryRefractory VF / VTVF / VT without pulse without pulseHemodynamicHemodynamic stable stable VTVTOther resistant Other resistant tachyarrhythmiatachyarrhythmia
AmiodaroniAmiodaroniDoseDose ::
RefractoryRefractory VF / VTVF / VT without pulse without pulse
300 mg in 20 ml 5% dextrose, i300 mg in 20 ml 5% dextrose, i//vv
TachyarrhythmiaTachyarrhythmia
– 150 mg in 20 ml 5% dextrose150 mg in 20 ml 5% dextrose duringduring 10 min10 min– RRepeatepeat 150 mg 150 mg at necessity at necessity– 300 mg300 mg inin 100 ml 5% dextrose100 ml 5% dextrose duringduring 1 hour1 hour
AmiodaroniAmiodaroni
ActionAction::
Increases duration of potential of actionIncreases duration of potential of action
Extends intervalExtends interval Q-T Q-T
Weak negative Weak negative inotropicinotropic action action - - can call a can call a hypotensionhypotension
LidocaineLidocaine
IndicationsIndications ::
RefractoryRefractory VF / VTVF / VT without pulse without pulse– aat inaccessibilityt inaccessibility of amiodaroni of amiodaroni
HemodynamicHemodynamic stable stable VTVT– aas alternative s alternative for amiodaroni
LidocaineLidocaine
DoseDose ::
RefractoryRefractory VF / VTVF / VT without pulse without pulse– 100 mg100 mg ii//vv– afterafter boluses 50 mg, max 200 mgboluses 50 mg, max 200 mg
HemodynamicHemodynamic stable stable VTVT– 50 mg50 mg ii//v.v.– afterafter boluses 50 mg, max 200 mgboluses 50 mg, max 200 mg
To lower a dose at elderly and at hepatic insufficiencyTo lower a dose at elderly and at hepatic insufficiency
Sodium bicarbonateSodium bicarbonate
IndicationsIndications ::
Heavy metabolic Heavy metabolic acidosis (pH <7.1)acidosis (pH <7.1)↑↑ K in bloodK in bloodSpecial circumstancesSpecial circumstancesPoisoning Poisoning by by energizersenergizers
Sodium bicarbonateSodium bicarbonate
DoseDose ::
50 mmol (50 ml 8.4% solution) i50 mmol (50 ml 8.4% solution) i//vv
Sodium bicarbonateSodium bicarbonate
ActionAction::AlkalineAlkaline agent agent ((increaseincrease pH) pH) ButBut can callcan call::– Increase in loading СО2Increase in loading СО2– Reduction of liberation О2 in fabricsReduction of liberation О2 in fabrics– Decrease Decrease contractility ofcontractility of myocardium myocardium– IncreaseIncrease Na in blood Na in blood
Co-operates with adrenalineCo-operates with adrenaline
CalciumCalcium
ActionAction::
It is necessary for normal reduction of a It is necessary for normal reduction of a myocardiummyocardium
Surplus can call Surplus can call arrhythmiaarrhythmia The trigger of destruction of cages The trigger of destruction of cages ischemicischemic
myocardiummyocardium Surplus can break brain restorationSurplus can break brain restoration
CalciumCalcium
IndicationsIndications ::
EMDEMD calling by :calling by :– ↑↑ K in bloodK in blood– ↓ ↓ Ca in bloodCa in blood – Overdose Overdose of of calcium calcium blockerblocker
DoseDose : :
10 ml 10% Ca Cl (6.8 mmol\l)10 ml 10% Ca Cl (6.8 mmol\l)Not to enter at once before or after bicarbonate Not to enter at once before or after bicarbonate sodiumsodium
NaloxoniNaloxoni
IndicationsIndications ::
Overdose Overdose of opiatesof opiates
Oppression of breath after appointment Oppression of breath after appointment of of opiatesopiates
NaloxoniNaloxoni
DoseDose ::
0.2 - 2.0 mg0.2 - 2.0 mg ii//vvIt can be demanded repeatedlyIt can be demanded repeatedly,, possible to possible to 10 10 mgmgInfusion can be demandedInfusion can be demanded
To estimaterhythm
+/- check up pulse
VF/VT
Defibrillation X 3if necessary
СРR 1 min
Ventricle fibrillation / Ventricle tachycardia without pulsewithout pulse
VF/VT
DischargeDischarge 200 J*
DischargeDischarge 200 J*
DischargeDischarge 360 J*
To make To make 3 3 dischargesdischarges if it is if it is necessarynecessary, , in a current in a current of 1 of 1 minuteminute
Not to interrupt Not to interrupt defibrillationdefibrillation for for BLSBLS
After the After the dischargedischarge, palpate , palpate pulse on carotids, only if on pulse on carotids, only if on an electrocardiogram a an electrocardiogram a rhythm correspondingrhythm corresponding to job to job of heartof heart
During СРRCorrection of the reversible reasons
If it is not made:To check up electrodes, an arrangement
and contactTo provide / to check up
- Passableness BP and O2 - Venous access
Adrenaline each 3 minesTo consider:
amidaroni, atropine / pacing buffers
Compression, respiratory ways Compression, respiratory ways and ventilationand ventilation
Passableness of respiratory waysPassableness of respiratory ways::– EndotrachealEndotracheal tube tube– LMLM– CombitubeCombitube
After maintenance of passableness After maintenance of passableness of of BPBP do not interrupt a compression for do not interrupt a compression for ventilationventilation
Venous access and preparationsVenous access and preparations FV/VTFV/VT
The central or peripheral veinThe central or peripheral vein
AdrenalineAdrenaline of 1 of 1 mg mg ii//vv or or 2-3 2-3 mg mg endotrachealendotracheal
To consider To consider amiodaroniamiodaroni 300 300 mg if mg if FV/VT FV/VT presentpresent after after 33rd categoryrd category
Alternatively Alternatively -- lidocaine lidocaine of 100 of 100 mgmg
To consider magnesium To consider magnesium 8 8 mmolmmol
False False asystoleasystole
When monitoring with paddle-gel padsWhen monitoring with paddle-gel pads
More likely with increasing number of More likely with increasing number of shocks and high chest impedanceshocks and high chest impedance
Displays apparent “asystole”Displays apparent “asystole”
Confirm rhythm with monitoring leadsConfirm rhythm with monitoring leads