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Hospital Life Support and Automated External Defibrillation

Hospital Life Support and Automated External Defibrillation. European Resuscitation Council. www.erc.edu. LEARNING OUTCOMES the student should be able to:-. Discuss the causes and prevention of cardiorespiratory arrest Discuss the role of the medical emergency team (MET)

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Hospital Life Support and Automated External Defibrillation

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  1. Hospital Life Support and Automated External Defibrillation European Resuscitation Council www.erc.edu

  2. LEARNING OUTCOMESthe student should be able to:- • Discuss the causes and prevention of cardiorespiratory arrest • Discuss the role of the medical emergency team (MET) • Demonstrate the ability to perform basic life support • Identify rhythms that can be defibrillated • Show an awareness of drugs used in cardiorespiratory arrest situations • Demonstrate the ability to perform hospital life support, including the safe use of the automated external defibrillator (AED)

  3. HOW DOES HOSPITAL LIFE SUPPORT DIFFER FROM BASIC LIFE SUPPORT? • IDENTIFICATION OF PATIENTS AT RISK • PREVENTION OF CARDIORESPIRATORY ARREST • ACCESS TO ADVANCED LIFE SUPPORT - AED / DEFIBRILLATION - ADMINISTRATION OF DRUGS - AIRWAY ADJUNCTS

  4. CAUSES AND PREVENTION OF CARDIORESPIRATORY ARREST • AIRWAY OBSTRUCTION • Blood • Vomitus • Foreign body • Direct trauma to face or throat • Central nervous system depression • Epiglottis • Pharangeal swelling • Laryngospasm • Bronchospasm • Bronchial secretions

  5. CAUSES AND PREVENTION OF CARDIORESPIRATORY ARREST • BREATHING INADEQUACY • Chronic or acute • Continuous or intermittent • Respiratory drive • Respiratory effort • Cervical cord damage • Myasthenia gravis • Guillain-Barre Syndrome • Multiple sclerosis • Chronic malnourishment

  6. CAUSES AND PREVENTION OF CARDIORESPIRATORY ARREST • BREATHING INADEQUACY (CONT) • Pulmonary disorders • Pneumothorax • Haemothorax • Infection • Aspiration • Exacerbation of COPD • Asthma • Pulmonary embolus

  7. CAUSES AND PREVENTION OF CARDIORESPIRATORY ARREST • CARDIAC ABNORMALITIES • Primary • Directly involving the heart • Ischaemia • Myocardial infarction • Secondary • The heart is affected by disease originating elsewhere

  8. IDENTIFYING PATIENTS AT RISK OF CARDIORESPIRATORY ARREST • Most people who suffer cardiorespiratory arrest die • If patients can be identified before arrest, lives will be saved • In approximately 80% of cases there is deterioration in clinical signs before cardiac arrest

  9. MEDICAL EMERGENCY TEAM • Provide early access to expert medical support • Have the ability to correct abnormalities • Can decrease overall mortality

  10. The Chain of Survival

  11. Early Access to emergency services or cardiac arrest team • Out of hospital summon EMS by dialling 999/112 • In hospital call cardiac arrest team ring 2222 (check number when on placement)

  12. External chest compressions and ventilation will slow down the rate of deterioration of the brain and heart • Basic Life Support should be performed immediately

  13. Check safety

  14. Check response

  15. Shout for help

  16. Tilt head backLift chin

  17. Check for breathing

  18. Raise the alarm

  19. Pinch nose

  20. Deliver two rescue breaths

  21. Allow air to come out

  22. Check for signs of a circulation

  23. No signs of circulation FIND CORRECT PLACE TO APPLY PRESSURE

  24. COMMENCE CHEST COMPRESSIONS • PRESS THE BREASTBONE 15 TIMES FOLLOWED BY 2 BREATHS AND CONTINUE

  25. REVIEW OF CARDIAC RHYTHMS

  26. SINUS RHYTHM

  27. SINUS TACHYCARDIA

  28. SINUS BRADYCARDIA

  29. ATRIAL FLUTTER

  30. ATRIAL FIBRILLATION

  31. VENTRICULAR FIBRILLATION

  32. VENTRICULAR TACHYCARDIA

  33. ASYSTOLE

  34. PULSELESS ELECTRICAL ACTIVITY (PEA)

  35. DRUGS USED IN CARDIACRESPIRATORY ARREST

  36. OXYGEN • Given in the highest concentration possible for all patients

  37. EPINEPHRINE (ADRENALINE) • Is the first drug used in cardiac arrest from any cause • It is given after each 3 minutes of CPR • Initial dose is 1mg • Increases cerebral and coronary perfusion by vasoconstriction

  38. ATROPINE • Used for asystole and pulseless electrical activity with a rate of less than 60 per min • Recommend dose for adults is 3 mgs in a single dose • Blocks the vagus nerve and increases sinus automaticity • No evidence that it is effective in asystole

  39. AMIODARONE • Used for refractory VF/VT and stable VT and other tachyarrhythmias • If VT/VF persists after first 3 shocks consider giving 300mgs • Prolongs QT intervals thereby slowing the heart rate

  40. OTHER DRUGS • MAGNESIUM SULPHATE • LIDOCAINE (LIGNOCAINE) • SODIUM BICARBONATE • CALCIUM

  41. Chain of survival

  42. The need for defibrillation • ventricular fibrillation: 80% of victims • survival decreases: 10% per minute • only treatment: electrical defibrillation • this means: delivering an electric shock with a device called an“Automated External Defibrillator” (AED)

  43. What is an AED? • a device that delivers electric shocks to victims with cardiac arrest

  44. all AEDs share the same operating principles • self-adhesive defibrillation electrodes • analyses the rhythm of the victim and decides when a shock is needed • accuracy is almost 100%

  45. AED features • voice prompts • memory • analysing • ECG

  46. Using an AED • three steps: • decide to use the AED • activate the AED • follow instructions

  47. AED Example of Use

  48. Switch on the AED • If NO signs of a circulation

  49. Attach the electrodes

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