Dr RB Rana ACLS 2011

8/7/2019 Dr RB Rana ACLS 2011

1/34

CPR: ACLSCPR: ACLSDr Resham B Rana, MD

ACLS National Trainer

National Academy of Medical Sciences

Nepal.March 9, 2011


2/34


3/34

Objectives:Objectives: Chest compressions,

Defibrillation,

Drugs,

During CPR: what else?


4/34


5/34

Initial steps:Initial steps:


6/34

Change A-B-C to C-A-BChange A-B-C to C-A-B


7/34

Chest compressionsand early defibrillation.

Chest compressions


8/34

High quality Chest compression:High quality Chest compression:


9/34

High quality Chest compression:High quality Chest compression:

Push hard to at least 5 cm

Push fast at a rate of at least 100 perminute

Allow full chest recoil

Change rescuer every 2 minutes Minimize interruptions in compressions

Cardiac thump is de-emphasised


10/34

Airway & breathingAirway & breathing Airway and breathing is to be assessed

after confirmation of unresponsiveness,

Airway to be managed by supraglotticdevice in absence ofexpert intubator,

Optimal respiration rate and tidal volume:

10 breaths per minute should be delivered

quickly over one second each. For BVM ventilation: with oxygen supplement

100%, chest should be visibly rise duringbreaths (a tidal volume of 10 ml/kg)

ECC:Ventilation ratio 30:2 (1 / 2 rescuer)


11/34

AirwayAirway -- CapnometryCapnometry Increased emphasis on the

use of capnography

to confirm and continuallymonitor tracheal tube

placement,

quality of CPR and

to provide an early indication of

return of spontaneous

circulation (ROSC)


12/34

Capnography RecommendationCapnography Recommendation

Capnography to confirm endotracheal tube placement.

Capnography to monitor effectiveness of resuscitation efforts.

Capnography Waveform


13/34

Pressure of end

tidal CO2 (PETCO2)

Ineffective chest

compressions

indicated by


14/34

Ventilation strategy:Ventilation strategy: Chest compression to ventilation ratio:

30:2 (1 or 2 rescuer) without advanced

airway,

Avoid excessive ventilation (10-12 per

minute with advanced airway),

Capnography: PETCO2 :


15/34

During CPR:During CPR: Ensure high quality CPR

Plan actions before interrupting CPR

Give oxygen

Advanced airway and capnography

ECC when advanced airway in place

Vascular access (IV/IO)

Adrenaline every 4 minutes,

Treat reversible causes


16/34

Rhythm assessment:Rhythm assessment:


17/34

Shockable rhythms:Shockable rhythms:


18/34

Ventricular fibrillationVentricular fibrillation


19/34

Pulseless VTs (PVT)Pulseless VTs (PVT)


20/34

Algorithm:Algorithm:


21/34

Sequence of steps: ShockableSequence of steps: Shockable1. Effective chest compression with

breathing,

2. Once Defibrillator is available:

shock and chest compression,

3. After third shock: shock and chest

compression then drugs,


22/34

Shock energy:Shock energy: Biphasic:

As per manufacturer recommendation

(120-200 J), 150 200 250,

Second and subsequent doses should be

equivalent or higher doses may be

considered,

Monophasic:

360 J one to all.


23/34

Drug/s:Drug/s: Give Adrenaline 1 mg after third

shock then every 4 minutes,

Amiodarone 300 mg can be given

delivered simultaneously along with

the adrenaline,

Further dose of amiodarone 150 mgis delivered in resistant / refractory

cases,


24/34

Drugs:Drugs: Use lidocaine in absence of

amiodarone

Use magnesium for torsades de

pointes

Continue high quality CPR

Find the reversible causes of arrest in

the line of Hs and Ts and manage

accordingly


25/34

NonNon--shockableshockable rhythms:rhythms:


26/34

AsystoleAsystole


27/34

AsystoleAsystole


28/34

PEA / EMD:PEA / EMD:


29/34

Algorithm:Algorithm:


30/34

Drugs:Drugs: Adrenaline is the only drug for these

rhythms,

1 mg every 4 minutes,

High quality CPR

Find the reversible causes of arrest

in the line of Hs and Ts and

manage accordingly


31/34

Reversible causes:Reversible causes:

5 Hs

Hypoxia, Hypovolemia,

Hypo/hyperkalemia,

Hydrogen ion, Hypothermia,

5 Ts

Txn Tneumothorax, Tamponade cardiac,

Toxins / drugs,

Thrombosis coronary,

Thrombosis pulm.,


32/34

Queries / CommentsQueries / Comments


33/34

SummarySummary Chest compressions

Airway & breathing, Defibrillation

Drug therapy

During CPR: what else?


34/34

Thanks!!Thanks!!

Dr RB Rana ACLS 2011

Documents

Transcript of Dr RB Rana ACLS 2011