3. kpcr odraslih dr aleksandar pavkovic
-
Upload
lksedukacija -
Category
Health & Medicine
-
view
3.914 -
download
11
Transcript of 3. kpcr odraslih dr aleksandar pavkovic
![Page 1: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/1.jpg)
![Page 2: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/2.jpg)
ILCOR - International Liaison Committee on Resuscitation) 1.Američko udruženje kardiologa (AHA-American Heart Association)
2. Evropski Savet za reanimaciju (ERC–European Resuscitation Council)
3. Kanadska fondacija za srčane bolesti i inzult (HSFC-Heart and Stroke Foundation of Canada)
4. Australijska i novozelandska komisija za reanimatologiju
(ANZCOR - Australian and New Zeland Committee on Resuscitation)
5. Udruženje za reanimatologiju Južne Afrike (RSCA – Resuscitation Council of Southern Africa)
6. Međuamerička fondacija za srčane bolesti (IAHF - Inter American Heart Foundation)
7. Udruženje za reanimatologiju Azije (RCA - Resuscitation Council of Asia)
1993
![Page 3: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/3.jpg)
![Page 4: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/4.jpg)
• Nagao i neocekivani prestanak cirkulacije krvi, izazvan funkcionalnim prestankom rada srca
• Prekid mehanicke aktivnosti srca –zastoj cirkulacije krvi
• Nagla nesposobnost srca da pumpa dovoljno krvi da bi se mozak odrzao u zivotu
Definicija akutnog zastoja srca –cardiac arrest-a
![Page 5: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/5.jpg)
![Page 6: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/6.jpg)
5H 5T Hipoksija Tromboza-koronarna
Hipovolemija Tromboembolija pluca
Hipotermija Tenzioni pneumotoraks
Hidrogen jon-acidoza Tamponada srca
Hiper/hipokalemija Trovanja/predoziranje lekovima
Etiologija cardiac arrest - a
![Page 7: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/7.jpg)
“Arrest vreme” - period od momenta nastanka cardiac arrest-a
do momenta zapocinjanja KPCR
![Page 8: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/8.jpg)
Provera disanja i palpiranje pulsa
Sigurni znaci akutnog zastoja srca:
1. GUBITAK SVESTI
2. PRESTANAK DISANJA
3. GUBITAK PULSA NAD VELIKIM KRVNIM SUDOVIMA
4. PROMENA BOJE KOZE I VIDLJIVIH SLUZOKOZA
![Page 9: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/9.jpg)
![Page 10: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/10.jpg)
EKG nije pokazatelj mehanicke vec elektricne aktivnosti
srcanog misica
![Page 11: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/11.jpg)
“Jelisije udje u kucu i nadje decaka gde mrtav lezi na postelji.
Usavsi, zatvori vrata za sobom i pomoli se.
