Imprint Cpr .Ppt

7/31/2019 Imprint Cpr .Ppt

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The Science of ACLS/CPR

ImPRINT Module ACLSPresenter: T. Kyle Harrison MD


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Goals for module:

The goal of this module is toteach the physiology of ACLS.

All physicians should know thebasics of resuscitation, thislecture will prepare you tounderstand the physiology CPRas it applies to ACLS.


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Theories on how CPR Works

Cardiac

CompressionPump

Intrathoracic

PressurePump


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Myocardial flow is the primary determinant

of survival from cardiac arrest.

The amount of chest compressed is the

critical determinant of flow.

Rate of 80-100 compressions per minute

provide for compression duration of 50%

which is optimal for blood flow.


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Ideal CPR only produces 25-40%

of pre arrest cardiac output.

Cardiac output = HR x SV

BP = CO x SVR

HR- Compression rate

SVDepth of compressions/recoil of chest

SVRAugumented with vasocontrictors


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Relaxation pressure during CPR is the trough

of the pressure waveform during the

relaxation phase of chest compressions andis analogous to diastolic pressure when the

heart is beating.

Gradient between right atria and aortaduring the decompressive phase of CPR is

described as the coronary perfusion

pressure.


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As the pressure in the coronary artery drops

there is a point in which the vessel will

collapse- the pressure at which the vesselcollapses is referred to a the coronary closing

pressure.

No myocardial blood flows until a minimumcoronary perfusion pressure is achieved

(usually 30-40 mm Hg but decreased to 5-10

mm Hg during an arrest).


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Stopping compressions will cause

the pressure to fall to zero andonly after compression

resumption achieves an adequate

pressure in the coronary will flow

resume.


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ABC now CAB

Airway/Breathing/Chest

Compressions

is now

Chest

Compressions/Airway/Breathin

g


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High Quality CPR

Compressions at least 100 per minute

At least 2 inches (5cm)Allow complete recoil

Rotate every 2 minutes

Limit interruptions in CPR to less than 10 sec

Ventilation rate 8-10 breaths/min


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High Quality CPR

Rescuer fatigue may lead toinadequate compression rates ordepth.

Significant fatigue and shallowcompressions are common after 1minute of CPR, although rescuers maynot recognize that fatigue is present for5 minutes.


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High Quality CPR

Avoid Over ventilation!

Goal 8-10 but average is 30 breaths perminute.

Avoid long/large breaths- understand

negative effects of intrathoracicpressure on CPR quality.

TV 500-600 cc


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Clinical correlate:

65 year old male

undergoing PCI for acuteMI develops VF, first twoshocks fail to convert

patient


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Physiologic Assessment of CPR

End tidal CO2

Arterial monitoring


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End Tidal CO2

Monitoring Petco2 trends during CPR has

the potential to guide individual

optimization of compression depth and rateand to detect fatigue in the provider

performing compressions.

An abrupt sustained increase in Petco2

during CPR is an indicator of ROSC.


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Use End Tidal CO2 for

confirmation of successfulendotracheal intubation.


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If Petco2 is


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If the arterial relaxation

diastolic

pressure is


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Arterial Monitoring

Arterial pressure monitoring can

also be used to detect ROSC during

chest compressions or when a

rhythm check reveals an organized

rhythm.

Can use femoral, axilliary, or brachial

artery for arterial line monitoring.


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VasopressorsUse of vasopressors has

been associtated withimproved coronary and

cerebral blood flow withCPR.


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Epinephrine

Direct Alpha and Beta Sympathetic

activation.

Vasoconstriction including coronary

and cerebral vascularity.

Increased myocardial contractility

Increased myocardial work load


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Epinephrine

It is reasonable to consider

administering a 1 mg dose ofIV/IO epinephrine every 3 to 5

minutes during adult cardiac

arrest.


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Vasopressin

40 units IV x 1 (half life 20 minutes)

Potent vasoconstrictor

Shifts blood from the peripheral

circulation to the central circulation.

Increases cerebral and coronary

blood flow during CPR in animal

models.


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Vasopressin

1 dose of vasopressin 40

units IV/IO may replaceeither the first or second

dose of epinephrine in the

treatment of cardiac arrest.


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AHA ACLS Information

http://guidelines.ecc

.org


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Discussion topics

Reflect on the cardiac arrests that

you have been present for and

think about what made the codego well and what made it go

poorly.

In the discussion we will discusshow teamwork can improve

performance in ACLS

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