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CARDIOPULMONARY RESUSCITATION PowerPoint Presentation

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Description : Check out this medical presentation on Emergency Medical Services (EMS), which is titled "CARDIOPULMONARY RESUSCITATION", to know about cardiopulmonary resuscitation including cardiopulmonary brain resuscitation (CPBR) and cardiopulmonary cerebral resuscitation (CPCR).

Tags : Emergency Medical Services, EMS, cardiopulmonary resuscitation, cardiopulmonary brain resuscitation, CPBR, cardiopulmonary cerebral resuscitation, CPCR, CPR

Published on : Aug 06, 2021 | Views : 6192 | Downloads : 29

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Slide 1-

DR SUJATA PROFESSOR DEPT.OF ANAESTHESIOLOGY &CRITICAL CARE UCMS & GTB HOSPITAL CARDIOPULMONARY RESUSCITATION
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CPBR/ CPCR CPR Cardiopulmonary brain resuscitation -CPBR Cardiopulmonary cerebral resuscitation-CPCR
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Goal Support & restore effective oxygenation, ventilation and circulation with return of intact neurological function. Intermediate Goal: Return of spontaneous circulation (ROSC)
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Approach BLS ( Basic Life Support) Primary survey. ACLS (Advanced Cardiovascular Life Support) Secondary survey
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Cardiopulmonary Resuscitation BLS ACLS PROLONGED LIFE SUPPORT A - Airway B - Breathing C - Circulation D- Defibrillation
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Does BLS work? BLS- maximum attention of public .MMajority(70-80%) of cardiac arrests Out-of-Hospital .Pre-hospital care –key factor ajority(70-80%) of cardiac arrests Out-of-Hospital .Pre-hospital care –key factor
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Adult Chain of Survival
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Early access Early CPR Early Defibrillation 1.Recognition of Early warning signs 2.Activation of Emergency Medical Services 3.Basic CPR 4.Defibrillation Early ACLS CHAIN OF SURVIVAL
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Before BLS Primary Survey Scene safety Check responsiveness Activate EMS and get AED Assess & Perform appropriate action. Performance of the action improves chances of survival and better neurological outcome
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Before BLS Primary Survey
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BLS Primary survey Support/ restore effective oxygenation, ventilation and circulation until ROSC or ACLS team takes over. No advanced interventions- airway tech./ drugs (use universal precautions) Early CPR and early defibrillation
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BLS Primary Survey….components
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Basic airway skills Head tilt- chin lift Jaw thrust without head extension (? Cx spine trauma) Mouth- to- mouth ventilation Mouth- to- nose ventilation Mouth- to- barrier device (pocket mask) Bag-mask ventilation
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AIRWAY BREATHING CIRCULATION DEFIBRILLATION A B C D
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Airway Head tilt, Chin lift, Jaw thrust AVOID HEAD TILT IF TRAUMA Keeping airway open- LOOK, LISTEN, FEEL LOOK LISTEN FEEL CHEST MOVEMENTS BREATH SOUNDS AIR FLOW RESP. RATE VOICE QUALITY CHEST MOVEMENTS CYANOSIS ABNORMAL SOUNDS TRACHEAL POSITION TRAUMA FLUID/BLOOD /VOMITING NOT MORE THAN 10 SECONDS
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BREATHING PRESENT RECOVERY POSITION AND TRANSPORT BREATHING ABSENT 2 EFFECTIVE RESCUE BREATHS SLOW BREATHS TIDAL VOL. 8-10 ml/kg Deliver in one sec. Rate- 10-12/min. Chest rise/ expand
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Assessing the victim 1-- Make sure the victim, any bystanders, and you are safe. 2-- Check the victim for a response. Shake shoulders gently Ask “Are you all right If he responds Leave as you find him. Find out what is wrong. Reassess regularly If he does not respond: Activate Code Blue and get AED 4 --Keeping the airway open, look, listen, and feel for normal breathing. OPEN AIRWAY Look, listen and feel for NORMAL breathing Do not confuse agonal breathing with NORMAL breathing
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Keeping the airway open, look, listen, and feel for normal breathing. ……OPEN AIRWAY
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Look, listen and feel for NORMAL breathing
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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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If he is not breathing normally Give 2 rescue breaths Pinch the nose Take a normal breath Place lips over mouth Blow until the chest rises Take about 1 second Allow chest to fall Repeat
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Chest Compressions Patient positioning: Firm and hard surface (ground, table/ hard bed) deflate air/ water mattresses. Rescuer's position: Level with patient, elbows vertically straight and locked, shoulders directly above the hands, heel of one palm over the other. Site : sternum in inter-mammary line. Depth: 11/2- 2 inches. Rate:100 per minute (5 cycles of 30:2-C:V over 2 min.). Allow complete chest recoil.
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CHEST COMPRESSIONS 30 CHEST COMPRESSIONS
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Hands off- time Less than 10 sec. Specific interventions: defibrillation, advanced airway, moving the patient. Avoid : Prolonged rhythm analysis Frequent pulse checks Too long breaths Unnecessary moving the pt.
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CHEST COMPRESSIONS Rate: 100/MIN., SITE- Sternal depression -1.5 in.-2 in. Universal compression-ventilation ratio (30:2) - Recommended for all single rescuers of infant, child and adult victims (excluding newborns) Two Rescuers = 30:2- ALL ADULTS, 15:2 – Infants and child PURPOSE : PUSH HARD,PUSH FAST PULSE PRESENT CONTINUE VENTILATION TILL SPONTANEOUS RESPIRATION PULSE ABSENT / NOT DETECTED PULSE CHECK NOT RECOMMENDED FOR LAY RESCUERS POOR SENSITIVITY-55% POOR SPECIFICITY-90% ACCURACY RATE -65% CHECK FOR SIGNS OF CIRCULATION
Slide 26-

