Imprint Cpr .Ppt
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Transcript of 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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Physiologic Assessment of CPR
If Petco2 is
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Physiologic Assessment of CPR
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