Cardio-Pulmonary and Cerebral Resuscitation Lecture 1

1. Cardio-Pulmonary and Cerebral Resuscitation Lecture 1 Department of Anesthesiology and Intensive Care The head of a department: I.Titov, DrPh.

2. The theme of lecture N 1 • Cardiopulmonary resuscitation. Symptoms of clinical death. Safar’s triple manoeuvre. Breathing. • Cardiopulmonary resuscitation. Chest compression. Complications of the CPR.

3. Part II. Cardiopulmonary resuscitation Life • For normal functioning all cells of the body require oxygen. If oxygen is not provided, death of organism appears within 4..5 minutes. • Brain is the tissue most susceptible to anoxia (absence of oxygen).

4. Part II. Cardiopulmonary resuscitation Process of the death Is not a momentary but stepwise process, which can take certain time. Five steps of the death: • Preagony • Terminal pause • Agony • Clinical death (reversible injury) • Biological death (irreversible injury)

5. Part II. Cardiopulmonary resuscitation Agony isa stage which precede to the death. Function of vital organs is severe disturbed, and conditions required for survival of organism cannot be met. • Unconsciousness • Blood pressure is undetectable • No pulse on arteries Clinical death: circulation stops completely and that leads to the cessation of breathing and nervous system activity.

6. Part II. Cardiopulmonary resuscitation Symptoms of clinical death • No pulse on arteries(carotid or femoral) • Change of skin colour • Unconsciousness • Gasping, cessation of breathing • Dilatation of eye pupils Duration of clinical death is 3(5) minutes

7. Part II. Cardiopulmonary resuscitation Biological death is irreversible condition. Metabolism and functioning of vital organs has completely ceased. Organ damage is as extensive that resuscitation of the body is impossible. Evident symptoms of the death: • Rigor mortis • Death spots on the body • Drop of body temperature to the level of the surrounding

8. Part II. Cardiopulmonary resuscitation • Adult BLS sequence Basic life support consists of the following actions: 1. Make sure that the victim, any bystanders, and you are safe. 2. Check the victim for a response (gently shake his shoulders and ask loudly, “Sir. Or Ms., are you all right?”) 3 A. If he responds: • Leave him in the position in which you find him provided there is no further danger. • Try to find out what is wrong with him and get help if needed. • Reassess him regularly.

9. Part II. Cardiopulmonary resuscitation • Adult BLS sequence 3 B. If he does not respond: • Shout for help, call 911 (USA and Canada) or 03 (Ukraine and Russian Fed) • Turn the victim onto his back and then open the airway using head tilt and chin lift: - place your hand on his forehead and gently tilt head back. - with your fingertips under the point of the victim’s chin, lift the chin to open the airway.

10. Part II. Cardiopulmonary resuscitation • Adult BLS sequence • 4. Keep the airway open, look, listen, and feel for normal breathing. • Look for chest movement • Listen at the victim’s mouth for breath sounds. • Feel for air on your cheek Look, listen and feel for no more than 10 sec to determine if the victim breathing normally.

11. Shake and Shout

12. Opening the airway • Head tilt • Chin lift • If cervical spine injury suspected: • jaw thrust

13. Assess Breathing • Look for chest movement • Listen for breath sounds • Feel for expired air • Assess for 10 seconds before deciding breathing is absent

14. Rescue breathing(Expired air ventilation) If he is not breathing normally: Ask someone to call for an ambulance. • Kneel by the side of the victim. • Pinch the soft part of the victim’s nose, using the index finger and thumb of your hand on his forehead. • Allows his mouth to open, but maintain chin tilt. • Take a normal breath and place your lips around his mouth, making sure that you have a good seal.

15. Part II. Cardiopulmonary resuscitation • Blow into his mouth and look on his chest, chest must rise; take about one second to make his chest rise as in normal breathing; this is an effective rescue breath. • Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest. • Take another normal breath and blow into the victim’s mouth once more to give a total of two effective rescue breaths. • Give each rescue breath over 1 sec rather than 2 sec.

16. Assess Circulation Check the victim’s pulse. A. If pulse on the carotid artery is not palpable – begin chest compression. • Place the heel of one hand in the centre of the victim’s chest. • Place the heel of your other hand on the top of the first hand. • Interlock the fingers of your hands and ensure that pressure is not applied over the victim’s ribs. Do not apply any pressure over the upper abdomen or the bottom end of the bony sternum (breastbone).

