Cardio-pulmonary Cerebral Resuscitation

(CPR)

Prof. M. H. MumtazProf. M. H. Mumtaz

PHASES

IBasic Life

Support (BLS)(ABC)

IIIProlonged Life Support (PLS)

(GHI)

IIAdvanced Life Support (ALS)

(DEF)

B L S

Tilt Head.

Lift Neck.

Support Chin.

A. AIRWAY

If Unconscious ?

B L S

Lung Inflation.– Mouth to Mouth.– Mouth to Nose.– Mouth to Tube.– Bag-wash.

B. BREATHE

If not breathing ?If not breathing ?

C. CIRCULATE

One Operator

Two Operators

B L SB L S

Cause

Nervous System.

Myocardium.

Sympathetic

Parasympathetic

Phase TwoAdvanced Life Support

(Restoration of Spontaneous Circulation)

Adrenaline. Alkali. Fluids.

D. DRUGS & FLUIDS

E. EKG

VentricularFibrillation

Asystole

BizarreComplexe

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

ECFK+

Lungs KidneyH +

ICF

Correction Bicarbonate Therapy: (CO2 Producing) H-CO3 + H+ H2CO3 CO2 + H2O

Carbonate Therapy: (Non CO2 Producing)

– Routine Indications Base Deficit > 10 Meq/L PH < 7.20 HCO3 < 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 Arrest1500-1600 mls

Lungs = 370 mls.Tissues = 60 mls.Muscles = 240 mls.Blood = 800-1000 mls.

(Arterial = 280-300)Venous Capillary = 600-700

Critical Survival Time

A M O U N T R E Q U I R E D / M I NF O R M E T . = 2 5 0 m l s

C R I T I C A L S U R V I V A L T I M E

1 0 0 0 T O 1 5 0 0= = 4 - 6 m i n

2 5 0

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”

ICS

VesselISS

insideout

A New Concept

Small Volume Hyperosmolar Saline

Colloid Resuscitation

4 ml/kg - 7.2-7.5% NaCl/Colloid

interstitium interstitium

Shock Small-volume hyperosmolar resuscitation

endothelial cell

Flow Flowerythrocyted d

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.