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Noile ghiduri de Resuscitare Cardio Respiratorie (RCR)

Noile ghiduri de Resuscitare Cardio Respiratorie (RCR). D. Săndesc Spitalul Judetean Timisoara 06.07.2006. RCR - Surse bibliografice principale. European Resuscitation Council Guidelines for Resuscitation 2005 1

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Noile ghiduri de Resuscitare Cardio Respiratorie (RCR)

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  1. Noile ghiduri de ResuscitareCardio Respiratorie (RCR) D. Săndesc Spitalul Judetean Timisoara 06.07.2006

  2. RCR - Surse bibliografice principale • European Resuscitation Council Guidelines for Resuscitation 20051 • International Liaison Committee on Resuscitation (ILCOR): 2005 International Consensus Conference on Cardiopulmonary Resuscitation2 • Resuscitation 2005; 67S1: S1-S189 • Resuscitation 2005; 67: 1-341

  3. Epidemiologie • Stop cardiac: 60% din decesele pacientilor cu cardiopatie ischemica Saravanan P et al. A survey of resuscitation training needs of senior anesthetists. Resuscitation 2005; 64: 93-6

  4. Epidemiologie • Stopul cardio-respirator (SCR) • ~ 460.000/an SUA1 • ~ 700.000/an Europa2 • 2/3: tentativa de RCR • Supravietuirea dupa RCR • 5-10% (15% dupa Fibrilatie Ventriculara – FV) • RCR cu Defibrilare in primele 3-5 minute: supravietuire pina la 49-75% ! • Fiecare minut:  7-10% supravietuirea ! • American Heart Association, Heart Disease and Stroke Statistics – 2005 Uptodate • Saus S et al. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. Eur Heart J 1997; 18: 1231-48

  5. RCR – Formula lui Safar • - Airway • - Breathing • - Circulate: masaj cardiac (15:2; 5:1) • - Drugs • - EKG • - Fibrilation • - Gauging (Evaluare) • - Human Mentation • - Intensive Care

  6. Time is … life !!!

  7. Resuscitarea: Lantul Supravietuirii (Chain of Survival) • Recunoasterea imediata a urgentei si apel pentru ajutor calificat (112) • Start RCR • Defibrilare rapida in SCR – FV; fiecare minut intarziere:  10-15% sansa de supravietuire • Terapia intensiva post-resuscitare

  8. RCR extraspital (personal nemedical) – inregistrare telefonica “Why is it that every time I press on his chest he opens his eyes, and every time I stop to breathe for him he goes to sleep?” * * Berg RA et al. Cardiopulmonary resuscitation: Bystander cardiopulmonary resuscitation- Is ventilation necessary? Circulation 1993; 88: 1907-1915

  9. Noile ghiduri de RCR – principalele modificari • Diagnosticul de Stop CR: pacient ce nu raspunde la stimuli si nu respira normal , NU prin cautare puls ! • Masajul cardiac • Inceput imediat si mentinut continuu • Mainile resuscitatorului: in mijlocul pieptului • Frecventa 100 / min • Raport compresii toracice / respiratie: 30/2

  10. Noile ghiduri de RCR – principalele modificari • Defibrilarea: • In FV cat mai precoce • 360 J din start la defibrilatoarele unipolare • 1 singur soc • Droguri: • Renuntare la Adrenalina doze mari • Amiodarona … • Hipotermia moderata postresuscitare

  11. RCR bazala la adult(Adult basic life support)

  12. RCR – Bazal • Verifica siguranta mediului/locului • Verifica daca victima raspunde: • zgaltaire umeri • “sunteti bine / totul e in regula?”

