Cardiac emergencies and cpr презентация

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HISTORICAL REVIEW 5000 - 3000 BC - first artificial mouth to mouth ventilation 1780 – first attempt of newborn resuscitation by blowing 1874 – first experimental direct cardiac massage 1901

Слайд 1Cardiac Emergencies and CPR
Lesson 5

Слайд 2HISTORICAL REVIEW
5000 - 3000 BC - first artificial mouth to

mouth ventilation
1780 – first attempt of newborn resuscitation by blowing
1874 – first experimental direct cardiac massage
1901 – first successful direct cardiac massage in man
1946 – first experimental indirect cardiac massage and defibrillation
1960 – indirect cardiac massage
1980 – development of cardiopulmonary resuscitation due to the works of Peter Safar

Слайд 3Introduction
Basic Life Support needed for patient whose breathing or heart has

stopped
Ventilations are given to oxygenate blood when breathing is inadequate or has stopped
If heart has stopped, chest compressions are given to circulate blood to vital organs
Ventilation combined with chest compressions is called cardiopulmonary resuscitation (CPR)
CPR is commonly given to patients in cardiac arrest as a result of heart attack

Слайд 4Review of Circulatory System
Circulatory system consists of heart, blood, and blood

vessels.

Слайд 5Cardiovascular System: Primary Functions
Transports blood to lungs
Delivers carbon dioxide and picks

up oxygen
Transports oxygen and nutrients to all parts of body
Helps regulate body temperature
Helps maintain body’s fluid balance

Слайд 6Anatomy and Physiology of the Heart
Ventricles pump blood through two

loops or cycles in body
Right ventricle pumps blood to lungs to pick up oxygen and release carbon dioxide
Blood returns to left atrium and then flows into left ventricle
Left ventricle pumps oxygenated blood through arteries to all areas of body
Blood returns through veins to right atrium, to be pumped again to lungs
Within heart, valves prevent back flow of blood so that it moves only in one direction through these cycles

Слайд 7Heart is composed of a unique type of muscle (myocardium) that

contracts to make pumping action.

Heart Muscle

Слайд 8Contractions are controlled by electrical signals under nervous system control
Heart Muscle


Слайд 9Arteries
Arterial blood is oxygenated, bright red, and under pressure
Carotid arteries —

major arteries passing through neck to head
Femoral arteries — major arteries to legs passing through thigh
Brachial arteries — in upper arm
Radial arteries — major artery of lower arm
Arteries are generally deeper in body than veins and more protected

Слайд 10Pulse
When left ventricle contracts, wave of blood is sent through arteries

causing pulsing blood pressure changes in arteries that can be palpated in certain body locations
A pulse can be felt anywhere an artery passes near skin surface and over a bone
Palpate carotid pulse on either side of neck

Слайд 11Pulse continued
Palpate femoral pulse in crease between abdomen and thigh
Palpate radial

pulse on the palm side of wrist proximal to base of thumb
Palpate brachial pulse on the inside of arm between elbow and shoulder

Слайд 12Capillaries
Arteries progressively branch into smaller vessels that eventually reach capillaries
Capillaries are

very small blood vessels connecting arteries with veins throughout body
Capillaries have thin walls through which oxygen and carbon dioxide are exchanged with body cells

Слайд 13Veins
From capillaries, blood drains back to heart through extensive system of

veins
Venous blood is dark red, deoxygenated, and under less pressure than arterial blood
Blood flows more evenly through veins, which don’t have a pulse
Veins have valves that prevent blood backflow

Слайд 14Heart Rate
Heart rate, measured as pulse, is affected by many factors
With

exercise, fever, or emotional excitement, heart rate increases to meet body’s greater need for oxygen
Various injuries and illnesses may either increase or decrease heart rate

Слайд 15Circulatory System: Emergencies
Any condition that affects respiration
Reduces ability to deliver oxygen
Severe

bleeding
Shock
Stroke
Reduces blood flow to brain
Heart conditions
Reduce tissue oxygenation

Слайд 16Circulatory System: Emergencies continued
Heart attack
Can lead to cardiac arrest
Ventricular fibrillation
Heart muscle

flutters rather than pumping blood

Слайд 17Cardiac Arrest
Heart may stop (cardiac arrest) as a result of heart

attack
Brain damage begins 4 - 6 minutes after cardiac arrest
Brain damage becomes irreversible in 8 - 10 minutes
Dysrhythmia, an abnormal heartbeat, may also reduce heart’s pumping effectiveness

