1 / 26

Cardiac arrest

Cardiac arrest. قل ان الموت الذي تفرون منه فانه ملاقيكم ثم تردون الى عالم الغيب والشهادة فينبئكم بما كنتم تعملون By Dr. Zuhair Al-Samarrae FRCS, FICS, CABS, DS, MBCHB. Cardiac arrest. سهل واضح بسيط. Cardiac arrest rythm ssss: 4. 1. بازلاء 2 .VF & 3.Pulseless VT 4.Asystole

raine
Download Presentation

Cardiac arrest

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Cardiac arrest قل ان الموت الذي تفرون منه فانه ملاقيكم ثم تردون الى عالم الغيب والشهادة فينبئكم بما كنتم تعملون By Dr. Zuhair Al-Samarrae FRCS, FICS, CABS, DS, MBCHB

  2. Cardiac arrest • سهل • واضح • بسيط

  3. Cardiac arrest rythmssss: 4 • 1.بازلاء • 2.VF & • 3.Pulseless VT • 4.Asystole • What is common to all?

  4. No cardiac output • Thats why patient will lose conciosness. • PEA (Pulseless Electric Activity) • VF/ VT • Asystole • Approach is same ,

  5. BLS +ACLS 2 things contribute significantly to survival: Early CPR (bystander CPR) Early Defibrillation All of the above is BLS EVERY MINUTE COUNTS

  6. Given the choice to take one coursewhich one u prefer: BLS or ACLS? BLS Early CPR & Effective D

  7. BLS vsACLS • Basic CPR&early DF--- PRIMARY IMPORTANCE • DRUGS---------------secondary importance, where only few drugs are supported by strong evidence • ACLS therapies such as advaced airway insertion and drugs have not been shown to increase survival to hospital discharge!!!! • Basically u need defibrillator& face mask i.e BLS

  8. BLS is ABCD, which letter most important? • D is more important than the Almond Board of California(ABC) • So how can you get an EFFECTIVEDF? How to increase chance of successful DF?

  9. Energy reserve-determine success • The more delay in DF—the more energy loss--- the less likely DF to be successful • Witnessed arrest vs unwitnessed arrest. • WITNESSED arrest--good reserve—more response to DF ---IMMEDIATELY DEFIBRILLATE

  10. Unwitnessed arrest---poor reserve what to do-how to increase reserve • 2 min of a GOOD CPR – improve coronary perfusion-improve reserve-more response to DF. • Do 2 min CPR after each defib.- EVEN if rhythm change to normal –many of whom donot have a perfusing rhythm.

  11. Defibrillation 360 j سهل واضح بسيط • Monophasic 360j • Biphasic 120j • If u donot know your machine :give 200j

  12. Concept of CPR • سهل • واضح • بسيط • Simply support your patient and give him what he needs----if not breathing –give him breathing - ---if no pulse—give him a pulse

  13. What is new in BLS? • EarlyCPR before DF in unwitnessed arrest • 30:2 cycles UNIVERSAL formula-for unintubated patients eg at the time of collapse • 2min CPR after each shock even if revert to sinus rythm,as this rhythm is often not perfusing • This formula applies forALL AGES • Emphasis on uninterrupted compressions • Avoid hyperventilation

  14. Approach to cardiac arrest • Act quickly • Support your patient ABCD • loooooooooooooooooook for the cause

  15. Approach to the cardiac arrest- do not waste time • Call first and fast • Start CPR immediately • New formula 30:2( 30 comp:2 vent)-cycles-this reduce interruption of cardiac compression • Note 30:2 cycle only for unintubated , but once intubated –no more سيكل , i.e continuos compresssion(100/min) ventilation 8-10/min • It looks slow ventilation? • No , avoid overventilation-it reduce venous return (as hyperventilation create +ve pressure in the chest)

  16. action sequence in cardiac arrest • Check responsiveness • Call first( for AED) • Start CPR cycle: 2 rescue breaths(each over 1 second to devote more time to compression (30)and then shock if it is VF. • Once intubated : no more سيكل i.e no synchronization: uninterrupted compression100/min

  17. What if you donot want to give mouth to mouse فارة الى فارة • You can do chest compression only!!! • Remember : avoid hyperventilation • ---it is unnecessary(C.O is 25% -33% at best) • ---can create +ve pressure in the chest (further reducing C.O) , • ---more gastric distension--may vomit and…

  18. Ventricular fibrillation-management • Witnessed- (good energy reserve) so DF 360 فورا Unwitnessed-(poor reserve) what to do ? -improve reserve(2min CPR) then DF 360, Where often they respond,what if no response?

  19. VF—WHAT IF 1ST SHOCK FAIL? CPR-shock-CPR-shock-CPR-SHOCK shock-2minCPR-shock-2min CPR-shock- 2min CPR • NO MORE 3STACKED SHOCKS i.e NO MORE SHOCK-SHOCK –SHOCK If available: intubate , give vasopressors(epinephrine) early

  20. So basically what are the new changes in VF management? • 2 min CPR interposed among shock shock shock sequence… WHY? • To maximize chance of response to shock • 2min CPR even if revert to normal rhythm as this rhythm is often not perfusing-PEA • Earlier use of ACLS therapies i.e intubation & medicines.

  21. Management of cardiac arrestsupport the patient+treat the cause Support the patient:Epinephrine+_Atropine Epinephrine: in ALL 4 arrest rhythm(1 mg /3-5min) Atropine :in VF/VT No atropine in PEA only ifبازلاء is slow in Asystole ALL patients Atropine dose: 1 mg every 3-5 min (max 3 doses)

  22. Treat specific cause • This applies to ALL cases of arrest rhythm Not just PEA( pulseless electrical activity) All the time consider 5 Hs &5 Ts in ANY arrest rhythm Unless you address the underlying cause….

  23. Treat the cause e.g • Unless u treat HypoMg of alcoholic…. • Unless treat arrythmia +the clot of MI…. • Unless treat eletrolyte imbalance in CRF…

  24. Word of caution about Dx of PEA? • A severely hypotensive patient may have no pulse+ sins rhyrhm • Also PEA : no pulse+ sinus rhythm? • How to differentiate?

  25. Post resuscitation support • Remember many of these patients need hemodynamic support i.e hypotensive and need vasopressors e.g dopamine Keep searching for treatable causes

  26. THANK YOU

More Related