Zatim se pope na postelju, leze na decaka,
polozi svoja usta na njegova usta,
svoje oci na njegove oci, svoje ruke na njegove ruke
disao je nad njim,
Te se ugrejalo telo decakovo”
![Page 12: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/12.jpg)
![Page 13: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/13.jpg)
Silvester1858
Holger-Nielsen 1932
![Page 14: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/14.jpg)
Peter Safar
1924-2003
![Page 15: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/15.jpg)
1. Rano prepoznavanje i pozivanje hitne pomoci
2. Rano izvodjenje osnovnog odrzavanja zivota
3. Rana defibrilacija
4. Rano produzeno odrzavanje zivota
“Lanac prezivljavanja”
AHA 1992
112
94
![Page 16: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/16.jpg)
Abc-dni redosled u izvodjenju KPCR
Faza I. OSNOVNO ODRZAVANJE ZIVOTA
A. (airway) OBEZBEDJENJE PROLAZNOSTI DISAJNOG PUTA
B. (breathing) OBEZBEDJENJE VESTACKOG DISANJA
C. (circulation) USPOSTAVLJANJE CIRKULACIJE
Faza II. UZNAPREDOVALO ODRZAVANJE ZIVOTA
D. (drugs and fluids) PRIMENA LEKOVA I INFUZIJA
E. (electrocardiografia) EKG DIJAGNOZA I TRETMAN
F. (fibrillation) TRETMAN FIBRILACIJE – DEFIBRILACIJOM
Faza III. PRODUZENO ODRZAVANJE ZIVOTA
G. (gauge) UTVRDJIVANJE UZROKA ZASTOJA SRCA I
NJEGOVO OTKLANJANJE
H. (high mental activity) OCUVANJE VISE MENTALNE AKTIVNOSTI
I. (intensive care) INTENZIVNO LECENJE
![Page 17: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/17.jpg)
![Page 18: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/18.jpg)
PODIZANJE BRADE UZ
ISTOVREMENI PRITISAK
NA CELO
ZABACIVANJE GLAVE
OTVARANJE USTA
POVLACENJE DONJE VILICE PREMA NAPRED
TROSTRUKI MANEVAR PO SAFARU
• ZABACIVANJE GLAVE UNAZAD –
DEFLEKSIJA GLAVE
![Page 19: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/19.jpg)
![Page 20: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/20.jpg)
Pomocna sredstva u odrzavanju disajnog puta
![Page 21: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/21.jpg)
![Page 22: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/22.jpg)
POLOZAJ RUKU ZA IZVODJENJE SPOLJNE KOMPRESIJE TORAKSA
![Page 23: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/23.jpg)
MEHANIZMI KRETANJA KRVI U TOKU SPOLJNE
KOMPRESIJE GRUDNOG KOSA
FAZA
KOMPRESIJE:
ZATVARAJU SE AV
ZALISCI I KRV SE
IZBACUJE U
PLUCA I AORTU
FAZA RELAKSACIJE:
MITRALNA I
TRIKUSPIDALNA
VALVULA
SE OTVARAJU
I OBEZBEDJUJU
DA KRV ISPUNI
KOMORE.
AORTNA VALVULA
SE ZATVARA I
OMOGUCAVA
PERFUZIJU
KORONARNIH ARTERIJA MEHANIZAM “SRCANE PUMPE” Kouwenhoven i sar. 1960
![Page 24: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/24.jpg)
MEHANIZMI KRETANJA KRVI U TOKU SPOLJNE
KOMPRESIJE GRUDNOG KOSA
FAZA KOMPRESIJE:
PULMONALNA VALVULA JE ZATVORENA, DOK SU MITRALNA I AORTNA
VALVULA OTVORENE. LEVA STRANA SRCA – PASIVNA CEV
MV 10 – 33 %
OD NORMALNOG
Psist. 60-80 mmHg
MAP 10-40 mmHg
MEHANIZAM “TORAKALNE PUMPE” Criley i sar. 1976.
PERFUZIJA ORGANA
ZA VREME KPCR
![Page 25: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/25.jpg)
ALTERNATIVNE METODE ARTEFICIJALNE
CIRKULACIJE
INTERPONIRANA ABDOMINALNA KOMPRESIJA - IAC
![Page 26: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/26.jpg)
C. ALTERNATIVNE METODE ARTEFICIJALNE
CIRKULACIJE
“CARDIO PUMP”
APARAT
AKTIVNA KOMPRESIJA – DEKOMPRESIJA ACD
![Page 27: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/27.jpg)
ALTERNATIVNE METODE ARTEFICIJALNE
CIRKULACIJE
PNEUMATSKE ANTISOK
“MAST” PANTALONE
AutoPulse
Aparat za mehanicku
kompresiju grudnog kosa
![Page 28: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/28.jpg)
INVAZIVNE TEHNIKE
ARTEFICIJALNE CIRKULACIJE
- Cardiac arrest u vezi sa nekontrolisanim
krvarenjem
- Cardiac arrest u toku intratorakalne
intervencije
- Tamponada srca
-Cardiac arrest u vezi sa velikim
medijastinalnim pomeranjem
- Masivna vazdusna embolija
- Masivna plucna embolija
- Srcani zastoj u vezi sa iskrvarenjem
ispod nivoa dijafragme (npr.rupturirana
aneurizma abdominalne aorte)
- Refaktorna ventrikularna fibrilacija u
stanju hipotermicnog cardiac arrest-a, kada
se perikardnom lavazom sa toplim rastvorima
zagreva srce do temperature pogodne za
defibrilaciju.
