内科学教学课件：Cardiac Arrest and CPR

1、Cardiac Arrest and CPR(Cardiopulmonary resuscitation),Heart arrest: heart ejection suddenly stop(VF/VT , bradycardia or ventricular arrest)Direct lead to sudden cardiac death .sudden cardiac death: one hour after acute symptomatic onset, nature death occurs because of cardiac cause, unconsciousness

2、is the characteristic. ,etiology,About 80% of sudden cardiac death is caused by coronary heart disease , 20% by other heart disease, such as cardiomyopathy, long Q-T syndrom, Brugada syndrom.,pathophysiology 1.ventricular fibrillation and tachycardia 2.bradycardia or cardiac arrest 3.Pulseless elect

3、rical activity (PEA):,Manifestation,prodromal period：several days before sudden death, chest distress and short breath may appear. Terminal period: in one hour after cardiovascular accident gets worse fiercely, serious chest pain, acute dyspnea, ventricular tachycardia. Heart arrest: sudden unconsci

4、ousness, local or general convulsion, breath stop, pale skin, pupil dilate, urinary and fecal incontinence Biological death: after heart arrest, irreversible cerebral damage happen in 4-6min, immediately CPR，defibrillation as early as possible, both are the key to avoid death.,*treat,Recognize heart

5、 arrest: sudden unconsciousness companied by main artery lose pulse, especially heart sound disappearing is the diagnosis standard. Cry for help: inform the first aid department without delaying CPR. Basic life support (BLS) circulation ,airway, breathing, (CAB) Advanced life support(ALS),Basic life

6、 support must keep effective breath and circulation. It is the first important step in CPR success.,Endotracheal intubation is the best method to set up airway, with which 2 person do CPR to ventilate the patient 810 times every minute.,1. external artificial cardiac compression,Artificial circulati

7、on Method: pose patient supine level, head low and foot high, hard board under the back. Press site locate the point where the line connecting nipples cross the anterior middle line (or the part beyond lower half of sternum).,Put one hand on the press site, the other hand overlap it, palm root keep

8、parallel to long axis of the sternum, fingers dont touch chest wall unbend elbow joints, force shoulder and back to press 5cm vertically, then relax quickly with touching chest wall press time is equal to relaxing time, press frequency is 100/min.,effect marker：ischemia improvement, pupils change sm

9、all to normal, great artery beat can be felt, consciousness reflex, groan, spontaneous respiration,Complication of cardiac compression,Rib fracture pericardial hemorrhage cardiac tamponade pneumothorax, hemothorax pulmonary contusion, liver or spleen rupture, lipid embolism.,AED: automated external

10、defibrillation electric defibrillation should be used as early as possible, it is advocated to be used in BLS,2.Make airway open,仰头抬颏法：use one hand to press forehead, the other hand lift chin, so the patients head is put to hypsokinesis后仰, minding to keep the line from chin apex to earlap vertical t

11、o ground, clear patients mouth.,3. artificial respiration,mouth to mouth breath: nip the patients nares, breath with quietude, completely cover the patients mouth with own mouth, then blow slowly for at least 1 second to insure thorax undulate cardiac compression and artificial breath frequency: 30：

12、2,advanced life support (ALS) 1. correct hypoxia tracheal intubation, mechanical ventilation, oxygen.,2. defibrillation and cardioversion: once find ventricular fibrillation, electric defibrillation with 360 joule should be done. If it is inefficacious, another 5 sets of cardiac compression and vent

13、ilation should be given about 2 min. At same time, administrate 1mg adrenaline intravenously, after that, do electric defibrillation with 360 joule again. If it doesnt succeed, adrenaline is administrated every 35min, defibrillation is given in interval. Synchronously the effort of improving ventila

14、tion and correcting blood biochemical marker are helpful to rebuild stable HR.,3.drug-D: build venous passage for patient of cardiac arrest as early as possible during CPR, Adrenaline, lidocaine and amiodarone can be applied for ventricular fibrillation,. Amiodarone dose: first 150mg is given intrav

15、enously and slowly for 10min, it can be repeated, then IV drop at 1mg/min for 6 hours, sequent 0.5mg/min continue, totally 2 gram can be achieved every day. According to state of an illness, procainamide, metoprolol, magnesium sulfate and calcium gluconate could be chose.,administration route （1）int

16、ravenous administration: after drug administration, normal saline 20 ml is inject to improve drug circulation （2）trachea administration （3）heart cavity administration,Adrenaline: first 1mg iv， repeat 1 time after 35min, if no effect, interval of 35min. b. trachea administration: 22.5mg dilute to 10m

17、l with NS, the directly inject into trachea. Lidocaine: first dose 11.5mg/kg iv,repeating dose is 0.5-1.5 mg/kg after 35min ，total dose may get 3mg/kg, after heart beat restore, maintaining dose is 2-4mg/min。,4. sodium bicarbonate (NB) correct metabolic acidosis: In 10min after cardiac arrest, respi

18、ratory acidosis is dominant, then metabolic acidosis.,Indication of NB complementarity be sure that circulation has stopped for at least 10min be sure that metabolic acidosis and hyperkalemia have occur. About 95 of the drowning show metabolic acidosis depend on blood gas analysis , metabolic alkalo

19、sis even worse.,Manage after CPR,Maintain effective circulation: entirely estimate state of illness, make out correct treatment evaluation. Maintain breath：machine ventilation, oxygen therapy, positive end-expiratory pressure (PEEP).,Prevent and treat cerebral ischemia and edema: the key that CPR su

20、cceed, body temperature decrease to 33-34; cerebral dehydrate ; prevent and treat convulsion; hyperbaric oxygen therapy; promote early cerebral blood flux infusion.,Prevent and treat ARF: maintain heart and circulation function, avoid nephrotoxic drugs. Correct acid-base and electrolytic disturbance

21、, prevent and treat secondary infection.,methods,Cerebral dehydrate: this progress go on with decreasing body temperature, the common drug 20% mannitol, mannitol has better effect to clean brain free radicals. Diuretics can be used together.,Prevent and treat convulsion: ataractic镇静剂 Promote brain blood flux infusion: CCB, researches have testified that CCB can increase cardiac output and relieve nerve tissue damage,Correct hypoxia: hypoxia must occur after cardiac arrest, myocar