Adult Cpr Copy 2
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Transcript of Adult Cpr Copy 2
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ADULT CPRADULT CPR
dr. Alfan Mahdi Nugroho, SpAnDept Anestesiologi & Intensive Care
RSCM - FKUI
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How the guidelines put together ?
ILCOR
AHA ERC
International Liaison Committee On Resuscitation
HSFC RCA ANZCORRCSA IAHF
ILCOR worksheethttp://www.ilcor.org/en/consensus-2010/worksheets-2010/
AHA guidelines ERC guidelineshttps://www.erc.edu/index.php/doclibrary/en/209/1/http://circ.ahajournals.org/content/vol122/18_suppl_3/
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The ChangesAHA 2005
AHA 2010
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ERC 2010
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CaveatsAHA 2010
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ADULT BLS
•IMMEDIATE RECOGNITION•ACTIVATE RESPONSE•CPR•EARLY DEFIBRILLATION
AHA 2010
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AHA 2010
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•Check pulse (10s)
• breath 8 - 10 X, recheck pulse
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ERC 2010
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BLS KEY CHANGES AND point of
emphasis•No responsiveness and absence of
normal breathing. ~ immediate recog.•LOOK LISTEN and FEEL •CAB from ABC•Chest compression quality•de-emphasis pulse check•building blocks...
AHA 2010
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BLS KEY CHANGES AND point of emphasis
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High Quality Compression
•adequate rate (100 X /menit)•adequate depth (5 cm adult and children,
4 cm infants or 1/3 ap diameter)•allow recoil•minimize interruption (exc adv airway &
defib)
•avoid excessive ventilation•rotation (2 minutes or 5 cycles)
AHA 2010
~ provide 25-33% normal CO
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CAB vs ABC
•No evidence showed improved outcomes
•Flow depends on compressions•Shorter delay, cut interruption
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CAB vs ABC
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CAB vs HANDS ONLY CPR
AHA 2010
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Building blocks of CPR AHA 2010
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Remember the blocks
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Airway•Mouth to mouth or mouth to mask•bag mask ventilation (trained, lone
rescuer not recommended)
•endotracheal tube (trained and freq only, interruption should < 10 sec)
•esophageal tracheal tube, laryngeal tube, laryngeal mask ~ alternatives
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Breathing•30:2 visible chest raise (6-7
kg/BW) over 1 sec•>40% FiO2 for HCP•10-12 times/minute or every 5-6
seconds•Non synchronous if intubated
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ALS KEY CHANGES AND point of
emphasis•Continuous quantitative waveform
capnography•Emphasizing chest compressions•Atropine•Emphasis on physiologic monitoring•Adenosine recommended for regular
monomorphic wide-complex tachycardia
AHA 2010
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ALS KEY CHANGES AND point of
emphasis
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AHA 2010
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AHA 2010
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ERC 2010
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Post Cardiac Arrest Care AHA 2010
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post cardiac arrest care
•Therapeutic hypothermia for comatose, unresponsive pts
•32-34oC for 12-24 hours•Monitor continuously core
temperature •Passive rewarming
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OUTCOME
•ROSC•SURVIVAL•HOSPITAL DISCHARGE•+ DISABILITY?
Circulation. 2006;114:2760 –2765.
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Caveats•Early CPR and rapid defibrilation
significantly increase chance for survival to hospital discharge
•ACLS tx ~ some meds and advanced airways increase rate of ROSC but have not been shown to increase rate survival and hospital discharge
Circulation 2006;114;2839-2849
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Caveats
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Peds
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TERIMA KASIH