Cardiopulmonary Resuscitation: History, Techniques, Causes, Diagnosis, and Operations, Slides of Public Health

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CARDIOPULMONARY

RESUSCITATION

HISTORICAL REVIEW

 5000 - first artificial mouth to mouth 3000 BC ventilation  1780 – first attempt of newborn resuscitation by blowing  1874 – first experimental direct cardiac massage  1901 – first successful direct cardiac massage in man  1946 – first experimental indirect cardiac massage and defibrillation  1960 – indirect cardiac massage  1980 – development of cardiopulmonary resuscitation due to the works of Peter Safar

Causes of circulation arrest Cardiac

• Ischemic heart disease (myocardial infarction, stenocardia)
• Arrhythmias of different origin and character
• Electrolytic disorders
• Valvular disease
• Cardiac tamponade
• Pulmonary artery thromboembolism
• Ruptured aneurysm of aorta Extracardiac - airway obstruction - acute respiratory failure - shock - reflector cardiac arrest - embolisms of different origin - drug overdose - electrocution - poisoning

Diagnosis of cardiac arrest

Symptoms of cardiac arrest

 absence of pulse on carotid arteries – a pathognomonic symptom  respiration arrest – may be in 30 seconds after cardiac arrest  enlargement of pupils – may be in 90 seconds after cardiac arrest Blood pressure measurement  Taking the pulse on peripheral arteries  Auscultation of cardiac tones Loss of time !!!

In case of unconsciousness it is necessary to estimate quickly  the open airway  respiration  hemodynamics

Main stages of resuscitation

A (Airway) – ensure open airway by preventing

the falling back of tongue, tracheal

intubation if possible

B (Breathing) – start artificial ventilation of

lungs

C (Circulation) – restore the circulation by

external cardiac massage

D (Differentiation, Drugs, Defibrilation) –

quickly perform differential diagnosis of

cardiac arrest, use different medication and

electric defibrillation in case of ventricular

fibrillation

Open the airway using a head

tilt lifting of chin. Do not tilt the

head too far back

Check the pulse on

carotid artery using

fingers of the other hand

B (Breathing)

Tilt the head back

and listen for. If

not breathing

normally, pinch

nose and cover

the mouth with

yours and blow

until you see the

chest rise.

C. Circulation Restore the circulation, that is start external cardiac massage

2 mechanisms explaining the restoration of circulation by external cardiac massage

Cardiac

pump

Thoracic

pump

Thoracic pump at the cardiac massage Blood circulation is restored due to the change in intra thoracic pressure and jugular and subclavian vein valves During the chest compression blood is directed from the pulmonary circulation to the systemic circulation. Cardiac valves function as in normal cardiac cycle.

ALGORITHM of Cardiopulmonary resuscitation

4 cycles: 15 compression and 2 breaths 10 cycles: 5 compression and 1 breath check the pulse on carotid arteries (5 sec) in case of absence of pulse continue resuscitation 2 breaths (duration 1 – 1.5 sec.) palpation of pulse on carotid arteries (5 – 10 sec.) in case of absence of pulse initiate external cardiac massage 1 person compression rate 80 – 100/min. compression/breath = 15 : 2 compression rate 80 – 100/min compression/breath = 5 : 1 2 breaths in 4 – 7 sec. (^) breath during 1 – 1.5 sec. after each 5 th compression 2 persons a a a

Possible arrhythmias after cardiac defibrillation ventricular tachycardia bradyarrythmia including electromechanical dissociation and asystole supraventricular arrhythmia accompanied with tachycardia supraventricular arrhythmia with normal blood pressure and pulse rate

Operations in case of asystole

Asystole

• Start CPR
• IV line
• Adrenaline:IV 1 mg, each 3-5 min.
  • or
  • intratracheal 2 - 2.5 mg
  • in the absence of effect increase the dose
  • Atropine 1 mg push (repeated once in 5 min)
  • Na Bicarbonate 1 Eq/kg IV
  • Consider pacing