Download presentation
Presentation is loading. Please wait.
1
In Hospital Resuscitation and Defibrillation
2
ABCDE approach Underlying principles
Complete initial assessment Treat life-threatening problems Reassessment Assess effects of treatment/ interventions Call for help early e.g. Medical Emergency Team
3
ABCDE Talking Difficulty breathing, distressed, choking
Shortness of breath Noisy breathing stridor, wheeze, gurgling See-saw respiratory pattern, accessory muscles
4
Nursing The Patient on his
ABCDE Head Tilt, Chin Lift, Jaw Thrust Simple Adjuncts Oro-pharyngeal Airway Naso-pharyngeal Airway. Advanced Techniques LMA ETT Open The Airway O2 Nursing The Patient on his Side Naso-Gastric Tube
5
ABCDE Inspect Palpate Percuss Auscultate
Chest Expansion Respiratory Rate Accessory Muscles Chest Deformities Cyanosis Inspect Palpate Tenderness Percuss Hyper-Resonance Auscultate Equal Air Entry Adventitious Sounds
6
O2 Treat the Underlying Cause
ABCDE Respiratory Supports: Non invasive Face mask Bag-Mask-Valve Tracheal Intubation &Controlled Ventilation O2 To All Hypoxic Patients Treat the Underlying Cause
7
Pulse – tachycardia, bradycardia
ABCDE Look at the patient Pulse – tachycardia, bradycardia Blood pressure Peripheral perfusion - capillary refill time Organ perfusion chest pain, mental state, urine output Bleeding, fluid losses
8
ABCDE Airway, Breathing Haemodynamic monitoring IV access Fluid challenge Inotropes/Vasopressors Treat Cause Oxygen/Aspirin/Nitrates/ Morphine for ACS
9
AVPU Score GCS ABC Check Blood Glucose level & Pupils Check Drug Chart
ABCDE AVPU Score GCS ABC Check Blood Glucose level & Pupils Check Drug Chart Consider Lateral Position
10
Remove clothes to enable examination - e.g. injuries, bleeding, rashes
ABCDE Remove clothes to enable examination - e.g. injuries, bleeding, rashes Avoid heat loss Maintain dignity
11
In Hospital Resuscitation Sequence for collapsed patient in a hospital
Check the patient for a response
12
In Hospital Resuscitation Sequence for collapsed patient in a hospital
Shout for help.
13
In Hospital Resuscitation Sequence for collapsed patient in a hospital
Look Listen Feel
14
In Hospital Resuscitation
Sequence for collapsed patient in a hospital No pulse No Breathing for 10 Seconds Call Resuscitation Team
15
In Hospital Resuscitation Sequence for collapsed patient in a hospital
Start CPR 30 : 2
16
In Hospital Resuscitation
Sequence for collapsed patient in a hospital When Resuscitation Team Arrives
17
Until Defibrillator/Monitor Attached
Open Airway Look for Signs of Life Call Resuscitation Team CPR 30:2 Until Defibrillator/Monitor Attached Assess Rhythm Shockable (VF/Pulseless VT) Non-shockable (PEA/Asystole)
18
Energy Level 150 - 200 J biphasic 360 J monophasic (VF/Pulseless VT)
Assess Rhythm Shockable (VF/Pulseless VT) 1 Shock J biphasic or 360 J monophasic Energy Level J biphasic 360 J monophasic Immediately resume CPR 30:2 for 2 min
19
(VF/Pulseless VT) Persists
2nd and subsequent shocks J biphasic 360 J monophasic Minimise Delays Between CPR and Shocks (< 10 s) Do not Delay Shock to Give Adrenaline Give Amiodarone Before 4th Shock IF Shockable (VF/Pulseless VT) Persists Deliver 2nd Shock After 2 min, assess rhythm: If organised electrical activity, check for signs of life: if ROSC start post resuscitation care if no ROSC go to non VF/VT algorithm CPR for 2 mins Adrenaline 1mg I.V Deliver 3rd Shock
20
CPR 30:2 Assess Rhythm Non-shockable (PEA/Asystole) Immediately resume
for 2 min
21
Until defibrillator/monitor attached
ALS Treatment Algorithm Open Airway Look for signs of life Call Resuscitation Team CPR 30:2 Until defibrillator/monitor attached During CPR: Correct reversible causes Check electrode position and contact Attempt / verify: IV access airway and oxygen Give uninterrupted compressions when airway secure Give adrenaline every 3-5 min Consider: amiodarone, atropine, magnesium Assess Rhythm Shockable (VF/Pulseles VT) Non-shockable (PEA/Asystole) During CPR: Correct reversible causes Check electrode position and contact Attempt / verify: IV access airway and oxygen Give uninterrupted compressions when airway secure Give adrenaline every 3-5 min Consider: amiodarone, atropine, magnesium 1 Shock J biphasic or 360 J monophasic Immediately resume CPR 30:2 for 2 min Immediately resume CPR 30:2 for 2 min
22
4Hs Reversible Causes Hypoxia 2) Hypovolemia Hyper-Hypokalemia
Fluid Restoration Urgent Surgery to Stop Bleeding Adequate Ventilation with 100% O2 4Hs Hyper-Hypokalemia Hypocalcemia Hypoglycmia Hypothermia Low Reading Thermometer IV CaCl
23
4Ts Reversible Causes Tension Pneumothorax Diagnosed Clinically
2) Toxins Diagnosed Clinically Decompress by Needle Thoracocentesis Insertion of Chest Tube Specific History & Lab Investigations Supportive TTT & Antidotes 4Ts Thromboembolism Tamponade Penetrating Chest Trauma Recent Cardiac Surgery Needle Pericardiocentesis Resuscitative Thoracotomy Consider Thrombolytic Therapy
24
Ulnar Edge of a Tightly Clenched Fist To the Lower ½ of Sternum
Precodial Thumb Ulnar Edge of a Tightly Clenched Fist 20 CM Height To the Lower ½ of Sternum Witnessed Monitored Shockable No Defilbrillator
25
Mechanism of Defibrillation
Defibrillation occurs by passage of electric current of sufficient magnitude across the myocardium to depolarize a critical mass of cardiac muscle simultaneously to enable the natural pace maker tissue to resume control.
