危重病學(xué)教學(xué)課件：Cardiopulmonary Cerebral Resuscitation

1、 Department of anesthesiologyThe first affiliated hospital of CQMUCardiopulmonary Cerebral Resuscitation(CPCR) Introduction Cardiopulmonary resuscitation (CPR) CPR refers to all treatments for cardiac or/and respiratory arrest CPR consists of reestablish artificial respiration and circulation Introd

2、uction Cardiopulmonary cerebral resuscitation (CPCR) Brain damage occurred very soon after cardiac arrest Recovery of cerebral function is needed after cardiac arrest CPR and Cerebral resuscitation are called CPCRSigns of Cardiac ArrestSudden deep unconsciousnessAbsent carotid and femoral pulseDilat

3、ed pupilsAshen cyanosisApnea or gaspingintroductionTypes of Cardiac ArrestVentricular fibrillationVentricular standstillElectro-mechanical dissociationintroductionChain of Survivalintroduction Immediate recognition of cardiac arrest and activation of the emergency response system Early CPCR Rapid de

4、fibrillation Effective advanced life support Integrated postcardiac arrest careSequence of CPCRBasic life support, BLSAdvanced life support, ALSPost cardiac arrest careSimplified Adult BLSAre you OKRecognition of cardiac arrestUnconsciousness: To tap or squeeze shoulder and ask are you OK Pulselessn

5、ess: To feel carotid pulse Recognition of cardiac arrestTo Activate ERSCall for hellpEarly CPCREarly CPR: C-A-BC: CirculationA: AirwayB: BreathingCirculation-chest compressionExternal chest compressionOpen chest compressionCirculation-external chest compressionCompression rateCompression/relaxationC

6、ompression depthCompression/respirationAt least100 times/min1:1At least 5 cm30: 2To push hard and fastCirculation-external chest compressionSupine on a firm surfaceLower third of sternumTwo fingers above xiphisternumCirculation-external chest compressionOverlapped and parallel handsCirculation-exter

7、nal chest compressionStraight elbowAt least 100 times/minAt least 5 cmPush hard, push fastInterruption less than 10 sSupine on a firm surfaceLower third of sternum/two fingers breadth above xiphisternumKeep elbows Straight Compress more than 5cm and 100 times/minTime of compression and release ratio

8、: 1/1Compression and breathing ratio: 30:2Circulation-external chest compressionComplications of ECC Ribs and sternum fracture Injuries to the heart, great vessels , lungs and liver Hemothorax, pneumothorax, cardiac tamponade Contraindication of ECC Serious malformation of chest wall Serious trauma

9、of chest wall Cardiac tamponadeOpen Chest Compression OCC is significantly more effective for increasing myocardial, cerebral, renal blood flow, coronary perfusion pressure, and survival rate when compared with ECC.Open Chest CompressionCardiac arrest during thoracotomyIneffective ECC for more than

10、10 min-IndicationsOpen Chest CompressionTraumatic injuries to the heart, lungs, and surrounding tissues.Intrathoracic bleeding and infection-Complications of OCCTo Open AirwayHead-tilt/chin-liftJaw-thrustTo lift the base of the tongue off the posterior pharyngeal wall-Mouth-to-mask respirationBreath

11、ingBreathingMouth-to-nose respirationMouth-to-mouth respirationTake “regular” breathTidal volume：about 500mlGive breath over 1 secondVisible chest riseCompression/breathing 30:2BreathingBreathing-Complication of artificial respirationInadequate ventilation Distention of the stomachAspiration of gast

12、ric contents DefibrillationVF is the commonest arrhythmia for cardiac arrestDefibrillation is the most effective therapy to VFThe time from VF to defibrillation is the single most important determinant of survival. Patients with VF should be defibrillated within 3 minutes after the onset of VF if po

13、ssibleDefibrillationElectrode placement: anterolateralRight midclavicular line2-4 intercostal spaceLeft midaxillary line5-6 intercostal spaceDefibrillationDefibrillation waveforms and energy levels Monophasic waveform defibrillator: 360J Biphasic waveform defibrillator: 120-200JAdditional one with e

14、qual or higher energy than the firstThe Effective Signs of BLS Palpable major pulses MAP60 mmHg Reduced pupils Disappearance of cyanosisRecovery of spontaneous circulation, ROSC Inadequacy of BLSManual methods without equipment, easy fatigue of rescuerThe effect of chest compression progressively de

15、creases with the increasing time of resuscitationAccording to the chain of survival, ALS should be begun early with equipmentsBLSAdvanced life supportPharmacotherapyTo stimulate spontaneous circulation To increase myocardial contractilityTo increase myocardial and cerebral blood flow perfusionTo pre

16、vent arrhythmiaTo treat acid-base and electrolytic unbalance -aimALS-Routes Of Drug Large vein or central venous access (IV) First choice Intraosseous (IO) Endotracheal route Direct injection into ventricular chamberPharmacotherapyALSPharmacotherapy- Epinephrine Main effects 1.To increase both cereb

17、ral and myocardial blood flow2.To increase aortic and coronary perfusion pressure, facilitate restoring spontaneous circulation 3.To change “fine fibrillation” to “coarse fibrillation” and facilitate defibrillationALSPharmacotherapy- Epinephrine Epinephrine is currently the drug of first choice for

18、CPRALSDosage and usage 1mg of first dosage repeated every 3 to 5 minutes.Pharmacotherapy- Vasopressin Vasopresin is reported as effective as epinephrine for cardiac arrest 40 U, IV/IOALS- AmiodaronePharmacotherapy Be considered for VF or pulseless VT unresponsive to CPR, defibrillation, and a vasopr

19、essor therapy An initial dose of 300 mg Followed by 1 dose of 150 mgALS- LidocainePharmacotherapy Be considered if amiodarone is not available An initial dose: 1-1.5 mg/kg Additional dose: 0.5-0.75 mg/kg, every 5-10 min Maximum dose: 3 mg/kg ALS- Magnesium sulfatePharmacotherapy Be considered to fac

20、ilitate termination of torsades de pointes An initial dose of 1-2 gALSAirway Management 90 percent CPR-needed victims have obstructed airway Measures in BLS to open airway can not last long Airway management is very important in ALSALSAirway ManagementEndotracheal IntubationALSBe performed as early

21、as possibleTo keep airway patencyTo protect airway from aspirationTo facilitate delivery of oxygen and mechanical ventilation8-10 breath per minuteAirway ManagementALSOropharyngeal AirwaysNasopharyngeal AirwaysReversible causesALSHypovolemiaHypoxiaHydrogen ion (acidosis)Hypo/hyperkalemiaHypothermiaH

22、ypoglycemiaTension pneumothoraxTamponade, cardiacToxinsThrombosisTraumaMonitoringALSEnd-Tidal CO2To reflect quantity of CPRPost cardiac arrest care To optimize cardiopulmonary function and vital organ perfusion To provide comprehensive treatment system of care including acute coronary interventions,

23、 neurological care, goal-directed critical care, and hypothermia. To identify and treat the precipitating causes of thearrest and prevent recurrent arrest.Initial objectivesKey pointsA comprehensive, structured, multidisciplinary system of care Therapeutic hypothermia Optimization of hemodynamics and gas exchange Immediate coronary reperfusion percutaneous coronary intervention (PCI) Glycemic control (8-10 mmol/L) Neurological diagnosis, management, and prognosticationInduced hypothermiaComat