Cardiopulmonary resuscitation Dr.Khanaliha 2015

C.P.R An effort to manually preserve intact brain function until restore blood pressure & breathing The objective is to delay tissue death & prevention of brain damage

Indication No breathing Cardiac arrest Agonal respiration

Agonal breathing Possible causes : cerebral ischemia – extreme hypoxia or anoxia Gasping &labor breathing with strong vocalization& myoclunus Serious medical sign (general process to complete apnea or -cardiogenic shock – cardiac arest- death)

Guidelines (International liasion committee on resuscitation ) Chest compression (5 cm depth- > 100 /min) Breathing (mouth to mouth & nose _ artificial breathing) Current recommendati on emphasis on high quality chest compression

During the first few minutes after the onset of cardiac arrest, chest compressions are the priority intervention, unless the cardiac arrest is due to asphyxiation, drowning, or suffocation, which are the only circumstances that ventilation must be provided before chest compressions. During the first few minutes after the onset of cardiac arrest, chest compressions are the priority intervention, unless the cardiac arrest is due to asphyxiation, drowning, or suffocation, which are the only circumstances that ventilation must be provided before chest compressions.

Methods & standards Two hands for adult comp one hand for children &two finger for infants Pulse check hes been removed Endotracheal tube &LMA 8- 10/min Children com/ven 15/2 Adult comp/ven is 30/2 New borne 3/1 ABC chang ed to CAB

Compression only CPR Chest compression without artificial breathing Rythmic compression staying alive Method is the same

Others techniques Interposed abdominal compression Internal cardiac massage in surgical patients

Pregnancy Uterous compress the IVC 30 degree left roll Emergency C/S

Advanced airway placement was pursued after the initial 600 chest compressions in all patients. Advanced airway placement was pursued after the initial 600 chest compressions in all patients.

CPR prolongs the duration of VF but cannot convert the arrhythmia to an organized rhythm in most circumstances. CPR prolongs the duration of VF but cannot convert the arrhythmia to an organized rhythm in most circumstances.

No device, other than a defibrillator, has been associated with consistently improved survival from cardiac arrest. No device, other than a defibrillator, has been associated with consistently improved survival from cardiac arrest.

Electric shock or defibrillation Restore a viable or perfusing heart rythm Uneffective for Asystole & pulseless electrical activity Effective for VF & pulseless V tach

Effectiveness In hospital Out of hospital Withnessed 52%& 19% Unwithnessed 33%&8% Withnessed 41% & 15% Unwithnessed 21% & 4% Compression only 13% Withnessed & shockable 53% & 37%

Risk factors Ts Hs Hypovolemia Hypoxia Hydrogenion Hyper &Hypo kalemia Hypothermia Hypoglycemia Hypovolemia Hypoxia Hydrogenion Hyper &Hypo kalemia Hypothermia Hypoglycemia Tablets or toxins Tension pneumothorax Tamponade Thrombosis Thromboembolism Traumatic cardiac arrest Tablets or toxins Tension pneumothorax Tamponade Thrombosis Thromboembolism Traumatic cardiac arrest

Complications Rib FX (Increase with age) Fat emboli Damage to abdominal viscus Upper airway complication Pulmonary complication peneumotorax hemotorax lung contusion Bleeding in ant. mediastinum Sternal FX (higher in women) Heart contusion

Ending C.P.R continue until Return of spontaneous circulation Dead

Any Question???