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MindMap Gallery Cardiac Arrest and Cardiopulmonary and Cerebral Resuscitation

Cardiac Arrest and Cardiopulmonary and Cerebral Resuscitation

Cardiopulmonary resuscitation and cardiopulmonary cerebral resuscitation. Cardiac arrest refers to the sudden termination of the effective ejection function of the heart and is the main cause of sudden cardiac death. Sudden cardiac death is characterized by sudden loss of consciousness within 1 hour after the onset of acute symptoms. It is caused by the heart. death due to causes.

Edited at 2023-10-29 13:42:34

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Cardiac Arrest and Cardiopulmonary and Cerebral Resuscitation

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Cardiac Arrest and Cardiopulmonary and Cerebral Resuscitation

cardiac arrest

Overview

Differentiate between cardiac arrest and sudden cardiac death

Cardiac arrest refers to the sudden cessation of the effective ejection function of the heart and is the main cause of sudden cardiac death.

Sudden cardiac death is a death caused by cardiac causes characterized by sudden loss of consciousness within 1 hour after the onset of acute symptoms.

Common heart rhythms during cardiac arrest

ventricular fibrillation

The electrocardiogram shows that the QRS complex disappears and is replaced by tremor waves of varying sizes and shapes, with a frequency of up to 200 to 400 times/min.

pulseless ventricular tachycardia

No aortic pulse, three or more premature ventricular contractions, and continuous QRS complex morphological abnormalities.

heart at rest, ventricular arrest

Occasionally p waves

pulseless electrical activity

QRS wave widening

Pathophysiological changes after cardiac arrest

The first thing to be damaged is the brain tissue

Irreversible damage to brain tissue can occur after 4-6 minutes of cardiac arrest

Common causes of cardiac arrest

Coronary heart disease is the leading cause of cardiac arrest in adults

Various cardiomyopathies

Severe bradyarrhythmias and ventricular arrest

Clinical manifestations of cardiac arrest

sudden loss of consciousness

respiratory arrest

Aortic pulse disappears

classic triad

cardiopulmonary cerebral resuscitation

component

The process of the adult survival chain

Immediately identify cardiac arrest and activate emergency response systems

Perform CPR as early as possible, focusing on chest compressions

rapid defibrillation

Effective advanced life support

Comprehensive post-cardiac arrest care

Basic Life Support (BLS)

It is the most basic rescue method to use bare hands and/or auxiliary equipment to maintain the circulation and breathing of cardiac arrest patients. The key points include chest heart compression, airway opening, artificial ventilation, and if possible, electric defibrillation can be considered.

Basic steps of BLS

Call to quickly identify and diagnose cardiac arrest under safe conditions

Assess whether the environment is safe

To determine the patient's consciousness, tap the patient's shoulders lightly and shout loudly to determine whether there is effective breathing. Observe the face, breathing, and chest rise and fall.

For adults and children, check the carotid artery (first left and then right), slide 2-3cm sideways from the middle of the patient's trachea, and check for 5-10 seconds.

Call to activate emergency response system

Call for help, call 120, and get an AED if possible

C chest compressions

body position

The patient is in the supine position. When turning over, the whole body rotates to protect the neck. Place the patient on the ground or a hard bed. The rescuer kneels on the right side of the patient and unties the patient's collar, tie and zipper.

method

adult chest compressions

Compression location: middle of sternum, lower sternum (midpoint between male nipples)

Pressing method: Overlap your hands and press vertically with the base of one palm. Cross the fingers of both hands and clasp them tightly. The fingers should be pointed upward as much as possible. The time of pressing and relaxing is roughly equal.

Compression depth: sternal depression 5-6cm (anterior and posterior diameter of thorax ½)

Compression frequency: 100-120 times/min, press 30 times continuously to enter the next link

Each compression and release time are equal, and the chest fully rebounds when released.

For 8-year-old children, the chest compression depth should reach at least 1/3 of the anteroposterior diameter of the thorax.

baby chest compressions

Compression site: the sternum below the line connecting the two nipples

Pressing method: middle finger and ring finger or both thumbs

Main points

Ensure compression frequency and depth

During compression, ensure that the chest fully rebounds

Minimize interruptions in chest compressions

Try to limit interruptions to less than 10 seconds to increase the chest compression time ratio to 60%

Do not hyperventilate

The ventilation volume should not be too large

The ratio of compressions to ventilation is 30:2. For double cardiopulmonary resuscitation in children, the ratio of compressions to ventilation is 15:2.

