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CARDIOPULMONARY RESUSCITATION & MANAGEMENT

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

By: Rosana , S.Ked Nila hapsari, S. Ked

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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.

epidemiologi

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Time is Critical!

• To begin resuscitation within a few minutes:• Patient’s collapse witnessed• EMS immediately activated• CPR started immediately• Defibrillation within minutes

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Review of the Circulatory System

What is the function of the circulatory system?

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The Circulatory System

Delivers O2 and nutrients

Removes CO2 and wastes

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

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Lack of O2

accumulation of wastes

quickly lead

• to death

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Major Arteries

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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 4–6 min

• Brain damage irreversible in 8–10 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 ASSOCIATION

CHANGES IN THE 2010 GUIDELINES AFFECTING

ALL RESCUERS

AMERICAN HEART ASSOCIATION

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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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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

AMERICAN HEART ASSOCIATION:2010 GUIDELINES

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New Sequence

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• 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

AMERICAN HEART ASSOCIATION:2010 GUIDELINES

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AMERICAN HEART ASSOCIATION:2010 GUIDELINES

AHA ECC Adult Chain of Survival - New

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Simplified Universal BLS algorithm

AMERICAN HEART ASSOCIATION:2010 GUIDELINES

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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

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

3 4

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

Copyright © 2004 Elsevier (USA). All Rights Reserved

DefibrillationDefibrillation

•Ventricular fibrillationa common cause ofarrest•Can only correct with defibrillation

Copyright © 2004 Elsevier (USA). All Rights Reserved

• Chance of success decreases with time

• AEDs save lives!

• Chance of success decreases with time

• AEDs save lives!

DefibrillationDefibrillation

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AEDs

• Safe, accurate & lightweight

• Easy to operate

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PAD

• AEDs in public places

• Training the public in CPR/AED

AED

Assess • Check your patient

Power

• Turn the power on

Patient

• Apply pads to patient

Analyze

• Stay clear while patient’s 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

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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