Слайд 18Causes of cardiac arrest
cardiac
extracardiac
Primary lesion of cardiac muscle leading to the

progressive decline of contractility, conductivity disorders, mechanical factors

all cases accompanied with hypoxia



Слайд 19Causes of Cardiac Arrest
Heart attack
Drowning
Suffocation
Stroke
Allergic reaction

Diabetic emergency
Prolonged seizures
Drug overdose
Electric shock
Certain injuries

Слайд 20Causes of circulatory arrest
Cardiac
Ischemic heart disease (myocardial infarction, stenocardia)
Arrhythmias of different

origin and character
Electrolytic disorders
Valvular disease
Cardiac tamponade
Pulmonary artery thromboembolism
Ruptured aneurysm of aorta

Extracardiac
airway obstruction
acute respiratory failure
shock
reflector cardiac arrest
embolisms of different origin
drug overdose
electrocution
poisoning

Слайд 21Cardiac Chain of Survival

Слайд 22Diagnosis of cardiac arrest

Symptoms of cardiac arrest
absence of pulse on

carotid arteries – a pathognomonic symptom
respiratory arrest – may be in 30 sec after cardiac arrest
pupil dilation – may be in 90 sec after cardiac arrest

Blood pressure measurement

Taking the pulse on peripheral arteries

Auscultation of cardiac tones

Loss of time !!!

Слайд 23Sequence of operations
Check responsiveness
Call for help
Correctly place the

victim and ensure the open airway
Check the presence of spontaneous respiration
Check pulse
Start external cardiac massage and artificial ventilation

Слайд 24In case of unconsciousness it is necessary to estimate quickly
the

open airway
respiration
hemodynamics


Слайд 25Main stages of resuscitation
C (Circulation) – restore the circulation by external

cardiac massage
A (Airway) – ensure open airway by preventing the falling back of tongue, tracheal intubation if possible
B (Breathing) – start artificial ventilation of lungs
D (Differentiation, Drugs, Defibrilation) – quickly perform differential diagnosis of cardiac arrest, use different medication and electric defibrillation in case of ventricular fibrillation

Слайд 26A (Airway)
 ensure open airway

Слайд 27Open the airway using a head tilt lifting of chin. Do

not tilt the head too far back

Check the pulse on carotid artery using fingers of the other hand

Слайд 28B (Breathing)
 
Tilt the head back and listen for. If not breathing

normally, pinch nose and cover the mouth with yours and blow until you see the chest rise.

Слайд 29mouth to mouth or mouth to nose respiration
ventilation by a face

mask and a self-inflating bag with oxygen

2 initial subsequent breaths

wait for the end of expiration

10-12 breaths per minute with a volume of app. 800 ml, each breath should take 1,5-2 seconds

Algorithm for artificial ventilation

Слайд 30C. Circulation
Restore the circulation, that is start external cardiac massage

Слайд 312 mechanisms explaining the restoration of circulation by external cardiac massage
Cardiac

pump

Thoracic pump

Слайд 32Cardiac pump during the cardiac massage
Blood pumping is assured by the

compression of heart between sternum and spine

Between compressions thoracic cage is expanding and heart is filled with blood

Слайд 33Thoracic pump at the cardiac massage
Blood circulation is restored due to

the change in intra thoracic pressure and jugular and subclavian vein valves
During the chest compression blood is directed from the pulmonary circulation to the systemic circulation. Cardiac valves function as in normal cardiac cycle.

Слайд 34ALGORITHM of Cardiopulmonary resuscitation
4 cycles: 15 compression and 2 breaths
10 cycles:

5 compression and 1 breath

check the pulse on carotid arteries (5 sec)

in case of absence of pulse continue resuscitation

2 breaths (duration 1 – 1.5 sec.)

palpation of pulse on carotid arteries (5 – 10 sec.)

in case of absence of pulse initiate external cardiac massage

1 person

compression rate 80 – 100/min.
compression/breath = 15 : 2

compression rate 80 – 100/min
compression/breath = 5 : 1

2 breaths in 4 – 7 sec.

