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Cardiopulmonary Resuscitation .

Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

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Page 1: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

Cardiopulmonary

Resuscitation

���������� ������. ������� ����������������������������������������

�������� ����! ���������

Page 2: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

"#$$����%��& ��'& �(�)�*$• 1. ����)� �)��,�������-$��.,)�/�

• 2. ����)� �!'� ventricular fibrillation

• 3. ����,'��� '��,���-$– �������� ���������

– ������������

– ������������������

Page 3: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

Cardiopulmonary Cerebral

Resuscitation

CPCR

Page 4: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces
Page 5: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

������������ !� • 1. ��������� : early, effective

ventilation

• 2.�������� : early, effective chest

compression

• 3.������#$������ : early defibrillation

• 4.���������%���&' : early ACLS

Page 6: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

The Adult Chain of Survival

��� ()�%� ����� �*#

Page 7: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

%���#��������+,-���� . 1.������+,-���� .%���.���/��• Basic Life Support = First A-B-C-D

“Primary ABCD Survey”

2. ������+,-���� .%���.���&' • Advanced Cardiovascular Life Support

(ACLS) = Second A-B-C-D

“Secondary ABCD Survey”

3. ���'����� ����������� : Postresuscitation

care

Page 8: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

%���#���*!�����%���#���*!����� Primary ABCD SurveyPrimary ABCD Survey

"��)�������'1��'�"��)�������'1��'� unresponsiveness unresponsiveness unresponsiveness unresponsiveness unresponsiveness unresponsiveness unresponsiveness unresponsiveness!'��������)� '!'��������)� ' call call call call call call call call for for for for for for for for HelpHelpHelpHelpHelpHelpHelpHelp$�,���&2/"3��$�,���&2/"3�� position the victimposition the victimposition the victimposition the victimposition the victimposition the victimposition the victimposition the victim

Preliminary first actionPreliminary first actionPreliminary first actionPreliminary first actionPreliminary first actionPreliminary first actionPreliminary first actionPreliminary first action

Page 9: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

Primary survey (BLS)���������� ����!�5�� 5�6��

• A = Airway: �01��� ��*������

• B = Breathing: 0���*�������������

• C = Circulation: ���������������

• D = Defibrillation: ��#$�������2��3++4� �5 VF/pulseless VT

Page 10: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

A: Airway

���������� ��������������� ����� ((LayLay rescuersrescuers))

-- �'�����%��" �" '�-�"���'�����%��" �" '�-�"��

-- finger sweepfinger sweep

-- ��8��(�$�,��%��" �" '�' %�9��8��(�$�,��%��" �" '�' %�9 :: ;��$(�)"<�;��$(�)"<� ((IIbIIb))

Page 11: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

A: Airway– �,��/�&�� )�����

head tilt-chin lift.

– 1�,)$*1���,2����� �������'

: Jaw thrust

– ����������-$��%)�����')"<�� ��

Page 12: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

B: Breathing

• 0���*��������:

• LOOK

• LISTEN

• FEEL

• ���-� 10 ������

Page 13: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

• ����&2/"3��;�����-$

• ��������� 2 ��

: ��� ����������%2� 1 �*���

: &� ��#�����!��%� �� ��

• ��23�2���������������$�'0���%� �� CPR

B: Breathing

Page 14: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

Breathing

Page 15: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

B: Breathing

• ��������������0��0���0��

: 6'2���������3���*���� ���3��&���7���������

• ������������������� �� ��: chest compression only CPR (class IIa)

Page 16: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

B: Breathing

• VF ��� 2- 3 ��� ��

: ������� ���&���8������������������

- �� � ���)*����������

- �����!��%� �� : ������ , gasping

Page 17: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

B: Breathing

• Reduce pulmonary blood flow

- cardiac output is 25-33% of normal

- decrease total body CO2 production &delivery- excessive hyperventilation

: decrease rate of compression: increase intrathoracic pressure : cumulative perfusion pressure

markedly reduced

Page 18: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

B: Breathing• ventilation & compression are

importance

- Prolonged VF sudden arrest

- Asphyxial cardiac arrest

• Progressive chest compression

(after 4 – 10 minutes of CPR)

- atelectasis

- thoracic deformity

Page 19: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

B: Breathing

• �� ��� !� ������������������ (hyperventilation)

• �����300����� ������� CPR

• Cardiac output ������� 25-33%

• �.*!������������ �� �� �����2 venous

return ���

tidal volume 6tidal volume 6--7 ml/kg (5007 ml/kg (500--600 ml)600 ml)

