1. Jeanine P. Wiener-Kronsih, MD
Critical Care Secrets
Polly E. Parsons, MD
Jeanine P. Wiener-Kronsih, MD
4th edition 2007
Mosby Elsevier

2. Part 2: Cardiopulmonary Resusciation
成功大學附設醫院 小兒科
王玠能醫師

3. Q1: What is meant by CPR?
To most people, CPR refers to BLS: rescue breathing and chest compression
To health providers, ACLS, PALS, and ATLS (advanced trauma life support)

4. Q2: Is iatrogenic cardiopulmonary arrest very common?
In a study of 562 in-hospital arrest, a major unsuspected diagnosis was in 14% of cases
Two common missed diagnoses: pulmonary embolus and bowel infarction
15% of in-hospital arrest were avoidable: respiratory insufficiency and hemorrhage
Direct iatrogenesis: procedures & medications (sedative-hypnotics, opiates, lidocaine.. Etc)

5. Q3: What are the ABCDs of resuscitation?
Airway
Breathing
Circulation
Defibrillation

6. Q4: How is BLS performed?

7. Chest Compression (Child 1~8 Y/O)
Maneuver: heel of one hand
Site: low half of sternum
Depth: (1~1.5 inches)
Rate: 100 per minute
Compression/Ventilation ratio = 15:2
Repeat 5 cycles

8. Chest Compression (Child > 8 Y/O)
Maneuver: heel of two hands & interlock fingers
Site: low half of sternum
Depth: (1.5~2 inches)
Rate: 100 per minute
Compression/Ventilation ratio = 15: 2
Repeat 5 cycles

9. Q5: How does blood flow during closed-chest compressions?
Cardiac pump model:
Thoracic pump model:

10. Q6: What is the main determinant of a successful resuscitation?
Access to defibrillation
Time to defibrillation

11. Q7: What is the role of pharmacologic therapy during PALS?
Immediate goals: improve myocardial blood flow, increase ventricular inotropy, and terminate life-threatening arrhythmia, thereby restoring and/or maintaining circulation

12. Q8: Is sodium bicarbonate indicated in the routine management of cardiopulmonary arrest?NO

13. Q9: What are the arrhythmias associated with most cardiopulmonary arrests?
VT or VF
PEA

14. Q10: What are the most common immediately reversible causes of cardiopulmonary arrest?
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hyperkalemia
Hypothermia
Tablets or toxin
Tamponade
Tension pneumothorax
Coronary Thrombosis
Pulmonary thrombosis

15. Q11: How should VF be treated?

16. 治療無脈搏 - 心室顫動 (VF)/無脈搏的心室頻脈 (Pulseless VT)
CPR急救
視需要給予去顫術三次 (Defibrillation)
Epinephrine /去顫術 (Defibrillate)
Lidocaine /去顫術 (Defibrillate)
Bretylium /去顫術 (Defibrillate)

21. Automated External Defibrillators
AEDs can shorten time to defibrillation and improve survival in adults.
Every healthcare provider should know how to use an AED.
AEDs are not yet recom- mended for children <8 years of age (or weighing <25 kg).
Optional Slide C: Rhythm Skills Station: Automated External
Defibrillators (may be used with AED information, near slide 11)
Use of AEDs is included in the Rhythm Skills Station.
AED use for adults has been associated with a 75% survival rate in airports and casinos when defibrillation is provided (with CPR) within 3 minutes of collapse.
Programs of public access defibrillation are being established and studied nationwide. These programs include placement of AEDs and rescuers trained to use them throughout the community. These programs should be established with physician direction and involvement of the local EMS system.
As part of the AHA’s support of public access defibrillation, every healthcare provider should be trained in the use of an AED.
Prehospital use of automated external defibrillation is recommended for children 8 years of age and older (ie, approximately 25 kg or larger) in cardiac arrest. There is inadequate data about the ability of an AED to discriminate between shockable and nonshockable rhythms in young victims with tachycardia. In addition, most AEDs deliver energy doses that may be excessive for small children.

22. Q12: Is pulseless idioventricular rhythm treatable?
Delayed defibrillation or prolonged VF results in a pulseless idioventricular rhythm
High dose epinephrine ( mg/kg)

23. Q13: How is asystole treated?
Perform CPR immediately
Every 5 minutes, use atropine and epinephrine

24. Q14: What are the appropriate routes of administration of drugs during resuscitation?
E-T tube: NAVEL (Naloxone, atropine, vasopressin, epinephrine, lidocaine)

25. Q15: What is the usual outcome of in-hospital CPR?
Only 5-20% of patients survive to discharge
Many patients who do survive have severe impairments of independence and cognition
It is not yet possible to confidently predict the outcome

26. Key points
Iatrogenic cardiopulmonary arrests can occur during procedures; extra care needs to be taken
Reversible causes
NAVEL
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