Cardiopulmonary Resuscitation

Department of Anesthesiology & Reanimation Faculty of Medicine, Padjadjaran University/ Hasan Sadikin General Hospital

Bandung

Objective:

• Identification phases of resuscitation

• Algorythm of CPR initiation

• Airway management

• Breathing support

• Circulation Support

• Drug s and fluids

Introduction1961 : Safar devided CPR into 3 phases

• Phase I :

Basic Life Support, goals of this phase action ( ABC) Emergency Oxygenation

• Phase II :

Advanced Life Support, goals of this phase action (DEF) Restoration of spontaneous circulation and stabilization of the cardiopulmonary system

• Phase III :

Prolonged Life Support, goals ( GHI) Post resuscitative brain oriented and intensive care

Awake? / No

Breath ? / No

Airway management

Breath ?/No

Breathing Support 2x

Carotid Pulse / No

Circulation support

Airway management:

The most common site of airway obstruction in comatouse patients :

• relaxed tongue , when patients head is in flexed or mid position

•Foreign matter : vomitus, blood

•stimulation in stuporous or lightly comatose patients Laryngospasm is usually caused by upper airway

• could be complete or partial obstruction, in complete obstrc (if not corrected) leads to apnea and cardiac arrest within 5 – 10 minute , in partial obstrc must be corrected promptly can result in brain damage or even cardiac arrest

Recognition of Airway obtruction ;

•Can not hear and feel of air flow at the mouth and nose for complete airway obstruction

• When patients still breathing inspiratory retraction of intercostal and supraclavicular

• Partial airway obstruction : snoring, crowing, gurgling, wheezing

• Hypercarbia : somnolence

• Hypoxemia : sympathetic stimulation

Manual clearing of the airway:

•The crossed finger maneuver

•Finger behind teeth manuever

•Tongue jaw lift manuever

Clearing the airway by suction

Technique for foreign body clearing

If the victim is conscious ,

• encourage to expel by coughing and spitting it out

•Apply abdominal thrust s or back blows

If the victim is unconscious

• Apply back blows or abdominal thrust in horizontal position

Positioning to open the airway

• Head tilt

• Neck lift

• Chin lift

• Jaw thrust

Open the airway using equipment

• Oropharyngeal airway

• Nasopharyngeal airway

• Endotracheal intubation

• Cricothyroidotomy and Tracheostomy

H

Chin Lift Neck Lift

Breathing support

Without equipment

Mouth to mouth and Mouth to nose

Mouth to adjunct ventilation

Bag Valve Mask with oxygen

Giving positive pressure during inspiration and spontaneous expiration

Mouth to mouth or mouth to nose ventilation

Exhalation consist of 16 - 18 % of oxygen

Recognition of cardiac arrest

unconsciousness, apnea or gasping, death like appearance(cyanosis, or pallor), absence of pulse in large arteries ( carotid or femoral )

Circulation Support

Cardiac arrest :

• Primary : Ventricular fibrillation, asystole caused by myocardial infarction

• Secondary : exsanguination, asphyxia

The most common caused of cardiac arrest : Ventricular fibrillation

Closed chest cardiac compressions

External cardiac compression (C) in combination with airway control ( A ) , breathing support (B) Made it possible to promptly initiate attempts at reversal of clinical death

The aims of cardiac compression : Initiate artificial circulation

1 operator

2 operators

Monitoring the effectiveness of CPR

•Cheking whether the spontaneously pulse has returned at first after 1 minute CPR, and every 2 – 5 minute there after

• intermittently palpating the carotid pulse

Emergency management of hemorrhage

• Control of external hemorrhage without surgical measures, by elevation and compression

•Positioning of conscious patients in horizontal with leg elevated

•ABC resuscitation initiation in unconscious patients

Drugs and Fluids

•Routes for drugs and fluid :

• Peripheral intravenous route for the administration of drugs and fluids should be establish as quicly as possible after the initiation of CPR without interrupting CPR

Drugs

Epinephrine ( Adrenaline ) may help restore spontaneous circulation in cardiac arrest of 1 – 2 minute duration

Alpha and beta receptor activity

Alpha receptor activity is the most important in cardiac arrest

Vasoconstriction, diastolic pressure raises, improve myocardial and cerebral blood flow