![Page 29: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/29.jpg)
B. BREATHING OBEZBEDJENJE VESTACKOG DISANJA –
METODA “POZAJMLJENOG DAHA”
![Page 30: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/30.jpg)
1. Skracivanje vremena za spoljnu kompresiju toraksa
2. Poremecaj ventilaciono perfuzionog odnosa
3. Povecanje intratorakalnog pritiska
- Smanjen venski povratak u srce i CO
- Smanjena perfuzija koronarnih arterija
4. Zeludacna distenzija (regurgitacija, plucna aspiracija)
5. Nastanak respiratorne alkaloze
- pomeranje krivulje disocijacije oksihemoglobina ulevo
6. Cerebralna vazokonstrikcija (ishemija)
7. Razvoj hiperventilacionog sindroma spasioca
(kod metode pozajmljenog daha)
![Page 31: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/31.jpg)
1. Skracivanje vremena za spoljnu kompresiju toraksa
![Page 32: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/32.jpg)
![Page 33: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/33.jpg)
2. Poremecaj ventilaciono - perfuzionog odnosa
![Page 34: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/34.jpg)
3. Povecanje intratorakalnog pritiska
- Smanjen venski povratak u srce i CO
- Smanjena perfuzija koronarnih arterija
![Page 35: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/35.jpg)
regurgitacija
aspiracija u pluca
podizanje dijafragme
smanjena
pokretljivost
plucnih krila
smanjenje
respiratorne komplijanse
povecanje
intragastricnog pritiska
povecanje
inspiratornog pritiska
popustanje donjeg
ezofagealnog sfinktera
![Page 36: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/36.jpg)
5. Nastanak respiratorne alkaloze - pomeranje krivulje disocijacije oksihemoglobina ulevo
![Page 37: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/37.jpg)
6. Cerebralna vazokonstrikcija
![Page 38: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/38.jpg)
![Page 39: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/39.jpg)
“At a cardiac arrest the first procedure is to take your own pulse”
Rule 3 from The House of God by Samuel Shem
![Page 40: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/40.jpg)
![Page 41: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/41.jpg)
IZVODJENJE KPCR OD STRANE JEDNE OSOBE
![Page 42: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/42.jpg)
IZVODJENJE KPCR U PRISUSTVU DVA REANIMATORA
![Page 43: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/43.jpg)
“Spoljasnja masaza srca obezbedjuje izvesnu ventilaciju pluca
i u slucaju da je prisutna samo jedna osoba na mestu nesrece,
paznju treba usmeriti na kompresiju grudnog kosa….”
