1. Cardio-pulmonary Cerebral Resuscitation (CPR) Prof. M. H. Mumtaz

2. PHASES I Basic Life Support (BLS) (ABC) III Prolonged Life Support (PLS) (GHI) II Advanced Life Support (ALS) (DEF)

3. B L S F Tilt Head. F Lift Neck. F Support Chin. A. A IRWAY If Unconscious ?

4. B L S F Lung Inflation. – Mouth to Mouth. – Mouth to Nose. – Mouth to Tube. – Bag-wash. B. B REATHE If not breathing ?

5. C. C IRCULATE One Operator Two Operators B L S

6. Cause F Nervous System. F Myocardium. Sympathetic Parasympathetic

7. Phase Two Advanced Life Support (Restoration of Spontaneous Circulation) F Adrenaline. F Alkali. F Fluids. D. D RUGS & FLUIDS

8. E. E KG Ventricular Fibrillation Asystole Bizarre Complexe

9. F. F IBRILLATION TREATMENT F Ext Defibrillation. F Lignocain.

10. Biochemical Changes

11. H - CO 3 + H + H 2 CO 3 CO 2 + H 2 O ECF K+ Lungs Kidney H + ICF

12. Correction F Bicarbonate Therapy: (CO 2 Producing) H - CO 3 + H + H 2 CO 3 CO 2 + H 2 O F Carbonate Therapy: (Non CO 2 Producing) – Routine Indications u Base Deficit> 10 Meq/L u PH< 7.20 u HCO 3 < 14 Mmol/L Meq HCO 3 = Base Deficit X wt. (kg) X.3

13. Correction F Problems – A. Alkalosis. - K + - O 2 Dissociation - Left Shift. - Depression of Myocard. – B. Sodium Over Load. F Oxygenation Ventilation.

14. Total Oxygen at Arrest 1500-1600 mls

15. Critical Survival Time

16. Requirement Drugs F Atropine. F Adrenaline. F Calcium. F Glucagon. F Isoprenalin. F Dopamine. F Debutamine. F Lignocaine. Equipment F Trained Doctor. F Laryngoscope. F Tube (ETT). F Ambu Resuscitation. F Defibrillator with Oscilloscope.

17. Emergency-Fluid Resuscitation

18. Primary volume therapy “Fill from inside out” ICS Vessel ISS inside out

19. A New Concept Small Volume Hyperosmolar Saline Colloid Resuscitation 4 ml/kg - 7.2-7.5% NaCl/Colloid

20. interstitium Shock Small-volume hyperosmolar resuscitation endothelial cell Flow erythrocyte dd

21. Physiological & Basic Mechanisms F Plasma osmolality= 285-295 mosmol/kg. F 7.2% NaCl = 2400 mosmol/kg. F End bolus infusion = 460 mosmol/kg. (4 ml/kg). –  Ttransmembrane osmotic gradient. –  –Endogenous fluid mobilization. (most pronounced in capillary districts) –  –  Plasma volume. –  Hydraulic resistance. –  Tissue perfusion.