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acid-base abnormalities during cardiopulmonary resuscitation cpr

Cardiac Output During CPR. Del Guercio LRM, et al. Circulation 1965; 32:I171-180.. . Normal CO = 2.5-3.6 L/m2(BSA)/min. Metabolism During CPR. Aerobic Metabolism. . Anaerobic Metabolism. Progressive increase CO2 in cells. . PCO2 90-475 mmHgPCO2 >475 ? EMD. . . ConfusionFollowing CPR. MacGregor DC,et al. J Thorac Cardiovasc Surg 1974..

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acid-base abnormalities during cardiopulmonary resuscitation cpr

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    1. Acid-Base Abnormalities DuringCardiopulmonary Resuscitation (CPR) Anakapong Phunmanee M.D. Associated Professor Faculty of Medicine, Khon Kaen University

    3. Metabolism During CPR

    7. Arterial vs Veneous blood during CPR

    9. Arterial blood during CPR

    13. Comparison of coronary perfusion pressure

    14. NaHCO3 administration duringCPR: A Mistake

    16. NaHCO3 administration during CPR Should not be used until other proven interventions (ET tube, defibrillation, cardiac compression, adrenaline) Estimated that this interventions required at least 10 min.

    17. Guideline for NaHCO3 administration during CPR Known preexisting metabolic acidosis with or without hyperkalemia Known hypercalcemia Doasage 1 mEQ/kg then no more than half for subsequent dose No more frequently than every 10 min Postresuscitation phase, guideed by arterial blood gas

    18. Alternate buffer agents during CPR THAM (tromethamine), potent amine buffer DCA (Dichloroacetate), stimulating pyruvate dehydrogenase (oxidative enzyme in step of lactate to pyruvate) However, no alternate buffer agents improve survival during CPR

    19. Buffering agents and survival

    20. Capnography

    21. Capnography

    22. PETCO2 & Hyperventilation

    23. PETCO2 & Cardiac Output

    24. Common causes of low PETCO2(< 2%) Inadequate ventilation Esophageal intubation Airway obstruction V/Q mismatch Pulmonary emboli Inadequate blood flow Inadquate chest compression Hypovolumia Tension pneumothorax Pericardial tamponade Decrease metabolic production eq. hypothermia

    25. End-tidal CO2 concentration (PETCO2) Clinical indication Confirm ET tube placement (sen, spec, 100, 90%) Esophageal intubation results in PETCO2 < 0.5% Guide hemodynamic status: inadequate chest compression PETCO2 < 1% Prognostic value: PETCO2 20 min after CPR < 10 mmHg accurately predicts death

    26. Acid-Base Abnormalities During CPR: Conclusion Intracellular acidosis plays an important role The treatment is properly performed CPR and airway management Pharmacologic buffers have no benefit and potentially risk

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