Post on 08-Aug-2015
The Most Provocative Talk of Your life “How To Do Damn Good CPR”
will begin in….
2
How to do Damn Good CPR Going Beyond ACLS
J. Scott Wieters MD
Will work for
Conflict Of interest
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picture of goal
Good CPR?
Fast CPR
Hard CPR
Uninterrupted CPR
ETCO2
• Cunningham LM, Mattu A, O'Connor RE, Brady WJ. Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation. Am J Emerg Med. 2012 Oct;30(8):1630-8. doi: 10.1016/j.ajem.2012.02.015. Epub 2012 May 23.
• Cunningham LM, Mattu A, O'Connor RE, Brady WJ. Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation. Am J Emerg Med. 2012 Oct;30(8):1630-8. doi: 10.1016/j.ajem.2012.02.015. Epub 2012 May 23.
How much pause?
Edelson DP, Robertson-Dick BJ, Yuen T, et al. Safety and efficacy of defibrillator charging during ongoing chest compressions: a multi-center study. Resuscitation 2010;81:1521–6.
Why?
STOP!
Pulse check/rhythm analysis 6 sec
Charging “I’m clear you’re clear we’re all clear” 6 sec
Post shock pulse/rhythm analysis 6 sec
18 sec
50% Less Survival
Vs.
PreshockPause
Preshock Pause <3s 6X ROSC
Every 5s = 18% Mortality
Man or Machine
VV
No Difference!
No Difference!
No Difference!12 studies 6,538 pts all showed
Man or Machine
VV
No Difference!
Defibrillation
I think you are giving me a Black
Pearl?
“There were 13 injuries 1986-1990
Most injuries involved a mild shock or burn.
“There are no serious injuries inflicted by defibrillation/cardioversion of a patient.“
Testing included four glove materials
Concerns that they leaked initially
Degraded with electricity
Took normal and post CPR nitrile gloves
Gloves break down after CPR and leak current.
Gloves tested under electrical current similar to defibrillation.
Electrical leak and glove degradation even after one shock.
Letter by Sullivan regarding article, "Hands-on defibrillation: an analysis of electrical current flow through rescuers in direct contact with patients during biphasic external defibrillation". [Circulation. 2008]
Can you feel the burn?
2012 Resuscitation
Dr. Larry Mellic UGA
Concerns that they leaked
Took normal and post CPR nitrile gloves
Gloves break down And leak Current.
Dangerous levels of Energy
Access
Aren’t IOs just for unconscious people?
DBP <30 ETCO2 <20 More EPI?
Hyperventilation?
PEA Asystole
Reversible Causes of PEA
– Hypovolemia
– Hypoxia
– Hydrogen ions (acidosis)
– Hyper/hypokalemia
– Hypothermia
– Tablets (drug OD) – Tamponade – Tension ptx – Thrombosis
(coronary) – Thrombosis (PE)
Wide? PEA
Electrolytes/ToxinsCa++ or Bicarb
Narrow? PEA
Obstruction/ShockDiagnose/Treat
ROSC?
ET CO2 PICTURE GOOD CPR
ETCO2
Pokorná et al.
Text
ETCO2
EtCO2 No ROSC
Arterial Line Anyone?
Hypothermia?
Cath Lab?
Future of Resuscitations?
Break for
Questions?
• Go Beyond ACLS
• Early High Quality CPR
• ETCO2 as marker
• Stay on the chest 80% of the time
• Minimize the Perishock Pause
• Go out and do Damn Good CPR!