Transcript Cardio-pulmonary Cerebral Resuscitation (CPR)

Cardio-pulmonary Cerebral
Resuscitation
(CPR)
Prof. M. H. Mumtaz
PHASES
I
Basic Life
Support (BLS)
III
Prolonged Life
Support (PLS)
(ABC)
(GHI)
II
Advanced Life
Support (ALS)
(DEF)
BLS
If Unconscious ?
A. AIRWAY

Tilt Head.

Lift Neck.

Support Chin.
BLS
If not breathing ?
B. BREATHE
 Lung
–
–
–
–
Inflation.
Mouth to Mouth.
Mouth to Nose.
Mouth to Tube.
Bag-wash.
BLS
C. CIRCULATE
One Operator
Two Operators
Cause
Sympathetic

Nervous System.
Parasympathetic

Myocardium.
Phase Two
Advanced Life Support
(Restoration of Spontaneous Circulation)
D. DRUGS & FLUIDS

Adrenaline.

Alkali.

Fluids.
E. EKG
Ventricular
Fibrillation
Asystole
Bizarre
Complexe
F. FIBRILLATION TREATMENT

Ext Defibrillation.

Lignocain.
Biochemical Changes
METABOLIC ACIDOSIS
Anaerobic Metabolism


Myocardial Cont.

Actions of Catech.

Threshold for VF.

Restoration of N. Beat.

S. Vasodilatation.

Pul. Vasoconstriction.

Potassium.

Bicarbonate.
Biochemical Changes
H-CO3 + H+
H2CO3
CO2 + H2O
ECF
K+
H+
ICF
Lungs Kidney
Correction
Bicarbonate Therapy:
(CO2 Producing)
H-CO3 + H+
H2CO3


CO2 + H2O
Carbonate Therapy:
(Non CO2 Producing)
– Routine Indications
 Base
Deficit
 PH
 HCO3
> 10 Meq/L
< 7.20
< 14 Mmol/L
Meq HCO3 = Base Deficit X wt. (kg) X .3
Correction

Problems
– A. Alkalosis.
- K+
- O2 Dissociation - Left Shift.
- Depression of Myocard.
– B. Sodium Over Load.

Oxygenation Ventilation.
Total Oxygen at Arrest
1500-1600 mls
Lungs
Tissues
Muscles
Blood
=
=
=
=
370 mls.
60 mls.
240 mls.
800-1000 mls.
(Arterial = 280-300)
Venous Capillary = 600-700
Critical Survival Time
AMOUNT REQUIRED/MIN
FOR MET. = 250 mls
CRITICAL SURVIVAL TIME
1000 T O 1500
=
= 4 -6 m in
250
Requirement
Drugs
 Atropine.
 Adrenaline.
 Calcium.
 Glucagon.
 Isoprenalin.
 Dopamine.
 Debutamine.
 Lignocaine.
Equipment
 Trained Doctor .
 Laryngoscope.
 Tube (ETT).
 Ambu Resuscitation.
 Defibrillator with
Oscilloscope.
Emergency-Fluid
Resuscitation
Primary volume therapy
“Fill from inside out”
Vessel
ISS
ICS
out
inside
A New Concept
Small Volume Hyperosmolar Saline
Colloid Resuscitation
4 ml/kg - 7.2-7.5% NaCl/Colloid
Shock
Small-volume hyperosmolar resuscitation
endothelial cell
d
erythrocyte
interstitium
Flow
Flow
d
interstitium
Physiological & Basic
Mechanisms



Plasma osmolality= 285-295 mosmol/kg.
7.2% NaCl = 2400 mosmol/kg.
End bolus infusion = 460 mosmol/kg.
(4 ml/kg).
– Ttransmembrane osmotic gradient.


– Endogenous fluid mobilization.
(most pronounced in capillary districts)


– Plasma volume.
–  Hydraulic resistance.
– Tissue perfusion.