Defibrillation AED: Follow the prompts. Manual defibrillator: Analyse rhythm, shockable- decide shock (Monophasic 360 J, Biphasic 120-200 J ), apply gel, charge, clear the patient, no inflammables (incl. oxygen), deliver shock….. Resume CPR immediately.
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AED
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Positioning of electrodes for automated external defibrillator
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DEFIBRILLATION ATTACH PADS TO VICTIM’S BARE CHEST
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Ventricular Fibrillation
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Continuous electrocardiogram showing successful treatment of ventricular fibrillation by a countershock (given at the arrow)
Slide 33-

ANALYSING RHYTHM DO NOT TOUCH VICTIM SHOCK INDICATED Stand clear Speak Aloud- “I Clear......You Clear.......All Clear!” Deliver shock IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN RECOVERY POSITION
Slide 34-

ACLS Secondary survey Advanced, invasive assessment and management techniques required. Basic airway adjuncts: OPA, NPA Advanced Airway interventions: Combitube, LMA, Endotracheal intubation. Advanced circulatory interventions: Drugs to control heart rhythm and blood pressure.
Slide 35-

ACLS Secondary Survey…… components
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TECHNIQUES- Mouth-Mouth, Mouth-Nose VENTILATORY DEVICES Masks, Bag-Valve Devices Airway Adjuncts 1.Oropharygeal Airway 2.Nasopharyngeal Airway 3.Esophageal –Tracheal Combitube 4.Laryngeal Mask Airway 5.Transtracheal catheter ventilation 6.Cuffed oropharyngeal airway AIRWAY EQUIPMENTS ADJUNCT of CHOICE: TRACHEAL TUBE PURPOSE MAINTAIN AIRWAYAND OXYGENATE
Slide 37-

ACLS Secondary Survey…….components
Slide 38-

Common Reversible Causes
Slide 39-

PROBLEMS AND COMPLICATIONS OF CHEST COMPRESSIONS RIB FRACTURES FRACTURE STERNUM RIB SEPARATION PNEUMOTHORAX HEMOTHORAX LUNG CONTUSIONS LIVER LACERATIONS FAT EMBOLI HIV, HEPATITIS INFECTIONS MANAGE ACCORDINGLY BUT CONTINUE CPR
Slide 40-

EFFECTIVE CHEST COMPRESSION WITH MINIMAL HANDS OFF IS KEY FOR EFFECTIVE CPR
Slide 41-

When to stop BLS ROSC, Conscious pt. ACLS team takes over Rescuer tired
Slide 42-

SUMMARY
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DRUGS EPINEPHRINE Peripheral vasoconstriction-  -adrenergic Increase in Central aortic perfusion pressure Decrease Threshold for Defibrillation Fine VF to Coarse VF
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For Rhythm Amiodarone Lidocaine Atropine Magnesium For Blood Pressure Epinephrine Vasopressin DOPAMINE-2-4 micro/kg/min.-DA rec 4-10 micro/kg/min- Beta-rec. 10-20 micro/kg/min- Alpha rec. DRUGS
Slide 45-

DEFIBRILLATOR WHITE-RIGHT SIDE RED- RIBS-LEFT MID-AXILLARY LEFT-OVER-LEFT SHOULDER ECG
Slide 46-

The dying heart IDENTIFY THE RHYTHM
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1.VENTRICULAR FIBRILLATION 2. RAPID VENTRICULAR TACHYCARDIA 3. PULSELESS ELECRICAL ACTIVITY 4. ASYSTOLE RHYTHMS
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Asystole 2 OR Pulseless Electrical Activity
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Slide 53-

UCMS >BH,DELHI