26
Defibrillation Success
Minimize Trans-Thoracic Impedance Electrode-Skin Contact Electrode Size Coupling Agent Paddle Force Phase of Ventilation Pads Versus Paddles One Shock Versus 3 Shock Sequence
27
Defibrillation Success
Electrode Position Antero-Apical Antero-Posterior Biaxillary
28
Synchronized Cardioversion
If the Electric Cardioversion is Used to Convert Atrial or Ventricular Tachyarrhythmias, the Shock Must be Synchronized to Occur with the R-wave of the ECG Rather Than the T-wave to Avoid the Relative Refractory Period and Minimizing the Risk of Inducing VF.
29
Tachyarrhythmia Adverse Signs
Synchronized Cardioversion Tachyarrhythmia Adverse Signs Regular Broad complex Tachycardia (Ventricular Tachycardia / SVT with Bundle branch block) Decreased Conscious Level Chest Pain Systolic B.P < 90 mmHg Heart Failure Irregular Broad complex Tachycardia (Polymorphic VT = Torsade de pointes / AF with BBB) Irregular narrow complex tachycardia (AF) Regular narrow complex tachycardia (SVT)
30
Anticipating Slight Delay
Synchronized Cardioversion PRECAUTIONS Anticipating Slight Delay Sedation Energy Doses 200 J Monophasic J Biphasic 100 J Monophasic J Biphasic
31
Post Resuscitation Care
Post Resuscitation Care Starts Where Return of spontaneous circulation is Achieved. ABCDE system-oriented approach to management should be followed in the immediate post resuscitation phase pending transfer to an appropriate high-care area.
32
Post Resuscitation Care
Immediate return of Normal cerebral Functions Obtunded Cerebral Functions ABCDE Ensure Clear Airway No Need For Tracheal Intubation Tracheal Intubation Adequate O2 & Ventilation O2 Mask Spontaneous Ventilation controlled Ventilation Hypoxia & Hypercapnia: Further Cardiac Arrest 2ry Brain Injury Hyporcapnia Cerebral Ischemia
33
Post Resuscitation Care
Pulse Bl.Pr. 1 Maintain Normal Sinus Rhythm Maintain Adequate cardiac output ABCDE 2 Peripheral Perfusion Capillary Refill Time < 2 Seconds Warm Pink Digits 3 Neck Veins Right Ventricular Failure Pericardial Tamponade Lung Bases 4 Left Ventricular Failure
34
Post Resuscitation Care
ABC DE To Assess the Neurological Function. Ensure that Cardiac Arrest has not been Associated with Other Medical or Surgical Conditions Requiring Immediate Treatment
35
Post Resuscitation Care
Patient Transfere Aim: To transfer the patient safely between the site of resuscitation and a place of definitive care Monitor Defibrillator O2 Supply Suction Apparatus Cannulae, Tubes, Drains are Secured
36
Post Resuscitation Care
Further Assessment History To Establish Regular Drug Therapy Before Cardiac Arrest Monitors ECG Capnography U.O.P Pulse Oximetry C.V.P Investigations C.B.C 12 Lead E.C.G Chest X.R Biochemistry Echocardiography A.B.G
37
Post Resuscitation Care
Optimizing Organ Function Target Mean Arterial Pressure Adequate U.O.P Consider patient’s Usual Blood Pressure Maintain Normal Sinus Rhythm To Avoid decrease in C.O.P Correct Hypo-perfusion During Cardiac Arrest I.V Fluids Inotropes
38
Post Resuscitation Care
Optimizing Organ Function Cerebral Perfusion Sedation Control of Seizures Treatment of Hyperthermia & Therapeutic Hypothermia Control of Blood Glucose
39
Post Resuscitation Care
Prognosis No Neurological Signs Can Predict the Outcome in the First Hours after ROSC Poor Outcome Predicted at 3 Days by: Absent Pupil Light Reflexes Absent Motor Response to Pain
40
Thank You
Similar presentations