  13. RCR – Bazal • a. Pacientul raspunde • urmarire • b. Pacientul nu raspunde • Striga dupa ajutor • Pozitionare - decubit dorsal • Eliberare cai aeriene

  14. RCR – Bazal • Verifica daca pacientul respira: • priveste • asculta • simte

  15. RCR – Bazal 5a. Pacientul respira normal • pozitia de siguranta • apel ambulanta • supraveghere

  16. RCR – Bazal

  17. RCR – Bazal • b. Pacientul nu respira normal • trimite sau cheama ambulanta • Masaj cardiac • in centrul toracelui • 100 / min (1/1) • 4-5 cm

  18. RCR – Bazal • a. Combina masajul cardiac cu respiratia artificiala 30 : 2

  19. RCR – bazal: aspecte particulare • RCR fara respiratie gura la gura • acceptabila • comparabila cu RCR standard1 • Respiratie artificiala initiala • Ventilatia • evitarea hiperventilatiei • 500-600 ml (6-7 ml/kg) volum curent2 • Kern KB et al. Circulation 2002; 105:645-9 • Baskett P et al. Resuscitation 1996; 31: 231-4

  20. RCR – Defibrilarea electrica automata(AED) e

  21. RCR – Defibrilarea FV – faze: • Electrica (~ 4 minute) • Circulatorie (min. 4-10) a) epuizare energetica miocardica b) defibrilarea directa neeficienta c) masaj cardiac:  sansele defibrilarii1 • Metabolica – supravietuirea improbabila2 RCR inainte de defibrilare (daca socul se administreaza la > 5 minute dupa SCR)3 • Ewy GA et al. In: 2006 Yearbook of Intensive Care and Emergency Medicine, J.L. Vincent (subred), Springer, Brussels; 316-327 • Kim F et al. Circulation 2005; 112: 715-719 • Langhelle A, Nolan JP. Resuscitation 2005; 66: 271-83

  22. RCR avansata

  23. RCR avansata – Droguri • Adrenalina (f 1mg/ml) • 1 mg la 3-5 min i.v. (2-3 mg traheal in 10ml) • Amiodarona(f 150 mg) • Indicatii • FV refractara la 3 socuri • Doza: 300 mg i.v. (diluat in glucoza 5% pana la 20 ml)   repetare 150 mg  perfuzie 900 mg/24h • Reactii adverse: bradicardie, hipotensiune • Atropina(f 1mg/ml) • Indicatii: - asistolie, DEM cu AV < 60/min • Doza: 3 mg i.v.

  24. RCR avansata – Droguri • Lidocaina (f 2%-20 mg/ml ,4%-40 mg/ml ) • Indicatii: FV si TV refractare (linia a 2-a dupa Amiodarona) • Doza: 1-1,5 mg/kg 50 mg (maxim 3 mg/kg prima ora) • Magneziu sulfat (f 50% , 20%) • Indicatii: • FV refractara cu hipoMg • Tahiaritmii ventriculare + hipoMg • Torsades des pointes • Toxicitate digitalica • Doza: 2 g i.v. (4ml sol 50%) in 1-2 min  repetare la 10-15 min

  25. RCR avansata – Droguri • Bicarbonat de Na(sol 8,4%-1mEq/ml) • Indicatii: • SCR cu hiperpotasemie • Intoxicatie cu antidepresive triciclice •  pH  7,1 • Doza: 50 ml sol. 8,4% p.e.v. Calciu (sol 10%) Indicatii : DEM cu – hiperpotasemie - hipocalcemie - supradozare blocanti de Ca Doza : 10 ml i.v. +/-repetat 7.

  26. RCR la copii • Frica de RCR la copii – nejustificata ! • Protocolul RCR adult – aplicabil la copil Particularitati • Start cu 5 respiratii • RCR 1 minut inainte de a cauta ajutor • Compresiuni toracice: 15/2 ,1/3 din diametru • cu 2 degete: copii < 1 an • 1/2 maini: > 1 an

  27. RCR la copii

  28. RCR la copii

  29. RCR la copii

  30. RCR la copii • Defibrilarea:4 J/Kg • > 8 ani – similar cu adultii • 1-8 ani • padele pediatrice (daca sunt disponibile) • padele tip adult • < 1 an – contraindicat

  31. RCR la copii

  32. RCR - Concluzii 1. Elemetul esential- MCE - Precoce - 100/min - Neintrerupt - Raport compresii /respiratii: 30/2 2. Defibrilarea (socul electric)-esential in FV si TV fara puls -soc unic, repetat la nevoie dupa minimum 2 minute de resuscitare -360 J

  33. RCR - Concluzii 3. Adrenalina 1 mg la 3 min 4. Tratamentul de prima linie al aritmiilor ventriculare –amiodarona 5. RCR la copii – dupa schema de la adult cu mici modificari

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