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Cardio-pulmonary Cerebral Resuscitation (CPR)

Cardio-pulmonary Cerebral Resuscitation (CPR). Prof. M. H. Mumtaz. PHASES. I Basic Life Support (BLS) (ABC). III Prolonged Life Support (PLS) (GHI). II Advanced Life Support (ALS) (DEF). B L S. Tilt Head. Lift Neck. Support Chin. If Unconscious ?. A. A IRWAY. B L S.

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Cardio-pulmonary Cerebral Resuscitation (CPR)

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  1. Cardio-pulmonary Cerebral Resuscitation(CPR) Prof. M. H. Mumtaz

  2. PHASES I Basic Life Support (BLS) (ABC) III Prolonged Life Support (PLS) (GHI) II Advanced Life Support (ALS) (DEF)

  3. B L S • Tilt Head. • Lift Neck. • Support Chin. If Unconscious ? A. AIRWAY

  4. B L S If not breathing ? • Lung Inflation. • Mouth to Mouth. • Mouth to Nose. • Mouth to Tube. • Bag-wash. B. BREATHE

  5. B L S C. CIRCULATE One Operator Two Operators

  6. Cause • Nervous System. • Myocardium. Sympathetic Parasympathetic

  7. Phase TwoAdvanced Life Support(Restoration of Spontaneous Circulation) • Adrenaline. • Alkali. • Fluids. D. DRUGS & FLUIDS

  8. E. EKG Ventricular Fibrillation Asystole Bizarre Complexe

  9. F. FIBRILLATION TREATMENT • Ext Defibrillation. • Lignocain.

  10. Biochemical Changes

  11. Biochemical Changes H-CO3 + H+ H2CO3 CO2 + H2O ECF K+ Lungs Kidney + H ICF

  12. Correction • Bicarbonate Therapy: (CO2 Producing) H-CO3 + H+ H2CO3 CO2 + H2O • Carbonate Therapy: (Non CO2 Producing) • Routine Indications • Base Deficit > 10 Meq/L • PH < 7.20 • HCO3 < 14 Mmol/L Meq HCO3 = Base Deficit X wt. (kg) X .3

  13. Correction • Problems • A. Alkalosis. - K+ - O2 Dissociation - Left Shift. - Depression of Myocard. • B. Sodium Over Load. • Oxygenation Ventilation.

  14. Total Oxygen at Arrest1500-1600 mls

  15. Critical Survival Time

  16. Drugs Atropine. Adrenaline. Calcium. Glucagon . Isoprenalin. Dopamine. Debutamine. Lignocaine. Equipment Trained Doctor . Laryngoscope. Tube (ETT). Ambu Resuscitation. Defibrillator with Oscilloscope. Requirement

  17. Emergency-Fluid Resuscitation

  18. Primary volume therapy “Fill from inside out” Vessel ISS ICS out inside

  19. A New Concept Small Volume Hyperosmolar Saline Colloid Resuscitation 4 ml/kg - 7.2-7.5% NaCl/Colloid

  20. d d interstitium interstitium Shock Small-volume hyperosmolar resuscitation endothelial cell Flow Flow erythrocyte

  21. Physiological & Basic Mechanisms • Plasma osmolality= 285-295 mosmol/kg. • 7.2% NaCl = 2400 mosmol/kg. • End bolus infusion = 460 mosmol/kg. (4 ml/kg). • ­ Ttransmembrane osmotic gradient. • ¯ • Endogenous fluid mobilization. (most pronounced in capillary districts) • ¯ • ­ Plasma volume. • ¯ Hydraulic resistance. • ­Tissue perfusion.

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