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CARDIOPULMONARY RESUSCITATION. DR J.O OLATOSI D.A,FWACS. CARDIAC ARREST. Sudden cessation of spontaneous and effective heart function Diagnosis’unresponsive Sudden deep unconsciousness Absent major peripheral pulses Absent spontaneous ventilation/agonal breathing - PowerPoint PPT Presentation
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DR J.O OLATOSI D.A,FWACS
04/22/23 22:25 1PRIMARY FMCP UPDATE - CPR LECTURE
CARDIAC ARRESTSudden cessation of spontaneous and
effective heart functionDiagnosis’unresponsive Sudden deep unconsciousnessAbsent major peripheral pulsesAbsent spontaneous ventilation/agonal
breathing Fixed dilated pupils not index for diagnosis or
prognosis
04/22/23 22:25 2PRIMARY FMCP UPDATE - CPR LECTURE
CAUSES OF CARDIAC ARREST
Airway obstructionBlood, vomit, foreign bodyTraumaInfection, inflammationLaryngospasmBronchospasm
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Decreased respiratory drive-CNS depression
Decreased respiratory effort-neurological lesion-muscle weakness-restrictive chest defect
Pulmonary disorders-pneumothorax, lung pathology
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Cardiac abnormalitiesPrimary
IschaemiaMyocardial infarctionHypertensive heart diseaseValve diseaseDrugsElectrolyte abnormalities
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SecondaryAsphyxiaHypoxaemiaBlood lossSeptic shock
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Cardiopulmonary ResuscitationA technique combining artificial ventilation and
chest compressions designed to perfuse vital organs or restore circulation in cardiac standstill.
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Early access to get helpEarly BLS to buy time-
CPR slows down deterioration of the brain
Early defibrillation to restart heart-restores a perfusing rhythm
Early ALS to stabilise circulation
failure of circulation for 3-4mins can lead to irreversible brain damage.
04/22/23 22:25
Adult BLS sequenceBasic life support consists of the following
sequence of actions:1 Make sure the victim, any bystanders,
and you are safe.
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2 Check the victim for a response.• Gently shake his shoulders and ask loudly,
‘Are you all right?’
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Shake and Shout
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3 A If he responds:
• Leave him in the position in which you find him provided there is no
further danger.• Try to find out what is wrong with him and
get help if needed.• Reassess him regularly.
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3 B If he does not respondShout for help.Turn the victim onto his back and then open the
airway using head tiltand chin lift: Place your hand on his forehead and gently tilt his
head back. With your fingertips under the point of the victim's
chin, lift thechin to open the airway.
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Opening the airwayHead tiltChin liftIf cervical spine
injury suspected: jaw thrust
C14
Assess BreathingLook for chest
movementListen for breath
soundsFeel for expired airAssess for 10 seconds
before deciding breathing is absent
C15
5 A If he is breathing normally:Turn him into the recovery position .Send or go for help, or call for an ambulance.Check for continued breathing.
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5 B If he is not breathing normally:Ask someone to call for an ambulance or, if you are
on your own, dothis yourself; you may need to leave the victim. Start
chestcompression as follows: Kneel by the side of the victim. Place the heel of one hand in the centre of the
victim’s chest. Place the heel of your other hand on top of the first
hand.
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Interlock the fingers of your hands and ensure that pressure is
not applied over the victim's ribs. Do not apply any pressure over the upper abdomen or the bottom end of the bony sternum (breastbone).
Position yourself vertically above the victim's chest and, with
your arms straight, press down on the sternum 4 - 5 cm.
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After each compression, release all the pressure on the chest
without losing contact between your hands and the sternum.
Repeat at a rate of about 100 times a minute (a little less than
2 compressions a second).Compression and release should take an equal
amount of time.
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Chest compressions
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6 A Combine chest compression with rescue breaths.
After 30 compressions open the airway again using head tilt and chin lift.
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Rescue breathing(Expired air ventilation)
Occlude victim’s noseMaintain chin liftTake a deep breathEnsure a good mouth-
to-mouth seal
Rescue breathing(Expired air ventilation)
Blow steadily (2 sec) into victim’s mouth
Watch for chest rise Maintain chin lift,
remove mouthWatch chest fall
C23
6 B Chest-compression-only CPR.If you are not able, or are unwilling, to give
rescue breaths, give chest compressions only.• If chest compressions only are given, these
should be continuous at a rate of 100 a minute.
• Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt resuscitation.
04/22/23 22:26 24PRIMARY FMCP UPDATE - CPR LECTURE
7 Continue resuscitation until:•qualified help arrives and takes over,•the victim starts breathing normally, or•you become exhausted.A valid DNAR order is presented
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ALSBasic Airway Adjuncts-Oropharyngeal AirwayNasopharyngeal Airway
Advanced Airway DevicesLaryngeal Mask AirwayCombitubeEndotracheal Tube
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DEFIBRILLATIONDefinition
“The termination of fibrillation or absence of VF/VT at 5 seconds after shock delivery”
Critical mass of myocardium depolarisedNatural pacemaker tissue resumes control
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DesignPower sourceCapacitorElectrodes
TypesManualAutomatedMonophasic or Biphasic waveform
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Defibrillator waveforms
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Damped Monophasic Truncated Biphasic
Biphasic DefibrillatorsRequire less energy for defibrillation
smaller capacitors and batteries lighter and more transportable
Repeated < 200 J biphasic shocks have higher success rate for terminating VF/VT than escalating monophasic shocks
04/22/23 22:26 PRIMARY FMCP UPDATE - CPR LECTURE 30
Automated external defibrillatorsAnalyse cardiac rhythmPrepare for shock deliverySpecificity for recognition of shockable
rhythm close to 100%
04/22/23 22:26 PRIMARY FMCP UPDATE - CPR LECTURE 31
Advantages:Less training required
no need for ECG interpretation Suitable for “first-responder” defibrillationPublic access defibrillation (PAD) programs
04/22/23 22:26 PRIMARY FMCP UPDATE - CPR LECTURE 32
Attach adhesive electrodesFollow audible and visual instructionsAutomated ECG analysis - stand clear Charges automatically if shockable
rhythm +/- manual override
04/22/23 22:26 PRIMARY FMCP UPDATE - CPR LECTURE 33
Relies upon:Operator recognition of ECG rhythmOperator charging machine and delivering
shockCan be used for synchronised
cardioversion04/22/23 22:26 PRIMARY FMCP UPDATE - CPR LECTURE 34
Defibrillator SafetyNever hold both paddles in one handCharge only with paddles on casualty’s chestAvoid direct or indirect contact Wipe any water from the patient’s chestRemove high-flow oxygen from zone of
defibrillation
04/22/23 22:26 PRIMARY FMCP UPDATE - CPR LECTURE 35
Manual DefribillationDiagnose VF/VT from ECG and signs of
cardiac arrestSelect correct energy levelCharge paddles on patientShout “stand clear”Visual check of areaCheck monitorDeliver shock
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