DEFINITION Cardiopulmonary resuscitation (CPR) is the manual application of chest compressions and ventilations to patients in cardiac arrest, done with an effort to maintain viability ADVANCED CARDIAC LIFE SUPPORT Advanced cardiac life support or advanced cardiovascular life support (ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest and other life- threatening medical emergencies, as well as the knowledge and skills to deploy those interventions. ACLS is a series of evidence based responses simple enough to be committed to memory and recall under moments of stress. ’ AMERICAN HEART ASSOCIATION (AHA) protocols are considered to be the GOLD standard ACLS protocols ' It gets reviewed every 5 year, now latest advancements in ecgguidelines.health.org INDICATION: “| Road Traffic Accident "1 Drowning “| Electric Shock Airway Obstruction |) Cardiac Arrest CONTRAINDICATION: v Do-not-resuscitate (DNR) CHAIN OF SURVIVAL: POSITIONING Positioning for CPR: 6 CPR is most easily and effectively performed by laying the patient supine on a relatively hard surface, which allows effective compression of the sternum. 0 Delivery of CPR on a mattress or other soft material is generally less effective. 0 The person giving compressions should be positioned high enough above the patient to achieve sufficient leverage, so that he or she can use body weight to adequately compress the chest. Remember to spell C-A-B Compressions: Restore blood circulation 1. Place the heel of one hand over the center of the person's chest, between the nipples. Place other hand on top of the first hand. Keep elbows straight and position shoulders directly above hands. 2. Use upper body weight (not just arms) as pushing straight down on (compress) the chest Compression rate:In adult victims of cardiac arrest, it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min Compression depth: During manual CPR, rescuers should perform chest compressions to a depth of at least 2 inches (5 cm) for an average adult, while avoiding excessive chest compression depths (greater than 2.4 inches [6 cm]) Chest recoil: It is reasonable for rescuers to avoid leaning on the chest between compressions, to allow full chest wall recoil for adults in cardiac arrest. If not trained in CPR, continue chest compressions until there are signs of movement or until emergency medical personnel take over. Airway: Open the airway Some signs of obstructed airway include poor air exchange, high pitch noise while breathing and inability to speak. If rescuer trained in CPR and performed 30 chest compressions, open the person's airway using the head-tilt, chin- lift maneuver. Put palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway. Breathing: Breathe for the person Rescue breathing can be mouth-to-mouth breathing or mouth-to- nose breathing if the mouth is seriously injured or can't be opened. With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal. Prepare to give two rescue breaths. Give the first rescue breath lasting one It may be reasonable for the provider to deliver 1 breath every 6 seconds (10 breaths per minute) while continuous chest compressions are being performed (i.e., during CPR with an advanced airway). The adequacy of breath given can be determined by observing for tise in victims chest. Continue CPR until there are signs of movement or emergency medical personnel take over recovery position The recovery position refers to one of a series of variations on a lateral recumbent or three-quarters prone position of the body. If a person is unconscious but is breathing and has no other life- threatening conditions, they should be placed in therecovery position, Putting someone in the recovery position will keep their airway clear and open. It also ensures that any vomit or fluid won't cause them to choke. DEMONSTRATION STEPS Before you begin Immediately upon seeing the victim and Before starting CPR, check: — Is the environment safe for the person? — Is the person conscious or unconscious? — If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?" — Check carotid pulse for 10 seconds. — If the person doesn't respond and two people are available, have one person call 108 or the local emergency number and have the other person begin