breath during 1 – 1.5 sec. after each 5th compression

2 persons

a

a

a

Слайд 35VENTRICULAR FIBRILLATION OR PULSELESS TACHYCARDIA
Witnessed
Unwitnessed
Precordial thump
Check pulse, if none:

Begin CPR
Defibrillate with

200 joules
Defibrillate with 200-300 joules
Establish IV access, intubate
Adrenaline 1 mg push
Defibrillate with 360 joules
Lidocaine 1 mg/kg IV, ET
Defibrillate with 360 joules

Слайд 36Possible arrhythmias after cardiac defibrillation
ventricular tachycardia
bradyarrythmia including electromechanical dissociation and asystole
supraventricular

arrhythmia accompanied with tachycardia
supraventricular arrhythmia with normal blood pressure and pulse rate

Слайд 37Operations in case of asystole
Asystole
Start CPR
IV line
Adrenaline:IV 1

mg, each 3-5 min.
or
intratracheal 2 - 2.5 mg
in the absence of effect increase the dose
Atropine 1 mg push (repeated once in 5 min)

Na Bicarbonate 1 Eq/kg IV
Consider pacing

Слайд 38Call First vs. Call Fast
Call First
If alone with adult victim
Any victim

of any age seen to collapse suddenly
Call Fast
If alone with child victim
Unresponsive victim in cardiac arrest because of respiratory arrest

Слайд 39Cardiopulmonary Resuscitation (CPR)
CPR helps keep patient alive by circulating some oxygenated

blood to vital organs
Ventilations move oxygen into lungs where it is picked up by blood
Compressions on sternum increase pressure inside chest, moving some blood to brain/other tissues

Слайд 40CPR continued
Blood circulation resulting from chest compressions not as strong as

circulation from heartbeat
Can help keep brain/other tissues alive until normal heart rhythm restored

Слайд 41CPR continued
Often electric shock from AED is needed to restore a

heartbeat—and CPR can keep patient viable until then
CPR effective only for a short time
CPR should be started as soon as possible
In some instances, the heart may start again spontaneously with CPR

Слайд 42CPR Saves Lives
CPR and defibrillation within 3-5 minutes can save over

50% of cardiac arrest victims
CPR followed by AED saves thousands of lives each year
In most cases CPR helps keep victim alive until EMS or AED arrives

Слайд 43General Technique of CPR
If unresponsive, not breathing, and no pulse,

start chest compressions
Find the correct hand position
Two hands for adults
One or 2 hands for child
Two fingers for infant

Слайд 44General Technique of CPR continued
Compress chest hard and fast at a

rate of 100 compressions/minute
Adult = 4-5 santimeters deep
Infant/child = 1/3 to 1/2 chest depth
Release completely between compressions




Слайд 45General Technique of CPR continued
If alone, alternate 30 chest compressions and

2 ventilations for any age patient
In two-rescuer CPR for infant/child, alternate 15 compressions and 2 ventilations
Chest-encircling method in infant
Give each ventilation over 1 second
Follow local protocol regarding oxygen

Слайд 46Single-Rescuer CPR
Check patient’s responsiveness,
open airway,
and determine that patient is

not breathing adequately
2. Give 2 ventilations, each lasting 1 second
3. Determine victim has no pulse

Слайд 47 Single-Rescuer CPR
2. Give 2 ventilations, each lasting 1 second
3. Determine victim

has no pulse

Слайд 48

Put hand(s) in correct position for chest compressions

Слайд 49
Give 30 chest compressions at rate of 100 per

minute
Then give 2 ventilations

Слайд 50Continue CPR until:
Patient begins to move
AED brought to scene and ready

to use
Professional help arrives to take over
You are too exhausted to continue

Слайд 51If patient starts moving, check for adequate breathing
If patient is breathing

adequately, put patient in recovery position and monitor breathing
When AED arrives, start AED sequence

Слайд 52Chest Compressions Alert
Be careful with your hand position
For adults/children, keep your

fingers off patient’s chest
Do not give compressions over bottom tip of breastbone

Слайд 53Chest Compressions Alert
When compressing, keep elbows straight and hands in contact

with patient’s chest at all times

Слайд 54Chest Compressions Alert
Compress chest hard and fast, but let chest recoil

completely between compressions. Minimize amount of time used giving ventilations between sets of compressions.



