CARDIO PULMONARY RESUSCITATION (CPR)

    CARDIO PULMONARY RESUSCITATION (CPR):

Hey  here is a complete information provided with all the procedures and drugs, dose, indication regarding cardio pulmonary resuscitation, I hope these are all helpfull to you …

Collect hands for CPR

What is a cardiac arrest?

Abrupt cessation of spontaneous and effective ventilation and systemic perfusion

CAUSES

  1. 5“H”s
  2. Hypoxia
  3. Hypovolemia
  4. Hypothermia
  5. Hydrogen ion
  6. Hypokalemia/Hyperkalemia

5“T”s

  • Tamponade cardiac (fluid outside the heart,& air in the pleural cavity)
  • Tension pneumothorax
  • Toxin
  • Thrombosis(Pulmonary and cardiac)
  • Traum

Also read:https://www.drugworlds.com/intravenous-insulin-protocol/?amp

CARDIO-PULMONARY RESUSCITATION

A basic life support for the purpose of oxygenating the brain, heart, and other vital organs until the appropriate definite medical treatment can restore the normal heart and lung function.

How Do you Recognize a Cardiac Arrest?

EARLY
Unresponsiveness
In the case of adults absence of carotid pulse and in case of infants Brachial pulse.
Absence of normal respiration( the victim is not breathing or only gasping)

LATE SIGN

  • Cyanosis
  • Cold clammy skin
  • Dilated pupils
  • ECG –Asystole/pulseless VT/ VF

CPR

High-quality CPR criteria as per AHA guideline 2018

  • The compression rate is at least 100 – 120/min
  • Compression depth is now 2-2.4 inches in adults
  • Allow complete chest recoil after each compression
  • Minimize interruption during chest compression(< 10secs)
  • Avoid hyperventilation.
  • Rotate compressor every 2 mins

Steps of Basic Life Support

 Assessment and Activate ERS & get an AED

  1. Make sure that scene is safe
  2. Check for response & breathing
  3. Tap & shout “Are you OK?”
  4. Check for absent or abnormal breathing
  5. Activate code blue (7201) & get an AED

Chest compression

  • Check for pulse at least 5 sec. , but no more than 10 sec.
  • If no pulse within 10 sec. start CPR with chest compressions first
  • 30:2
  • Compressions
  • Centre of chest
  • 5-6 cm depth
  • 2 per second (100-120 min-1)
  • Maintain high quality
  • Compressions with minimal Interruptions
  • Continuous compressions
  • once airway secured
  • Switch CPR provider every
  • 2 min cycle to avoid fatigue
  • Position self correctly (i.e. close to and adequately
    above the patient, kneel on the bed close to the patient),
  • >Locate the correct hand position. (4 fingers above the
    xiphoid sternum)
  • >Push hard at 2-2.4 inches & Push fast at the rate of
    at 100-120/minute

 

Opening Airway

  • Clean the airway by finger sweep in case of visible
    foreign body, or oral suction
  • Tilt the head back and lift the chin((using head –
    tilt/chin – lift), Double maneuver

Giving mouth-to-mouth breaths

  • The nostrils of the victim are pinched closed to assist with an airtight seal
  • The provider puts his mouth completely over the patient’s mouth
  • If the victim is not breathing or only gasping, GIVE 2 RESCUE BREATHS & Observe for visible chest rise.

Using the bag-mask device

  • The provider ensures a tight seal between the mask and the
    patient’s face.
  • The bag is squeezed with one hand for approximately 1
    second, forcing at least 500 mL of air into the patient’s lungs.

Defibrillation

Defibrillation is the application of electrical shock to help restore the heart’s regular rhythm.

Shockable (VT)

Monomorphic VT

Broad complex rythm
– Rapid rate
– Constant QRS morphology

Polymorphic VT
– Torsade de Pointes

VENTRICULAR TACHYCARDIA

Fast heart rhythm which does not allow the heart to fill properly and cardiac output is compromised and reduced

Shockable (VF)

  • Bizarre irregular waveform
  • No recognizable QRS complexes
  • Random frequency and amplitude
  • Uncoordinated electrical activity
  • Coarse/fine
  • Exclude artifact
    – Movement
    – Electrical interference

Non-shockable (Asystole)

  • Absent ventricular (QRS) activity
  • Atrial activity (P waves) may persist
  • Rarely a straight line trace
  • Adrenaline 1 mg IV then every 3-5 min

Non-shockable (Pulseless Electrical Activity)

  • Clinical features of cardiac arrest
  • ECG normally associated with an output
  • Adrenaline 1 mg IV then every 3-5 min

Monophasic

 

Biphasic

Placement of Defibrillator’s Paddles

  • There are two accepted positions to optimize current delivery to the heart:
  • (1) Anteroapical – one pad/paddle is placed to the right of the sternum just below the clavicle and the other is centered laterally to the normal cardiac apex in the anterior or midaxillary line (V5–6)
  • (2)Anteroposterior – the anterior pad/paddle is placed over the precordium or apex, and the posterior pad/paddle is placed on the back in the left or right infrascapular region.