CPR. — If alone and have immediate access to a telephone, call 108 or local emergency number before beginning CPR. Get the AED, if one is available. — As soon as an AED is available, deliver one shock if instructed by the device, then begin CPR. — Put the person on his or her back on a firm surface. — Kneel next to the person's neck and shoulders. DEFIBRILLATION Biphasic wave form: 120- 200 J Monophasic wave form: 360 J ‘AED- device specific v Failure of a single adequate shock to restore a pulse should be followed by continued CPR and second shock delivered after five cycles of CPR HOW TO USE DEFIBRILLATOR SAFETY If patient not intubated remove 02 delivery devices If intubated either leave bag valve resuscitator attached to ET or remove it If available use self adhesive defibrillation pads Do not place over pacemakers Remove transdermal patches. -PROCEDURE Place sternal paddle over right of the sternum below clavicle Place apical paddle in mid axillary line in 5th IC space ‘Switch on the defibrillator Charge the defibrillator to 200J or 360J Warn all other rescuers to stand clear- ‘ARE YOU CLEAR’Visually check all are clear Ensure yourself you are not touching patient or bed ‘| AM CLEAR’ Deliver shock Restart CPR with out checking pulse. Automatic External Defibrillator (AED) An automated external defibrillator (AED) is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation (VF) and pulseless ventricular tachycardia, and is able to treat them through defibrillation Switch onAED. Attach electrode pads. Place electrodes as that of manual one Follow voice commands Make sure no one in contact with patient Push shock button. BREATHING DEVICES BASICAIRWAYS. Oropharyngeal airway Nasopharyngeal airway ADVANCED Endotracheal tube Laryngeal mask airway Laryngeal tube Oesophageal tracheal tube Nasopharyngeal airway * OROPHARYNGEALAIRWAY ENDOTRACHEALTUBE Laryngeal mask airway Laryngeal tube Oesophageal tracheal tube Routes of Administration * Peripheral lV — must followed by 20 ml NS push Central lV — fast onset of action, but do not wait or waste time for CV line Intraosseous — alternative IV route in peds, also in Adult vulntratracheally (down an ET tube)- not recommended now a days Oxygen v IV Fluids LidocaineIndications: VT, VF “+ Can be toxic so no longer given prophylactically + IV dose : v 1-1.5 mg/kg bolus then continuous infusion of 2-4 mg/min * Can be given down ET tube “ Signs of toxicity: v slurred speech, seizures, altered consciousness “+ Magnesium Used for refractory VF or VT caused by hypomagnesemia and Torsades de Pointes Dose: 1-2 grams over 2 minutes Side Effects « Hypotension Asystole Propranolol/ Esmolol Beta blocker that may be useful for VF and VT that has not responded to other therapies Very useful for patients whose cardiac emergency was precipitated by hypertension Epinephrine Alpha, beta-1, and beta-2 stimulation | Increases heart rate, stroke volume and blood pressure © IV Dose: v 1 mg every 3-5 minutes v May increase ischemia because of increased O2 demand by the heart 34. Sodium Bicarbonate “METABOLIC acidosis / hyperkalemia Airway and ventilation have to be functional (IV Dose: v — 1 mEq/kg | Side effects: | Metabolic alkalosis | Increased CO2 production . 35. ADENOSINE | Slows conduction time through the A-V node, can interrupt the reentry pathways through the A-V node Potassium channel opener and hyperpolarization | IV Dose: v 6 mg rapid iv push, follow with NS flush.. v Second dose 12 mg v Side effects:- Flushing of face, bronchospasm . 36. POST CARDIACARREST CARE . 37. Objectives ~Optimize cardiopulmonary function and vital organ perfusion. “After out-of-hospital cardiac arrest, transport patient to an appropriate hospital with a comprehensive post—cardiac arrest treatment “Transport the in-hospital post- cardiac arrest patient to an appropriate critical-care unit Try to identify and treat the precipitating causes of the arrest and prevent recurrent arrest5. 38. CONCLUSION Cardiopulmonary arrest is loss of airway, breathing, or meaningful circulation. Cardiopulmonary resuscitation (CPR) is the use of therapeutic interventions, primarily BLS that are designed to restore spontaneous circulation following cardiac or pulmonary arrest. 6. 39. BIBLIOGRAPHY: v