Академический Документы
Профессиональный Документы
Культура Документы
Presented in:
The 1st Sumatera Anesthesiology Update – April 2019
Objective
Source: Resuscitation Council (UK). "Prevention of Cardiac Arrest and Decisions about CPR." (2015).
Chain of Survival
Chain of Prevention
Source: Smith GB, Prytherch DR, Psirides AJ. An Overview of the Afferent Limb. In: DeVita MA, Hillman K, Bellomo R, editors. Textbook of Rapid Response Systems 2ed. Switzerland:
Springer International; 2017. p. 159-72.
Airway Obstruction & Respiratory Failure
Decision to intubation
1. Failure to maintain a patent airway
2. Loss of protective reflexes
3. Failure to adequately oxygenate or ventilation
4. Anticipated clinical deterioration
Thomas V, Abraham S. Adding an" R" in the" DOPE" Mnemonic for ventilator troubleshooting. Indian Journal of Critical Care Medicine. 2018 May 1;22(5).
Cardiac Arrest Management
Source: Fulde GW, Preisz P, Berry MJ. Cardiopulmonary resuscitation. In: Fulde GW, Fulde S, editors. Emergency Medicine. Australia: Churchill Livingstone; 2014. p. 1-12.
Chest Compression
Source: Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Neumar RW, O’neil BJ, Paxton JH, Silvers SM, White RD. Part 7: adult advanced cardiovascular life support:
2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015 Nov 3;132(18_suppl_2):S444-64.
Advanced Cardiac Life Support Algorithm
CPR
START Shockable
(VF/Pulseless VT)
CPR
CPR
Non-shockable
(PEA/Asystole)
Source: Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Neumar RW, O’neil BJ, Paxton JH, Silvers SM, White RD. Part 7: adult advanced cardiovascular life support:
2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015 Nov 3;132(18_suppl_2):S444-64.
Post Cardiac Arrest Care
Cardiovascular Care Glucose Control
1. Acute cardiovascular intervention
2. Hemodynamics goal Seizure Management
Treatment of Pulmonary Embolism
Targeted Temperature Management
1. Hypothermia induction Sedation and Analgesic
2. Avoidance of hyperthermia
System of Care
Respiratory Care
1. Ventilation
2. Oxygenation
Source: Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, Leary M, Meurer WJ, Peberdy MA, Thompson TM, Zimmerman JL. Part 8: post–cardiac arrest care:
2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015 Nov 3;132(18_suppl_2):S465-82.
Oxygen Delivery
DO2 = CO x CaO2
SV x HR Hb x SPO2 x 1.34
Cellular Disfunction
Source: Malbrain ML, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, Van Regenmortel N. Fluid overload, de-resuscitation, and outcomes in critically ill or injured
patients: a systematic review with suggestions for clinical practice. Anaesthesiology intensive therapy. 2014;46(5):361-80.
Impact of Fluid Overload
Excess volume expansion results in organ dysfunction
ROSE Concept
Resuscitation
Optimization
Stabilization
Evacuation
Resuscitation Endpoint
1. Hemodynamic endpoint MAP, CVP, PAC, ScVO2, IVC
2. Metabolic endpoint lactate, BE, pH, ETCO2
3. Regional endpoint Gastric tonometry, gastric PCO2, gastric intramucosal pH
Source: Connelly CR, Schreiber MA. Endpoints in resuscitation. Current opinion in critical care. 2015 Dec 1;21(6):512-9.
Take Home Message