CARDIOPULMONARY RESUSCITATION & MANAGEMENT

Advisor: dr.Nicolaas P.S, Sp. An

epidemiologi

Time is critical

> 300,000 people experience sudden cardiac death in prehospital settings each year. If resuscitation begins within a few minutes, many of these individuals have a chance for survival.

Time is Critical!
To begin resuscitation within a few minutes: Patients collapse witnessed EMS immediately activated CPR started immediately Defibrillation within minutes

Review of the Circulatory System

What is the function of the circulatory system?

The Circulatory System

Delivers O2 and nutrients

Removes CO2 and wastes

Why is the function of the circulatory system critical to our survival?

Lack of O2

accumulatio n of wastes

quickly lead
to death

Major Arteries

Heart Physiology
LV contracts sends wave of blood Pressure wave felt as pulse No contraction = No blood flow = cardiac arrest

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Time is Critical!
Brain damage begins in 46 min Brain damage irreversible in 810 min

Circulation must be restored within 4 6 minutes.

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CPR
Provides minimal amount of circulation/oxygenation until cause of cardiac arrest corrected External chest compressions circulate blood Artificial ventilations provide O2 to lungs

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HISTORY

2010 : New Guidelines on CPR (AHA)

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Causes of Cardiac Arrest

Heart disease Respiratory arrest Medical emergencies Drowning and suffocation Congenital heart defects Trauma

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AMERICAN HEART AMERICAN HEART ASSOCIATION ASSOCIATION

CHANGES IN THE 2010 GUIDELINES AFFECTING ALL RESCUERS

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AMERICAN HEART ASSOCIATION:

2010 GUIDELINES
Health Care Provider*
PUSH HARD AND PUSH FAST At least 100 COMPRESSIONS / MINUTE* Allow the chest to recoil -- equal compression and relaxation times <10 seconds for pulse checks or rescue breaths Compression Depth*
Adults 2 Child/Infant 1/3 depth of chest 1.5" infant 2" child

Avoid excessive ventilations

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AMERICAN HEART ASSOCIATION:

2010 GUIDELINES
A-B-C changed to C-A-B*
Critical element is chest compressions
Delay in A-B Avoidance of A & B

Early defib If alone--call and retrieve AED

Exception asphyxial arrest

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New Sequence

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AMERICAN HEART ASSOCIATION: 2010 GUIDELINES

Cricoid pressure not recommended
Advanced airway = 1 every 6-8 seconds
Adult: 1 every 5-6 Peds: 1 every 3

With advanced airway- no pause

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AMERICAN HEART ASSOCIATION:

2010 GUIDELINES
AHA ECC Adult Chain of Survival - New

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AMERICAN HEART ASSOCIATION:

2010 GUIDELINES
Simplified Universal BLS algorithm

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Causes of Cardiac Arrest

Heart disease Respiratory arrest Medical emergencies Drowning and suffocation Congenital heart defects Trauma

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CPR
Compression : ventilation remains 30 : 2 Duration of 2 breaths = 5 seconds

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CPR 1 Rescuer
If there is no pulse, find your landmarks, lower half of the sternum, between the nipples

CPR 1 Rescuer
Begin chest compressions

CPR 1 Rescuer
Perform 30 chest compressions Push hard Push fast Allow the chest to recoil after each compression

CPR 1 Rescuer
Administer two ventilations then return to compressions

CPR 2 Rescuer
1 2

CPR - Children

Use heel of one hand Keep airway open with other hand 30 compressions:2 ventilations if alone (2 rescuers use 15:2)

CPR - Infant

Give chest thrusts and puffs of air 30 compressions:2 ventilations if alone 15 compressions: 2 ventilations with 2 rescuers

Defibrillation

Ventricular fibrillation a common cause of arrest Can only correct with defibrillation

Copyright 2004 Elsevier (USA). All Rights Reserved

Defibrillation

Chance of success decreases with time AEDs save lives!

Copyright 2004 Elsevier (USA). All Rights Reserved

AEDs

Safe, accurate & lightweight Easy to operate

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PAD

AEDs in public places Training the public in CPR/AED

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AED

Assess

Check your patient

Power
Turn the power on

Patient

Apply pads to patient

Analyze

Stay clear while patients heart rhythm analyzed

Clear

Head to toe and toe to head: everyone is clear!

Shock
Defibrillate

Patient

Standard is set of 1 shock Immediately restart CPR for 2 minutes then check pulse

ADULT CARDIAC ARREST ALGORITHM

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Summary
Continual beating, or contracting, of the heart is necessary to keep blood circulating throughout the body. Brain damage begins in 4 to 6 minutes of cardiac arrest. There are many causes of sudden cardiac death, but the most common is ventricular fibrillation.
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Summary

Survival from cardiac arrest depends on the sequence (chain) of survival. Rescuers are critically important in maintaining the sequence (chain) of survival.

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Thank you

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