Cardiopulmonary Resuscitation CPR

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Cardiopulmonary Resuscitation (CPR)
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Who Needs Resuscitation?

• Collapsed patient in shock due to
• Hypovolemia
• Cardiogenic reasons
• Anaphylaxis
• Sepsis
• After cardiac arrest

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Objectives of Resuscitation

• Establish blood circulation in the tissues
• Establish normal functioning of myocardium
• Establish normal functioning of respiratory
  system and of gas exchange
• Correct malfunctioning of different system

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Objectives of Resuscitation

• Correct acid-base status and electrolyte status
• Correct glycemic status
• Provide support to different system if needed
• Ensure tissue perfusion and urine output
• Abolish hypoxia and hypercarbia

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Resuscitation in Obstetrics
Aortocaval compression due to pregnant uterus
makes resuscitation (CPR) less effective

• Pregnancy
• Less than 25 weeks Routine or normal
  resuscitation protocol
• 2532 weeks
• Use wedge
• CPR
• Immediate cesarean section

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Resuscitation Procedure for Hypovolemic Shock

• Oxygen by mask
• Establish IV line 1618 gauge cannula
• Place patient in supine position with head down
  initially or leg raised
• Replace volume as required by proper fluids
• Crystalloids
• Colloids
• Whole blood
• Blood component

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Resuscitation Procedure for Hypovolemic Shock
(contd)

• Monitor
• Cardiovascular system Pulse, blood pressure,
  central venous pressure
• Central nervous system Responding to command
• Urine output
• Respiration rate
• General condition

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Resuscitation Procedure for Hypovolemic Shock
(contd)

• Provide support
• Cardiovascular system if needed
• Respiratory system if needed
• Renal system by dopamine

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Resuscitation Procedure for Cardiogenic Shock

• Oxygen by mask
• Supine position
• Pulse, blood pressure and electrocardiogram
  monitoring
• Cardiovascular system support by medicines
• Coronary dilators
• Anti-arrhythmic drugs
• Thrombolytic drugs

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Resuscitation Procedure for Cardiogenic Shock
(contd)

• Respiration support if needed
• Renal support
• Correct restrictive volume IV fluids
• Analgesics
• Sedatives

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Resuscitation Procedure for Anaphylactic Shock

• Adrenaline
• Oxygen by mask
• Steroids
• IV fluid Appropriate selection

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Resuscitation Procedure for Anaphylactic Shock
(contd)

• Supine position Head-down tilt
• Cardiogenic drugs/support
• Sedative if required
• Renal protection
• Respiratory support

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Resuscitation Procedure for Sepsis

• Oxygen by mask
• Establish IV line 1618 gauge cannula
• Place patient in supine position with head down
  initially or leg raised
• Replace volume as required by proper fluids
• Crystalloids
• Colloids
• Whole blood
• Blood component

14
Resuscitation Procedure for Sepsis (contd)

• Monitor
• Cardiovascular system Pulse, blood pressure,
  central venous pressure
• Central nervous system Responding to command
• Urine output
• Respiration rate
• General condition

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Resuscitation Procedure for Sepsis (contd)

• Provide support
• Cardiovascular system if needed
• Respiratory system if needed
• Renal system by dopamine
• Antibiotics

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ResuscitationCardiac Arrest

• Diagnosis of cardiac arrest
• No central or peripheral pulse
• Absence of heart sounds
• Dilated pupils
• Respiratory arrest
• Absence of bleeding
• General appearance Pallor, cyanosis, no signs of
  circulation

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ResuscitationBasic Life Support

• Given when special equipment is not available
• Consists of
• Supine position
• Airway control by head-chin lift
• Clearance of airway and mouth-to-mouth ventilation

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ResuscitationBasic Life Support

• Chest compression after initial thump
• Compression/ventilation ratio of 152 for
  non-intubated patients
• Compression/ventilation ratio of 51 for patients
  with endotracheal intubation
• Rate of compression should be 80100/minute
• HELP SHOULD BE SOUGHT as soon as possible

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ResuscitationAdvanced Life Support

• Given with the use of special equipment and drugs
• Consists of
• Airway control by endotracheal tube/laryngeal
  mask airway
• Use of drugs to stimulate heart and support of
  systems
• Use of defibrillator to resume normal heart beat