New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR...
Transcript of New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR...
![Page 1: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/1.jpg)
3/4/2019
1
New Strategies in Resuscitation
Walt Lubbers, MD FAAEMUniversity of Cincinnati
No financial disclosures
1
2
![Page 2: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/2.jpg)
3/4/2019
2
3
4
![Page 3: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/3.jpg)
3/4/2019
3
New Strategies in Resuscitation
Walt Lubbers, MD FAAEMUniversity of Cincinnati
5
6
![Page 4: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/4.jpg)
3/4/2019
4
1.Fix your compressions
7
8
![Page 5: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/5.jpg)
3/4/2019
5
100-120 cpm
2.0-2.4”
Idris et al, Circulation. 2012;125:3004-3012.
1241241601608080 140140
9
10
![Page 6: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/6.jpg)
3/4/2019
6
Stiel et al. Circulation. 2014;130:1962-1970.
1.8”1.8”
2.4 in2.4 in2 in2 in
Push hard…kindaDon’t push that fast
Push CorrectlyDon’t Stop
Push HardPush Fast
11
12
![Page 7: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/7.jpg)
3/4/2019
7
ARE YOU DOING THAT?
13
14
![Page 8: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/8.jpg)
3/4/2019
8
15
16
![Page 9: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/9.jpg)
3/4/2019
9
RT
Compressions
IV/ MedsIV/
Meds
Lines
Airway
Leader
Other guySpectator
17
18
![Page 10: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/10.jpg)
3/4/2019
10
19
20
![Page 11: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/11.jpg)
3/4/2019
11
21
22
![Page 12: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/12.jpg)
3/4/2019
12
23
24
![Page 13: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/13.jpg)
3/4/2019
13
25
26
![Page 14: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/14.jpg)
3/4/2019
14
60 Seconds
27
28
![Page 15: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/15.jpg)
3/4/2019
15
Identify the need
Put the pieces together
Make a controlled stop
Fill in the gap
29
30
![Page 16: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/16.jpg)
3/4/2019
16
HIGH
PERFORMANCE
CPR
RateDepth
ReleaseVentilations
Pauses
31
32
![Page 17: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/17.jpg)
3/4/2019
17
Chest compressions:
a 2 person job
2. Your pulse check is too long
33
34
![Page 18: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/18.jpg)
3/4/2019
18
21 SECONDS
35
36
![Page 19: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/19.jpg)
3/4/2019
19
21 sec
11 sec
56 sec
37
38
![Page 20: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/20.jpg)
3/4/2019
20
Forget about 2 minutes
Don’t stop until you are ready
39
40
![Page 21: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/21.jpg)
3/4/2019
21
NOTIFICATION/ SAY “P ULSE CHECK”STOP CPR
STABILIZE COMPRESSOR
HANDS OFF PATIENT
LOOK AT MONITORANALYZE RHYTHM
COMMAND PULSE CHECK
RECOGNIZE RHYTHM
VERBALIZE RHYTHM
PULSE CHECK : FINGERS ON PATIENTMOVE FINGERS
FEEL PULSE
RECOGNIZE PULSEVERBALIZE PULSE
COMMAND SHOCK
DELIVER SHOCK
CHARGE DEFIBRILATORCLEAR PATIENT
PUSH BUTTON
SHOCK DELIVERED
FIRST COMPRESSOR MOVES
NEW COMPRESSOR MOVES INNEW COMPRESSOR HANDS ON
BEGIN COMPRESSIONS
41
42
![Page 22: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/22.jpg)
3/4/2019
22
NOTIFICATION/ SAY “PULSE CHECK”STOP CPR
STABILIZE COMPRESSOR
HANDS OFF PATIENT
LOOK AT MONITOR
ANALYZE RHYTHM
COMMAND PULSE CHECK
RECOGNIZE RHYTHM
VERBALIZE RHYTHM
PULSE CHECK: FINGERS ON PATIENT
MOVE FINGERS
FEEL PULSE
RECOGNIZE PULSE
VERBALIZE PULSE
COMMAND SHOCK
DELIVER SHOCK
CHARGE DEFIBRILATOR
CLEAR PATIENT
PUSH BUTTON
SHOCK DELIVERED
FIRST COMPRESSOR MOVES
NEW COMPRESSOR MOVES IN
NEW COMPRESSOR HANDS ON
BEGIN COMPRESSIONS
Precharge defibrillator
Have next compressor ready
Be looking at the monitor
Never just stop
43
44
![Page 23: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/23.jpg)
3/4/2019
23
3.You’re bagging to fast… or
maybe too slow
45
46
![Page 24: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/24.jpg)
3/4/2019
24
Continuous Interrupted
ROSC 24.2 25.3
Survival 9.0 9.7
Neuro intact 7.0 7.7SAME!
47
48
![Page 25: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/25.jpg)
3/4/2019
25
Continuous Interrupted
CCF 0.83 0.77
Pauses > 2 sec 3.8 7
Pre-shock pause 12 12
Post-shock pause 6 6
Intubated 48% 49%
SAME!
SAME!
SAME!
SAME!
REALLY LOW!
37 breaths/ minute
49
50
![Page 26: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/26.jpg)
3/4/2019
26
Synchronous Asynchronous Compressions
What is your survival?
51
52
![Page 27: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/27.jpg)
3/4/2019
27
What’s your Utstein survival?
MEASUREIMPROVEMEASURE
53
54
![Page 28: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/28.jpg)
3/4/2019
28
4.Data drives your improvements
55
56
![Page 29: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/29.jpg)
3/4/2019
29
Improve Family PresenceImprove ETCO2 use
57
58
![Page 30: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/30.jpg)
3/4/2019
30
59
60
![Page 31: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/31.jpg)
3/4/2019
31
+ / -Resus
61
62
![Page 32: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/32.jpg)
3/4/2019
32
1
0.9%
63
64
![Page 33: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/33.jpg)
3/4/2019
33
RateDepthRecoil
VentilationCCF
Peri-shock interval
+ / -Resus
65
66
![Page 34: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/34.jpg)
3/4/2019
34
Resus
67
68
![Page 35: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/35.jpg)
3/4/2019
35
The
ERire
The ER
ADminisgard Mt
Cardior
Minis
CVICU
Among patients resuscitated from VF/pVT OHCA
with ST-segment elevation on their
postresuscitation ECG, the prevalence of coronary
artery disease has been shown to be 70% to 85%.
More than 90% of these patients have had
successful percutaneous coronary intervention.
Conversely, among patients resuscitated from VF/pVT
OHCA without ST-segment elevation on their
postresuscitation ECG, the prevalence of coronary
artery disease has been shown to be 25% to 50%. For
these patients, early access to the cardiac
catheterization laboratory is associated with a 10%
to 15% absolute higher functionally favorable
69
70
![Page 36: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/36.jpg)
3/4/2019
36
5.A change in survival takes more
than a single department
DOUBLE YOUR UTSTEIN SURVIVAL
IN 5 YEARS
71
72
![Page 37: New Strategies in Resuscitation...STOP CPR STABILIZE COMPRESSOR HANDS OFF PATIENT LOOK AT MONITOR ANALYZE RHYTHM COMMAND PULSE CHECK RECOGNIZE RHYTHM VERBALIZE RHYTHM PULSE CHECK:](https://reader033.fdocuments.us/reader033/viewer/2022041616/5e3b9776cd7303041c2d5954/html5/thumbnails/37.jpg)
3/4/2019
37
73