Cardio-pulmonary Cerebral Resuscitation (CPR) Prof. M. H. Mumtaz.
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Transcript of Cardio-pulmonary Cerebral Resuscitation (CPR) Prof. M. H. Mumtaz.
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Cardio-pulmonary Cerebral Resuscitation
(CPR)
Prof. M. H. MumtazProf. M. H. Mumtaz
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PHASES
IBasic Life
Support (BLS)(ABC)
IIIProlonged Life Support (PLS)
(GHI)
IIAdvanced Life Support (ALS)
(DEF)
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B L S
Tilt Head.
Lift Neck.
Support Chin.
A. AIRWAY
If Unconscious ?
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B L S
Lung Inflation.– Mouth to Mouth.– Mouth to Nose.– Mouth to Tube.– Bag-wash.
B. BREATHE
If not breathing ?If not breathing ?
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C. CIRCULATE
One Operator
Two Operators
B L SB L S
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Cause
Nervous System.
Myocardium.
Sympathetic
Parasympathetic
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Phase TwoAdvanced Life Support
(Restoration of Spontaneous Circulation)
Adrenaline. Alkali. Fluids.
D. DRUGS & FLUIDS
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E. EKG
VentricularFibrillation
Asystole
BizarreComplexe
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F. FIBRILLATION TREATMENT
Ext Defibrillation.
Lignocain.
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Biochemical Changes
METABOLIC ACIDOSIS
Anaerobic Metabolism Myocardial Cont.
Actions of Catech.
Threshold for VF.
Restoration of N. Beat.
S. Vasodilatation.
Pul. Vasoconstriction.
Potassium.
Bicarbonate.
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Biochemical Changes
H-CO3 + H+ H2CO3 CO2 + H2O
ECFK+
Lungs KidneyH +
ICF
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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
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Correction Problems
– A. Alkalosis. - K+
- O2 Dissociation - Left Shift.
- Depression of Myocard.– B. Sodium Over Load.
Oxygenation Ventilation.
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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
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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
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Requirement
Drugs Atropine. Adrenaline. Calcium. Glucagon . Isoprenalin. Dopamine. Debutamine. Lignocaine.
Equipment Trained Doctor . Laryngoscope. Tube (ETT). Ambu Resuscitation. Defibrillator with Oscilloscope.
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Emergency-Fluid Resuscitation
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Primary volume therapy
“Fill from inside out”
ICS
VesselISS
insideout
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A New Concept
Small Volume Hyperosmolar Saline
Colloid Resuscitation
4 ml/kg - 7.2-7.5% NaCl/Colloid
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interstitium interstitium
Shock Small-volume hyperosmolar resuscitation
endothelial cell
Flow Flowerythrocyted d
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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.