Page 20: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

B: Breathing• ��04� ��� gastric inflation, aspiration

: �� ��� !� ������������������ : Cricoid pressure

Page 21: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

• ��#������������ 8-10 �� #����� ���#2� � �����!��%� �� ��

• synchronize breaths between chest compression

B: Breathing

Page 22: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

C = Circulation

• ������ .�(��6'2�����������!�30

3��� � .��#����3�2���� 10%(poor sensitivity)

� � .��#����3�2���3��� 40% (poor specificity)

• �(����1&2/����)� '��%�;"

����;�����-$ -�/�����>6��������-$��.,)�/�

Page 23: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

• �$����� ���.��: ���� .� 3����*� 10 �*��� • �5 3������� ��������

C = Circulation

Page 24: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

• ����,'�

: ����,'���%��"�����8�����SBP 60-80 mmHg

�MAP at carotid artery > 40 mmHg

��. � .�#����������)*���30&�� ��������

C = Circulation

Page 25: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

Survival

Coronary perfusion pressure

Effective chest compression

Cerebral perfusion pressure

ROSC Neurological outcome

Page 26: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

• Chest compression

:14 - 22% inadequate(2 rescures)

:40% insufficient depth (JAMA 2005)

C = Circulation

Page 27: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

C = Circulation

“ Push hard and fast ”

Page 28: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

C = Circulation

• ��8�����,'�

: $�,����'�����1�� 5���1

: &2/����)� ''�2�!/�� (����&2/"3��

• : �(���������� ������'� ��,�1 lower half of sternum (between the nipple)

• : �/�� '!/����%?��,��� ���

• : �/�� '!/����%;��?��,���1�

Page 29: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

C = Circulation

�������

: �, @� 11/2-2 �*�� (4-5 )�.)

��� 1/3-1/2 �������� �������2�7� ���

����)� �• compression : relaxation = 50:50

• completely recoil after compression

'��������, = 100/min (class IIa)

Page 30: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

C = Circulation

• Compression-Ventilation Ratio

• 30 : 2 (1 or 2 rescuer)

• � ��) �%������1����� '��.,�,'�

Page 31: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

• Effective chest compression– Depth

– Rate

– Circulatory-ventilation ratio

– Duty cycle

– Hand position

– Surface underneath the victim

C = Circulation

Page 32: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

• Inadequate and interrupted chest compression

• Decreased successful resuscitation

Reduces cardiac output and coronary and cerebral blood flow (Circulation 2002,2004)

Excessive ventilation rates

Page 33: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

• Fatiguing effect

: decrease quality/depth of

compression at 1 min. and again at

4-5 min. of CPR

: awareness of fatique after 5 min.

change every 2 min (after 5 cycles)

quickly switch (<5 seconds)

C = Circulation

Page 34: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

��������A/'�!'�����,'�

- Fractured ribs & sternum .�����- Pneumothorax

- Hemothorax

- Lungs, heart, spleen, liver laceration

- Ruptured stomach, diaphragm

- Fat embolism

Page 35: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

• ���������(��3������ (only healthcare

provider)

: ��#������������ 10-12/min (1 �� �$� 5-6

�*��� )

: ��� ������%2���� 1 �*���

: 0���*�� .������$� 2 ��� (3����*� 10 �*��� )

Definite Pulse � (����$�;,/

Page 36: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

DEFIBRILLATION �������.����-$,/��;��B�

Page 37: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

���&���8

• VF .�����&$�

• �*> ��?�� !� 0�&*�>*@�. �� electrical defibrillation

• 6�&�������� #������

• VF &���7�0� !���0A� asystole

Page 38: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

• ���$��� ����3�2�� 5 ���

• ��( .����� ����3�2�� 2 - 4 ���

• ����#$�������� 3-5 ��� � 6�&�����&' &$�

• ��#������ �*#��� VF ��� 7-10 % #�����

Page 39: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces
Page 40: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

Compression First & Shock First

: Insufficient data� CPR before

defibrillation for all VF.

Page 41: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

• CPR first & defibrillation first

: CPR 1.5-3 min before defibrillation�improve return of spontaneous circulation (ROSC) and survival rate.

