1. Cardiopulmonary Resuscitation Dr Hajijafari anesthesiologist KUMS

2. Introduction to CPR BLS ACLS

3. Time is Critical! > 300,000 people experience sudden cardiac death in prehospital settings each year. If resuscitation begins within a few minutes, many of these individuals have a chance for survival.

4. Time is Critical! To begin resuscitation within a few minutes: Diagnosis EMS immediately activated CPR started immediately Defibrillation within minutes

5. What is the function of the circulatory system?

6. The Circulatory System Delivers O 2 and nutrients Removes CO 2 and wastes

7. Time is Critical! Brain damage begins in 4–6 min Brain damage irreversible in 8–10 min Circulation must be restored within 4 – 6 minutes.

8. CPR Combines external chest compressions with artificial ventilation: –Provides 30% (or less) of normal circulation –Only effective for short period of time

9. Causes of Cardiac Arrest

10. Heart disease Respiratory arrest Medical emergencies Drowning and suffocation Congenital heart defects Trauma

11. The cause of cardiac arrest is important BUT do not delay CPR to obtain history

12. ABC change to CAB

13. CPR – 1 Rescuer Assess responsiveness Summon EMS Position the patient

14. CPR – 1 Rescuer Check for a pulse (≤ 10 seconds)

15. CPR – 1 Rescuer If there is no pulse, find your landmarks, lower half of the sternum, between the nipples

16. CPR – 1 Rescuer Begin chest compressions

17. CPR – 1 Rescuer Perform 30 chest compressions Push hard Push fast Allow the chest to recoil after each compression

18. CPR – 1 Rescuer Administer two ventilations then return to compressions

19. CPR – 1 Rescuer Check for a pulse (≤ 10 seconds) Normal pulse

20. If there is no breathing, give two breaths, each lasting 1 second Open the airway

21. CPR – 2 Rescuer 1 2 3 4

22. CPR - Children Use heel of one hand Keep airway open with other hand 30 compressions:2 ventilations if alone (2 rescuers use 15:2)

23. CPR - Infant ABC 30 compressions:2 ventilations if alone 15 compressions: 2 ventilations with 2 rescuers

24. Sequence of Survival

25. Chain of Survival for Adult

26. Sequence of Survival Also known as Chain of Survival Recognition and Early Access Early CPR Defibrillation Early Advanced Care

27. Recognition and Early Access Depends on public education EMS must be immediately notified 9-1-1 dispatchers can provide CPR instructions

28. Early CPR Must begin within 4-6 minutes of collapse Public training is necessary Rescuers have a critical role

29. Copyright © 2004 Elsevier (USA). All Rights Reserved Defibrillation Ventricular fibrillation a common cause of arrest Can only correct with defibrillation

30. Ventricular Fibrillation The most common cause of sudden cardiac death –disorganized heart activity –Heart muscle cannot pump blood

31. Ventricular Fibrillation Requires immediate defibrillation CPR lengthens window of survival

32. Early Advanced Care Medication Advanced airway management Post-resuscitation care

33. AED

34. AEDs Safe, accurate & lightweight Easy to operate

35. AED AEDs in public places Training the public in CPR/AED

36. AED

37. Universal Steps Power ↓ Patient ↓ Analyze ↓ Shock

38. Power Turn the power on

39. Patient Apply pads to patient

40. Analyze Stay clear while patient’s heart rhythm analyzed

41. Clear

42. Shock Defibrillate

43. Patient Standard is set of 1 shock Immediately restart CPR for 2 minutes then check pulse

44. Summary of BLS Continual beating, or contracting, of the heart is necessary to keep blood circulating throughout the body. Brain damage begins in 4 to 6 minutes of cardiac arrest. There are many causes of sudden cardiac death, but the most common is ventricular fibrillation.

45. ACLS

46. IV Access Airway management Medication and defibrilation Post CPR

47. ADULT CARDIAC ARREST ALGORITHM

55. MANAGEMENT OF SYMPTOMATIC BRADYCARDIA & TACHYCARDIA

56. BRADYARRHYTHMIA

60. TACHYARRHYTHMIA

64. DRUGS & DOSAGE → CARDIOVERSION ↓

65. THANK YOU