Kouwenhoven, Jude i Knickbocker
![Page 44: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/44.jpg)
-Odrzava prohodan disajni put
-Poboljsava razmenu gasova za vreme cardiac arresta i KPR
-Poboljsava venski povratak u srce, CO i koronarnu perfuziju
-Poboljsava cerebralni perfuzioni pritisak
![Page 45: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/45.jpg)
PREDNOSTI:
- Sprecavanje aspiracije zeludacnog sadrzaja ili krvi iz orofarinksa
- Isporuka adekvatnog tidal volumena
bez prekida u spoljnoj kompresiji grudnog kosa
- Slobodne ruke spasioca
- Traheobronhijalna aspiracija
- Endotrahealno davanje lekova
NEDOSTACI:
-Zahteva vestinu i iskustvo
-Neuspesna intubacija (50% u vanhospitalnim uslovima)
-Pogresna intubacija ( 6-14% u vanhospitalnim uslovima)
- Prekid u spoljnoj kompresiji grudnog kosa
![Page 46: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/46.jpg)
![Page 47: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/47.jpg)
A. Alternativni načini obezbeđenja disajnog puta
Laringealni tubus
![Page 48: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/48.jpg)
![Page 49: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/49.jpg)
I – gel laringealna maska - Termoplasticni elastomer nalik na gel
- Bez naduvavanja kafa
- Postavlja se za manje od 5 s
![Page 50: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/50.jpg)
-preko igle (translaringealna “jet” ventilacija)
- hirurska
![Page 51: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/51.jpg)
![Page 52: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/52.jpg)
![Page 53: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/53.jpg)
1. rezim ventilacije - CMV
2. FiO2- 1
3. f - 10/min
4. TV - 6-7 ml/kg tt
5. Pinsp. 20 - 25 cmH20
-PREDNOSTI:
-Slobodne ruke spasioca
- Konstantan inspiratorni protok i inspiratorno vreme
- Pritiskom cikliran (barotrauma, zeludacna distenzija)
![Page 54: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/54.jpg)
•U toku ET intubacije
•Kod ventilacije usta na masku
•Kod ventilacije sa maskom i AMBU balonom
•Kod ventilacije sa LMA
![Page 55: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/55.jpg)
![Page 56: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/56.jpg)
VAZOPRESORI
ADRENALIN a b
• doze:
• “standardne ” 1 mg na svakih 3 – 5 min.
• “srednje” 2 – 5 mg na svakih 3 – 5 min.
• “rastuce” 1 – 3- 5 mg na svakih 3 – 5 min.
• “visoke” 0.1 mg / kg/tt na svakih 3 – 5 min.
• VAZOPRESIN (ADH) V1 40 IJ
![Page 57: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/57.jpg)
• produzava trajanje akcionog potencijala
• usporava repolarizaciju
• najsnazniji inhibitor abnormalnog srcanog automatizma • tromboflebitis !
• perif. vazodilatacija
• doze: 300 mg ( u 20 ml 5% glukoze)
• + 150 mg
• kontinuirana inf. 900 mg /24h
150 m
g
AMIODARONE C
OR
DA
RO
NE
![Page 58: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/58.jpg)
• smanjuje podrazljivost miokarda
• prolongira refraktorni period
• podize prag osetljivosti za nastanak VF
• doze: bolus : 1 -1.5 mg/kg tt na 5-10 min do max 3
mg/kg tt u prvom satu; nastaviti sa kont. infuzijom 2-
4/mg/min
![Page 59: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/59.jpg)
![Page 60: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/60.jpg)
• klasican parasimpatikolitik
• smanjuje tonus n. vagus-a
• olaksava AV sprovodjenje
• ubrzava srcanu radnju u slucajevima sinusne
bradikardije
• Indikacije:
asistolija i PEA refraktorne na A i O2
sinusna, atrijalna i nodalna bradikardija pracene
hemodinamskom nestabilnoscu
![Page 61: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/61.jpg)
- Odgovaran za celijske mehanizme miokardne kontrakcije
- HIPERKALIJEMIJA
- IZRAZITE HIPOKALCEMIJA
- POSLE MASIVNIH TRANSFUZIJA
- KOD PREDOZIRANJA BLOKATORIMA
KALCIJUMSKOG KANALA
- hloridne soli Ca++
- ne sa bikarbonatima na istu venu
![Page 62: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/62.jpg)
![Page 63: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/63.jpg)
8.4% NaHCO3
Nezeljeni efekti ranog
davanja bikarbonata: • nastanak ekstracelularne alkaloze