Defribrillation

Amount of Jule

  • Adult – 150J , 150J ,150J ,200J,200J
  • Pediatric- 2-4j /kg of BW

Do’s

  • Be ready with a defibrillator
  • Assess shock-able rhythm
  • Remove metallic items from the patient’s body
  • Maintain PAAS(P-power cord, A-analyze shock,
  • A-attach defibrillator lead, S-shock)
  • Apply jelly properly
  • Apply 25lb pressure on the paddle for fixation
  • Be clear before shock(I clear, you clear, all clear)

DON’Ts

  • Do not Defibrillate on ECG lead
  • Defibrillate on hairy or wet chest
  • Defibrillate over a pacemaker generator box(permanent pacemaker)
    Defibrillate until temporary pacemaker is turned off
  • Have any direct or indirect contact with the patient
  • Have the patient in contact with the metal fixtures
  • Use loose or extension cord
  • Charge or discharge paddles in the air
  • Pass charged paddles to another member of the staff
  • Discharge over medication patch
  • Touch beds

 Table showing Drugs, Dose, Indication and action in CPR

DRUGIndicationDoseAction
Adrenaline (1mg/ml)
Class: adreno receptor agonist (no dilution is required) (paed - 1ml+9ml in 10 cc syringes take 1ml from it +9ml NS take 1ml makes 1ml =0.01mg
Cardiac arrest1mg(1ml) iv bolus in case of cardiac arrest for adult patients
Dose can be repeated at each 3-5mins
Max dose upto 18mg
Inotropic:increase CONTRACTILITY
Chronotropic:increase heart rate
Domotropic :increase conductivity
Bathmotropic:increase ventricular irritability threshold
Vasopresin
(1amp contains 20u)
Class:Antidiuretic hormone
Vasoconstrictor
Cardiac arrest40U (2ml) for replacement of first or second dose of adrenaline
Can be given only once in the CPR
Antidiuresis
Increase peripheral vascular resistance
Vasoconstriction
Calcium gluconate
Class: electrolyte and water balance agent
Cardiac arrest1gm(1amp =10ml) Iv bolus slowly over 10mins
It shouldn't given in the same line with sodium bicarbonate simultaneously one after another
After giving sodium bicarbonate flush with 10ml then give calcium
Stimulates secretion and enzymes activity
Stimulate action potential , cell division and metabolic activities
Maintains renal function
Sodium bicarbonate(893mmol/ltr)
Class:alkalizer
(Take in 50cc for adults)
For paediatric children 50:50 NS dilution is used take in 50 cc syringes
Metabolic and expiratory acedosis 1mmol/kg bolus in emergency according to the levels of acidosis dose can be calculated During cardiac arrest mixed metabolic and respiratory acidosis occurs , hypoxia generates lactic acid , resulting in metabolic acidosis
Concurrently ventilator failure results in co2 retention, resulting respiratory acidosis
Cordarone(50mg/ml) 1amp contains 3ml)
Class:classiii
Antiarrhythmic (diluted in 50ml 5℅D infused over 10mn to 1hr for 1st dose)
(For second dose 50 ml over 1gr)
(For VT/VF23 hr)
600/900 mg in 5℅D
Verticular tachycardia
Ventricular
Fibrillation
Cardiac arrest
After 2nd cycle of CPR
First dose 300mg bolus dose in slowly IV
Second dose 150mg 1hr
Supressess arryhthmogenic activity of heart muscles
Atropine (0.6mg/ml)
Class:Antichollinergic , parasympathomytics, mydriatic 2cc
Bradycardia with pulse(heart rate equal to 50 beats/min) 0.5mg IV bolus dose can be repeated at each 3-5mins
Max dose upto 3mg
Increase heart rate

Post cardiac arrest care

Therapeutic Hypothermia(to reduce cerebral metabolic rate and inflammatory response)

Hemodynamic and ventilation optimization

Immediate Coronary reperfusion with PCI

Neurologic care

Common complications due to CPR

  • Rib fracture,
  • sternal fractures,
  • bleeding in the anterior mediastinum,
  • heart contusion,
  • hemopericardium
  • upper airway Complications,
  • damage to the abdominal viscera – lacerations of the liver and spleen, fat emboli,
  • pulmonary complications – pneumothorax, hemothorax, lung contusions.

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