17. Part II. Cardiopulmonary resuscitation • 30 compressions : 2 breaths for • 1-person CPR • 2-person CPR

18. Part II. Cardiopulmonary resuscitation • Chest compressions: • Depress sternum 4-5 cm • Rate: 100 per minute

19. PRECORDIALBLOW • Indications: • Confirmed of blood circulation stop

20. Continue resuscitation until: • Qualified help arrives and takes over • The victim shows signs of life • You become exhausted

21. Airway management and ventilation • Basic airway management and ventilation • The laryngeal mask airway and Combitube • Advanced techniques of airway management • Basic mechanical ventilation

22. Safar’s triple manoeuvre • Open mouth • Head Tilt and Chin Lift

23. Jaw Thrust

24. SUCTION

25. Ventilation by mouth through a mask • Advantages: • Allows to avoid direct contact • Reduces probability of infected • Allows to raiseO2 • Restrictions: • Tightness maintenance • Stomach inflating

26. Bag-valve-mask

27. Advantages Direct contact allows to avoid Allows to increase concentration О2 - to 85 % Can be used with an obverse mask, LМ, Combitube, endotracheal tube Restrictions At use with an obverse mask: Risk of inadequate ventilation Risk of inflating of a stomach 4 hands are necessary for optimum use Ventilation by means of bag Аmbu

28. Installation LМ

29. Advantages Speed and simplicity of installation Presence of the different sizes More effective ventilation in comparison with an obverse mask Allows to avoid laryngoscopy Restrictions Does not protect from aspiration Does not approach in situations when high pressure use on a breath is required It is impossible to aspirate from bottom BP Laryngeal mask

30. Choice of an air line of the suitablesize

31. Simple adaptations for maintenance of BP

32. Installation of pharyngo-oral an air line

33. Installation of pharyngonasal an air line

34. Advantages Speed and simplicity of installation Allows to avoid laryngoscopy It is possible to use, when pressure upon a breath the high Restrictions It is accessible only 2 sizes There is a risk of ventilation through a gastric gleam Damage of cuffs at installation Trauma in an installation time Only for disposable use Combitube

35. Ventilation by means of Combitube

36. Intubation oftracheas Attempt of intubation: • Preoxygenation of the patient • 30 seconds on each attempt • Spend a tube through a vocal crack under the control of direct sight • At any doubts or complexities, reoxygenation the patient before the subsequent attempts • Patients are harmed by unsuccessful attempts of oxygenation, instead of intubation!

37. Installation of endotracheal tube

38. Advantages Allows to increase PO2 to 100 % Isolates BP, preventing of aspiration Allows aspirated of BP Alternative way for introduction of medicine Restrictions Training and experience are absolutely necessary Unfortunate attempt, esophageal intubation Risk of deterioration of damage back and a brain during laryngoscope Intubation of trachea

39. Confirmation of correct position of ETT in a trachea • Direct visualisation during laryngoscope • Auscultation: • With two sides, on average axillary's lines • Over epigastrium • Symmetric movements of thorax during ventilation

40. Sellick”s manoeuvre • Pressure on cricoid cartilage on purpose of occlusion a gullet about cervical department of a backbone

41. Advantages Decrease of risk of aspiration and regurgitation It can be applied at intubation, and also ventilation by means of an obverse mask and LM Lacks Can complicate intubation Can complicate ventilation by means of an obverse mask or LM Avoid at active vomiting Sellick”s manoeuvre

42. Cricothireotomy Indications • Impossibility of maintenancepassableness of BP in another way Complications • Displacement of cannula • Emphysema • Bleeding • Gullet punching • Hypoventilation

43. DEFIBRILLATION

44. Rhythm of a stop of blood circulation • Fibrillation of ventricles • Ventricle's tachycardia «without pulse» • Asystole • Electro-mechanical dissociation (EMD)

46. Asystole • There is no activity of ventricles (complex QRS) • Activity of auricles (waveP) can be • Seldom straight line • Possibility of small waves ofVF

48. The mechanism of DEFIBRILLATION • Definition • “The termination of fibrillation or absence VF/VT in 5 seconds after the discharge” • Depolarized all weight of a myocardium • Natural pacemeker renew job

49. Automatic external DEFIBRILLATOR • Analyze a heart rhythm • Make the discharge • Specificity in recognition of the rhythm in subject which is defibrillation comes nearer to 100 %

50. Automatic external DEFIBRILLATOR • Attach sticky electrodes • Follow the sound and visual instruction • The automatic analysis of an electrocardiogram - do not touch the patient • The automatic discharge at a corresponding rhythm • +/-a manual overload