Change of presser

Change roles every two minutes, and the substitution operation should be completed within 5 seconds to reduce the time between chest compressions.

A Open airway

First clean up respiratory secretions and dentures

Head-up and chin-up method

Suitable for patients without head and neck trauma, 90 degrees

mandibular support method

Suitable for patients with suspected head and neck trauma

B artificial ventilation

Mouth-to-mouth artificial ventilation

Pinch the patient's nostrils with the thumb and index finger placed on the patient's forehead, completely cover the patient's nostrils with your lips, and inhale normally. No deep inhalation is required.

mouth-to-mask ventilation

The frequency of artificial ventilation is 10-12 times per minute

D early defibrillation

The sooner the better

standard position

2 intercostal spaces on the right edge of the sternum, 5th intercostal space on the left and anterior axillary line

Ventricular fibrillation is the most common arrhythmia in patients with non-traumatic cardiac arrest, and defibrillation is the fastest and most effective way to terminate ventricular fibrillation.

The defibrillation energy of the bidirectional wave defibrillator is 120-200J, and the defibrillation energy of the unidirectional wave defibrillator is 360J.

Situation without cardiopulmonary resuscitation

The rescuer may cause serious injury to himself or be in a fatal danger situation (such as being infected with an infectious disease) when performing rescue operations.

There are clinical features of obvious irreversible death (such as rigor mortis, cadaverous spots, decapitation, body transection, corpse decomposition)

The patient had a last wish to refuse resuscitation

Judging the effectiveness of cardiopulmonary resuscitation

30 chest compressions and 2 artificial ventilations are called a cycle, and the patient is evaluated after completing 3 cycles or 2 minutes.

carotid pulse

Spontaneous breathing occurs

Pupils change from large to small

Complexion and lips change from cyanotic to rosy

altered sanity

Advanced Cardiovascular Disease Support

A --Open airway; B --Oxygen therapy and artificial ventilation C -- Loop support D Find the cause of cardiac arrest

Open airway A

oropharyngeal airway

Suitable for patients with loss of consciousness, no gag reflex, and coma

Nasopharyngeal airway

Suitable for tracheal obstruction

endotracheal intubation

Monitoring the end-tidal capnography waveform is a reliable method to confirm and monitor the correct position of the endotracheal tube

Alternative supraglottic advanced airways

Oxygen therapy and artificial ventilation B

bag-mask ventilation

Each ventilation squeezes about 1/2 of the adult balloon to provide a tidal volume of approximately 600 ml.

Each ventilation should last one second to keep the airflow slow

Mechanical Ventilation

Loop support

ECG and blood pressure monitoring

Establish a route of administration

For intravenous access, the antecubital vein and external jugular vein are commonly used. Try not to use the veins of the hands or lower limbs.

bone marrow pathway

Intratracheal administration

Commonly used drugs for cardiopulmonary resuscitation

Epinephrine is the drug of choice for cardiac arrest

Amiodarone

lidocaine

magnesium agent

sodium bicarbonate

atropine

Steroid

Finding the cause of cardiac arrest

Treatment after cardiac arrest

Post-cardiac arrest treatment goals

Initial goals of treatment after cardiac arrest

Post-cardiac arrest follow-up goals

Treatment after cardiac arrest

Optimize ventilation and oxygen

Maintain effective circulatory function

Establish or maintain intravenous access

ECG and blood pressure monitoring

If the patient is hypotensive, infusion is required to maintain at least systolic blood pressure ≥90mmHg or mean arterial pressure ≥65mmHg.

Invasive hemodynamic monitoring

brain resuscitation

Main measures for brain resuscitation

maintain blood pressure

target temperature management

32-36℃

Prevent and treat cerebral hypoxia and cerebral edema

Result of brain resuscitation

Complete recovery of conscious and autonomous activities

Recovery of consciousness leaves behind mental retardation, mental disorder or physical dysfunction, etc.

decortical syndrome

brain death

Terminate CPR

After 20 minutes of cardiopulmonary resuscitation, the patient still had no response to himself, no spontaneous breathing, no signs of spontaneous circulation, and the electrocardiogram showed a straight line.

For patients with tracheal intubation, the carbon dioxide waveform detection ET carbon dioxide still cannot reach more than ten millimeters of mercury.

organ donation