Слайд 55Problems with CPR Technique
CPR often ineffective because of poor technique
Compressions not

delivered steadily and constantly during resuscitation efforts
Often compressions are too shallow, resulting in ineffective blood flow
Compressions may be given at too fast a rate
Only good-quality CPR improves chances of survival

Слайд 56Chest Compressions: Bradycardia in Child
Infant or child being given rescue breaths

or oxygen may have a pulse but still inadequate perfusion
If pulse < 60 beats/minute and infant or child has signs of poor perfusion, provide CPR

Слайд 57Skill:
CPR For Adult or Child
(Two Rescuers)

Слайд 58Two-Rescuer CPR for Adults and Children
Minimizes time between rescue breaths and

compressions
CPR becomes more effective
Can more quickly set up AED
Reduces rescuer fatigue

Слайд 59Two-Rescuer CPR
Performed in cycles of 30:2 for adult (15:2 for infant

or child)
One rescuer provides breaths, second rescuer gives chest compressions
Rescuers switch positions every 2 minutes
Change done after full CPR cycle
Accomplish change in < 5 seconds

Слайд 60Two-Rescuer CPR continued
If AED present, one rescuer gives CPR while the

other sets up unit
If unit advises CPR, rescuers give CPR together
Third rescuer can apply cricoid pressure

Слайд 61Two-Rescuer CPR continued
If you are assisting another trained rescuer who places

an advanced airway:
Chest compressions given continually
No pauses for ventilations
Give ventilations at rate of 8 – 10 breaths/ minute

Слайд 62Transitioning from One-Rescuer CPR to Two-Rescuer CPR
Second rescuer moves into position

on other side to prepare to take over chest compressions
First rescuer completes a cycle of compressions and ventilations While first rescuer pauses to check for a pulse, second rescuer finds correct hand position for compressions

Слайд 63Transitioning from One-Rescuer CPR to Two-Rescuer CPR
When first rescuer says, “No

pulse, continue CPR,”
second rescuer begins chest compressions and first rescuer then gives only ventilations

Слайд 64Differences in Two-Rescuer Training
If First Responder started CPR, arriving second rescuer

may have a higher level of training
Rescuer with greater training determines how CPR should best be continued

Слайд 65 Rescuer 1 checks ABCs. Rescuer 2 locates site for

chest compressions.

Слайд 66 If no pulse, rescuer 2 gives 30 compressions for

adult (15 for child) at rate of 100/minute.

Слайд 67Rescuer 1 gives 2 breaths.

Слайд 68 Continue cycles of 30:2 for adults (15:2 for child).

After 5 cycles (~ 2 minutes) switch positions.

Слайд 69Adult or Child Two-Rescuer CPR Continued
Continue CPR until:
Patient moves
AED brought to

scene and ready to use
Advanced help arrives and takes over
If patient starts breathing and has pulse, put in recovery position and monitor ABCs
If AED brought to scene, start AED sequence

Слайд 70Uses different hand position
Place thumbs of both hands on sternum while

fingers encircle chest
Compress breastbone with both thumbs while squeezing chest with fingers
Same rate and depth as usual

Two-Rescuer CPR: Infants

Слайд 71Skill:
CPR: Infants
Two Rescuers

Слайд 72 Rescuer 1 checks ABCs. Rescuer 2 locates site for

chest compressions.

Слайд 73If no pulse, rescuer 2 gives 15 chest compressions.

Слайд 74Rescuer 1 gives 2 breaths.

Слайд 75Infant Two-Rescuer CPR Continued
Continue cycles of 15:2 for ~ 2

minutes then switch roles
Continue CPR until:
Infant moves
Advanced help arrives and takes over
If infant starts breathing, hold in recovery position and monitor ABCs

Слайд 76When Not to Perform CPR
Presence of a Do-Not-Resuscitate (DNR) order
Patient

obviously dead (decapitation; incineration; or clear signs of prolonged death, such as rigor mortis and dependent lividity)
Not safe to be on the scene and the patient cannot be moved somewhere safe
A physician pronounces the patient dead

Слайд 77Drugs used in CPR
Atropine – can be injected bolus, max 3

mg to block vagal tone, which plays significant role in some cases of cardiac arrest
Adrenaline – large doses have been withdrawn from the algorithm. The recommended dose is 1 mg in each 3-5 min.
Vasopresine – in some cases 40 U can replace adrenaline
Amiodarone - should be included in algorithm
Lidocaine – should be used only in ventricular fibrillation

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