. Bikarbonati dovode do stvaranja CO2 koji brzo ulazi u celije i dovodi do “paradoksne” intracelularne acidoze
• nastanak hipernatremije i potencijalno fatalnog osmolariteta
• inaktivacija datih lekova, posebno adrenalina
• pomeranje krivulje disocijacije oksihemoglobina u levo –otezano oslobadjanje kiseonika tkivima
![Page 64: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/64.jpg)
8.4% NaHCO3
prva doza 50mmol
![Page 65: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/65.jpg)
Posle bolus injekcije treba pustiti 20 -30 ml
infuzionog rastvora radi brzeg dospevanja
leka u centralnu cirkulaciju
![Page 66: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/66.jpg)
PUTEVI PRIMENE LEKOVA U KPCR
- PREKO PERIFERNE VENE -PREKO CENTRALNOG
VENSKOG KATETERA
![Page 67: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/67.jpg)
INTRAMUSKULARNI SUBKUTANI
ORALNI , REKTALNI
INTRAOSEALNO DAVANJE LEKOVA
![Page 68: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/68.jpg)
ENDOTRAHEALNO DAVANJE LEKOVA U
KPCR
-ONDA KADA JE POTREBNO URGENTNO DAVANJE LEKOVA
-A INTRAVASKULARNI PUT JE TESKO ILI NEMOGUCE OBEZBEDITI:
3-10 x veca doza od standardne i.v.
Rastvarac: destilovana voda
![Page 69: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/69.jpg)
INTRAKARDIJALNO DAVANJE LEKOVA U
KPCR
KRVARENJA U PERIKARDU, TAMPONADA SRCA
HEMATO I PNEUMOTORAKS
DIREKTNO NADRAZIVANJE MIOKARDA IGLOM
LACERACIJA KORONARNIH SUDOVA
UBRIZGAVANJE LEKA DIREKTNO U SRCANI MISIC
PREKID MASAZE SRCA
intramuskularni
subkutani
oralni
rektalni
![Page 70: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/70.jpg)
VF je najcesci, terapijski najizazovniji I potencijalno izleciv oblik zastoja srca.
![Page 71: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/71.jpg)
ELEKTRICNA
AKTIVNOST BEZ
PULSA - PEA
![Page 72: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/72.jpg)
U prvih 10 s cardiac arrest-a
Po novim preporukama za KPCR 2010. god.
Izvodjenje prekordijalnog udarca je izgubilo na znacaju
![Page 73: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/73.jpg)
Kod VF/VT koje nastaju za vreme srčane kateterizacije,
Kod pacijenata u ranom postoperativnom periodu posle kardiohiruških operacija,
Kod pacijenata kod kojih su već postavljene samolepljive elektrode
5 s
![Page 74: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/74.jpg)
![Page 75: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/75.jpg)
• Pravilna pozicija elektroda
• Koriscenje elektrodnog gela
• Velicina lopatica 8- 12 cm kod
odraslih
• Pritisak elektroda 8 kg
• Defibrilacija na kraju ekspirijuma
• Izrazena maljavost g.k. – brijanje
• Ponavljanje defibrilacije
![Page 76: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/76.jpg)
![Page 77: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/77.jpg)
![Page 78: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/78.jpg)
• Kod odraslih i dece starije od godinu
dana
• Aksilarna samolepljiva elektroda
se postavlja vertikalno
• Strategija neprekinute KPR (30:2)
Nastavlja se i tokom postavljanja
elektroda
• Strategija jednog soka:
360 J monofazni
150 – 360 J bifazni
![Page 79: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/79.jpg)
MONITORING EFIKASNOSTI IZVODJENJA KPCR
KAPNOGRAFSKA KRIVULJA
ETCO2
PALPACIJA PULSA
PRACENJE VELICINE
ZENICA
BOJA KOZE I VIDLJIVIH
SLUZOKOZA
EKG
DIREKTNO MERENJE
KRVNOG PRITISKA
PULSNA OKSIMETRIJA
KAPNOGRAFIJA
EKSPIRIJUM INSPIRIJUM EKSPIRIJUM INSPIRIJUM
5-5.5% 35-40mmHg
UZ dijagostika
![Page 80: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/80.jpg)
![Page 81: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/81.jpg)
![Page 82: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/82.jpg)
![Page 83: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/83.jpg)
![Page 84: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/84.jpg)
![Page 85: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/85.jpg)
Tretman postishemično – anoksičnog
oštećenja mozga
indukovana
hipertenzija
hemodilucija
heparin
“čistači slobodnih O2
radikala
antagonisti Ca++
kortikosteroidi
KONTROLISANA
HIPOTERMIJA
barbiturati ?
