CARDIOPULMONARY RESUSCITATION DR J.O OLATOSI D.A,FWACS 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

CARDIAC ARREST Sudden cessation of spontaneous and effective heart function Diagnosis’unresponsive Sudden deep unconsciousness Absent major peripheral pulses Absent spontaneous ventilation/agonal breathing Fixed dilated pupils not index for diagnosis or prognosis 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

CAUSES OF CARDIAC ARREST Airway obstruction Blood, vomit, foreign body Trauma Infection, inflammation Laryngospasm Bronchospasm 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

-restrictive chest defect -pneumothorax, lung pathology Decreased respiratory drive -CNS depression Decreased respiratory effort -neurological lesion -muscle weakness -restrictive chest defect Pulmonary disorders -pneumothorax, lung pathology 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Cardiac abnormalities Primary Ischaemia Myocardial infarction Hypertensive heart disease Valve disease Drugs Electrolyte abnormalities 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Secondary Asphyxia Hypoxaemia Blood loss Septic shock 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Cardiopulmonary Resuscitation A technique combining artificial ventilation and chest compressions designed to perfuse vital organs or restore circulation in cardiac standstill. 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Early access to get help Early 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. 4/20/2017 7:16 AM

Adult BLS sequence Basic life support consists of the following sequence of actions: 1 Make sure the victim, any bystanders, and you are safe. 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

2 Check the victim for a response 2 Check the victim for a response. • Gently shake his shoulders and ask loudly, ‘Are you all right?’ 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Shake and Shout 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

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. 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

3 B If he does not respond Shout for help. Turn the victim onto his back and then open the airway using head tilt and 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 the chin to open the airway. 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Opening the airway Head tilt Chin lift If cervical spine injury suspected: jaw thrust

Assess Breathing Look for chest movement Listen for breath sounds Feel for expired air Assess for 10 seconds before deciding breathing is absent

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. 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

5 B If he is not breathing normally: Ask someone to call for an ambulance or, if you are on your own, do this yourself; you may need to leave the victim. Start chest compression 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. 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

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. 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

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. 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Chest compressions 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

6 A Combine chest compression with rescue breaths. After 30 compressions open the airway again using head tilt and chin lift. 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Rescue breathing (Expired air ventilation) Occlude victim’s nose Maintain chin lift Take a deep breath Ensure 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 mouth Watch chest fall

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. 4/20/2017 7:16 AM PRIMARY 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 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

ALS Basic Airway Adjuncts- Oropharyngeal Airway Nasopharyngeal Airway Advanced Airway Devices Laryngeal Mask Airway Combitube Endotracheal Tube 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

DEFIBRILLATION Definition Critical mass of myocardium depolarised “The termination of fibrillation or absence of VF/VT at 5 seconds after shock delivery” Critical mass of myocardium depolarised Natural pacemaker tissue resumes control 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Design Types Power source Capacitor Electrodes Manual Automated Monophasic or Biphasic waveform 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Defibrillator waveforms Damped Monophasic Truncated Biphasic 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Biphasic Defibrillators Require 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 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Automated external defibrillators Analyse cardiac rhythm Prepare for shock delivery Specificity for recognition of shockable rhythm close to 100% 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Less training required Suitable for “first-responder” defibrillation Advantages: Less training required no need for ECG interpretation Suitable for “first-responder” defibrillation Public access defibrillation (PAD) programs 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Attach adhesive electrodes Follow audible and visual instructions Automated ECG analysis - stand clear Charges automatically if shockable rhythm +/- manual override 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Operator recognition of ECG rhythm Relies upon: Operator recognition of ECG rhythm Operator charging machine and delivering shock Can be used for synchronised cardioversion 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Defibrillator Safety Never hold both paddles in one hand Charge only with paddles on casualty’s chest Avoid direct or indirect contact Wipe any water from the patient’s chest Remove high-flow oxygen from zone of defibrillation 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

Manual Defribillation Diagnose VF/VT from ECG and signs of cardiac arrest Select correct energy level Charge paddles on patient Shout “stand clear” Visual check of area Check monitor Deliver shock 4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE

4/20/2017 7:16 AM PRIMARY FMCP UPDATE - CPR LECTURE