• ( out-of-hospital VF arrest, JAMA 1999)

• �� 3��� ����/��%2��'���( .�����

• -�/ defibrillator -�/;,/)�*���%�.,

D = Defibrillation

Page 42: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

• Monophasic waveform : one polarity– Damped sinusoidal (MDS)

– Trucated exponential (MTE)

• Biphasic waveform– Truncated exponential – Rectilinear biphasic

Page 43: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation– Monophasic damped sinusoidal

– Monophasic truncated exponential

– Biphasic truncated exponential

– Rectilinear biphasic

Page 44: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

.�� ��3++4� : ��#$������ 1 ���5�1. Monophasic waveform : 360 Joules

2. Biphasic waveform

:truncated exponential waveform : 150 - 200 J

:rectilinear biphasic waveform : 120 J

: If unknown � 200 J

: �� 3��� %2��'��0 ���� ������� escalating & non-

escalating energy

D = Defibrillation

Page 45: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

• &�&�!�3++4� (Conductive material)

– ��@���B���3++4�%� �� �� (thoracic impedance)

– ��.�� ��3++4�� !��2

– �.*!�6�&�����– Hairy chest : high impedance

D = Defibrillation

Page 46: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

%���%� Electrode

: 8-12 cms

: �/'����� 4.3 cm �(�-�/)��, myocardial injury

Page 47: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

#������ ���� Electrode

Sternum : closed to clavicle, right border of sternum

Apex : 5th ICS & MAL

�� ��� !� �*��5� !�

* implantable cardioverter

defibrillator (ICD)

* permanent pacemaker

Page 48: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

!�5��'����-�/)�� %'�

1. �01���!�

Page 49: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

!�5��'����-�/)�� %'�

2. 0��0$D������.�� ��

360 J �� ' 200 J

Page 50: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

!�5��'����-�/)�� %'�

3. 0��0$D� “lead select” �0A� “Paddles”

Page 51: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

!�5��'����-�/)�� %'�

4. �� EKG gel , cream

3����2 K-Y jelly , ultrasound gel

Page 52: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

!�5��'����-�/)�� %'�

5. �� paddles � ��#������ sternum-apex

6. #��&����!�3++4������

Page 53: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

!�5��'����-�/)�� %'�

7. �5 VF/pulseless VT

��C��1'� charge

Page 54: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

!�5��'����-�/)�� %'�

8. ��0$D� “Charge”

Page 55: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

!�5��'����-�/)�� %'�9. ���!���!� charge

.�� ����� ! paddles ��2� #��&��� �

Page 56: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D = Defibrillation

!�5��'����-�/)�� %'�

10. ���� �� paddles 10

kg.

11. ��0$D� ”Discharge” ��� &� %2� .2�����

Page 57: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

D: Defibrillation

Oxygen and fire risk

������������������� �� (sparking)

#��&������ Paddle

������#$��������%5� O2-enriched atmosphere

Page 58: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

Marquette: monophasic 360 J

Page 59: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

Zoll: monophasic 360 J

Page 60: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

Nihon Kohden: biphasic 150-270 J

Page 61: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

Philips: biphasic 150-200 J

Page 62: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

Zoll: biphasic 120 J

Page 63: Cardiopulmonary Resuscitation - Prince of Songkla Universitymedinfo2.psu.ac.th/surgery/Edu_be_document/... · Cardiopulmonary Resuscitation . ˘ ˇˇ ˆ ... resuscitation Reduces

CPR #������ 5 cycles ��� 2 min.

Most victims show asystole or PEA for several minutes after defibrillation�CPR can convert to perfused rhythm. (Resuscitation 2002,2003,2005)

�� ��� !� �����������$� ���� �.�!�0���*�� .������!�3++4������

� ������.����-$ 1 ���5�

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• #��&����!�3++4������ : shockable rhythm?

• 0F*��#* CPR #�����!� ��%5� charging defibrillator

• �������#$������

• ��',/�� CPR 5 �'1����� � ������.����-$

• �(�A5(�;")� %'�9

� ����� CPR 5 �'1

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Automatic External defibrillator (AED)

improve survival rate from out-of-hospital sudden cardiac arrest.

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Adult BLS Healthcare Provider Algorithm

�&��2��������������!�5�� 5�6��

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Summary��."

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Basic life support• Check responsiveness

• Activate emergency response system

• Call for defibrillator: PHONE FIRSTA = Airway

B = Breathing

C = Circulation

D = Defibrillation:1 shock for VF/VT

Within 4 minute

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• The American Heart Association. Part 4: Adult Basic Life Support. Circulation 2005;112:IV-18-IV-34.

• The American Heart Association. Part 7.2: Management of cardiac arrest. Circulation 2005;112:IV-57-IV-66.

• The American Heart Association. Part 3: Defibrillation. Circulation.2005;112:III-17-III-24.

• The American Heart Association. Part 3: Overview of CPR. Circulation 2005;112:IV-12-IV-17.

• Hazinski MF, et al. Major changes in the 2005 AHA Guidelines for CPR and Emergency Cardiac Care (ECC). Circulation 2005;112:IV-206-IV-211.

References

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