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Current trends in CPBR: Techniques and underlying mechanism. Dr. Gaurav Dhakate. University College of Medical Sciences & GTB Hospital, Delhi. Anyone, anywhere, can now initiate cardiac resuscitative procedures. All that is needed are two hands. JAMA 1960. History :.
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University College of Medical Sciences & GTB Hospital, Delhi
Anyone, anywhere, can now initiate cardiac resuscitative procedures. All that is needed are two hands.
1978 : The first AED was originally designed and created by American biomedical engineer Joshua L. Koelker and Italian emergency medical professional Jordan M. Blondino.
2010 AHA ECC guidelines mark the 50th anniversary of CPR.
To maintain circulation to brain and heart thereby prevent the tissue death and brain damage until cardiac activity is restarted.
ventilation and circulation with return of intact neurological function.
Following a cardiac arrests, 3 distinct phases are characterized in the body:
Cardiac vs non cardiac
out of hospital and in the hospital SCA.
witnessed or unwitnessed .
Single approach for maximum benefit…..
Chain of survival
Early access to the victim
C A B Defibrillation
A B C Defibrillation
WHY THE CHANGE?
Firm and hard surface (ground, table/ hard bed) deflate air/ water mattresses.
Level with patient, elbows vertically straight and locked, shoulders directly above the hands, heel of one palm over the other.
Assessed at beginning while assessing responsiveness.
Look, Listen & feel ……has been removed
Compression only CPR for bystander rescuer
How does a shock act?
Why early? Will help only if myocardium is still viable.
Rhythm shockable: VF
Types : Manual defibrillators,
Automated external defibrillators (AED).
Adult and child (1-8 yrs).
Infants: Manual defib is preferred.
>4 J/kg- 9J/kg have effectively defibrillated children and animal models.
Less time consuming.
Optimal energy level: undecided.
Monophasic manual defibrillators: 360 J f/b 360 J subsequently.
Biphasic defibrillators: Better and safe. No studies on exact initial energy levels. Use manufacturers guidelines (120 J – 200 J).
Subsequent shocks: use same or higher energy levels.
AED: as programmed.
RETURN OF ELECTRICAL ACTIVITY ……. CONTRACTILITY IS LIKELY TO BE LIMITED ..NOT SUFFICIENT ENOUGH TO PUMP BLOOD FORWARD.
Advanced circulatory interventions:
Access for drug administration: IV/ IO/ ET.
IV: Preferred route, follow drug admin by 20 ml
fluid bolus, elevate limb for 10-20 secs.
IO: If iv route not available.
All drugs given iv can be given IO.
ET: Ideal dose not known, 2-2.5 X IV dose.
Dilute in 5-10 ml NS.
(Epi., vasopressin, atropine, lidocaine
Drugs to control heart rhythm and blood pressure.
BP: Adrenaline, Vasopressin, Dopamine.
Replaces 1st or 2nd dose of adrenaline.
Rhythm: Atropine, Lidocaine, Amiodarone, Magnesium,
Bradycardia: 0.5 mg upto a total of 3mg.
CPR, shock and vasopressor. 300 mg iv/ io first
dose, 150 mg iv/ io 2nd dose if reqd.
1-1.5 mg/kg iv/ io 1st dose, rpt 0.5-0.75
mg/kg upto total 3 doses or 3mg/kg.
load 1-2 g iv/ io in 10 ml 5% Dex 5-20 mins.
6 mg rapid flush large vein, if reqd 12 mg
twice after 1-2 min.
IV injections f/b 20 ml fluid bolus and raising the arm.
Head tilt- chin lift/ jaw thrust
Basic airway adjuncts:
Advanced Airway interventions:
Laryngeal mask airway,
Combitube (esophageal-tracheal combitube)
( no more C:V 30:2 cycles).