![Page 86: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/86.jpg)
•450. god p.n.e. Hipokrat
•1803. god „‟ruska metoda”
•1814. god Baron Larrey, lekar Napoleonove vojske
•1984. god Safar I Bellamy - Koncept “prividne smrti za zakasnelu reanimaciju”
2002. god. ILCOR 2004. februar HACA protokol – objavljen na Iniverzitetu u Cikagu,
2005. novembar ERC preporuke
•Evropa: (275 odrasla pacijenta)
The Hypothermia after Cardiac Arrest Study Group (HACA).Mild therapeutic hypothermia to improve
the neurologic outcome after cardiac arrest. N. Engl. J. Med. 2002;346:549-56
•Australija (u cetiri bolnice u Melburnu 49% versus 29%)
Bernard SA, Gray TW, Buist MD et al. Treatment of comatose survivors of out-of-hospital cardiac
arreswit induced hypothermia. N. Engl J Med 2002; 346:557-63
Srbija IKVB Sremska Kamenica (12 pacijenata):
Srdanovic I, Petrovic M, Canji G et al. The first cohort of therapeutic hypotermia after cardiac
arrest. Resuscitation, 2006; 69 (1):115
![Page 87: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/87.jpg)
Terapijska kontrolisana umerena hipotermija
Neuroprotektivan efekat blage hipotermije
Redukcija cerebralnog metabolizma – 7%/ºC
(smanjena potrošnja O2 i glukoze)
Cerebralna vazokonstrikcija
(smanjuje ICP, vaskularnu permeabilnost i edem)
Prevencija nastanka apoptoze i neuralnog oštećenja
Smanjeno stvaranje slobodnih O2 radikala
Poboljšanje jonske homeostaze i blokada destruktivne
ishemijske biohemijske kaskade (akumulacija glutamata,
receptorske aktivacije i intracelularnog nagomilavanja Ca)
Supresija inflamatorne kaskade sa smanjenjem leukocitne infiltracije
proinflamatornih produkata i bioaktivnih supstancija
![Page 88: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/88.jpg)
•Paketi leda na femoralni predeo
•Vodom punjeni pokrivaci i podloge
•Forsirani hladan vazduh 0.3 ºC/h
•Ledeni infuzioni rastvori
•Endovaskularno hladjenje
![Page 89: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/89.jpg)
•Kardiovaskularna nestabilnost
•Pneumonije
•Veca ucestalost infekcije
•Smanjen motilitet GIT-a
•Smanjen metabolizam jetre
•Poremecaj bubrezne funkcije
•Metabolicka acidoza
•Elektrolitni poremecaji
(hipofosfatemije, hipomagnezemija)
•Poremecaj koagulacije, trombocitopenija,
leukopenija
•Hiperglikemija
![Page 90: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/90.jpg)
![Page 91: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/91.jpg)
![Page 92: 3. kpcr odraslih dr aleksandar pavkovic](https://reader030.fdocuments.us/reader030/viewer/2022012306/5560c163d8b42af43b8b546f/html5/thumbnails/92.jpg)
TRUDNOCA
Udar struje I groma
Utapanje
Bronhijalna astma Anafilakticki sok
Trauma Elektrolitni poremecaji Trovanja