cpr 2015
TRANSCRIPT
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LOGO
Paleerat Jariyakanjana, MDEmergency physician
26/1/59
CPR 2015
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ContentsSystems of care and continuous
quality improvementAdult BLS & CPR quality: HCP BLSAdult advanced cardiovascular life
supportPost-cardiac arrest care
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Systems of care and continuous quality improvement
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Components of a system of care
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Adult BLS & CPR quality: HCP BLS
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Immediated recognition and activation of emergency response system
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Chest Compression Depth -updated
2010
> 5 cm
2015
5 – 6 cm
Push Hard !Class I, LOE C-LD
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Chest Compression Rate -updated
2010
> 100
2015
100 – 120 Push Fast !Class IIa, LOE C-LD
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Fully Recoil !do not leaning on chest
Class IIa, LOE C-LD
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Minimizing Interruptions ! -updatedAchieve chest compression fraction
(CCF)
unprotected airway ≥60%
0 9030 60 120
CCF = 105120= 87.5
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Audiovisual Feedback Devices
during CPR
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Delayed ventilationwitnessed OHCA with a shockable
rhythm + EMS
3 cycles of 200 continuous
compressions + passive oxygen insufflation & airway
adjuncts
Class IIb, LOE C-LD
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Respiratory Rate (No advanced airway)
Avoid Hyperventilation !30 : 2 Class IIa, LOE C-LD
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Respiratory Rate (advanced airway) - updated
2010
> 8-10
2015
10 Avoid Hyperventilation !
Class IIb, LOE C-LD
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Team-Based Resuscitation
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Adult advanced cardiovascular life support
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Vasopressors for resuscitationVasopressinNo advantageRemoved from the Adult Cardiac
Arrest Algorithm
EpinephrineASAP
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ETCO2 for prediction of fail resuscitationFailure to achieve an ETCO2 of >10
mm Hg by waveform capnography after 20 min of CPR may be considered as one component of a multimodal approach to decide when to end resuscitative efforts
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Post-cardiac arrest drug therapyLidocaine Inadequate evidence to support the routine
usemay be considered immediately after ROSC
from cardiac arrest due to VF/pVT
ẞ-blockers Inadequate evidence to support the routine
usemay be considered early after
hospitalization from cardiac arrest due to VF/pVT
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Post-cardiac arrest care
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Coronary angiographyshould be performed emergently for
OHCA pt c suspected cardiac etiology of arrest & ST elevation on ECG
Emergency coronary angiography is reasonable for select adult pt who comatose after OHCA of suspected cardiac origin but without ST elevation on ECG
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Targeted temperature management
All comatose adult pt with ROSC after cardiac arrest should have TTM, with a target temperature between 32-36 ◦C selected and achieved, then maintained constantly for at least 24 hr
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Continuing temperature management beyond 24 hrActively preventing fever in
comatose pt after TTM
Out-of-hospital coolingnot recommend
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Hemodynamics goals after resuscitationAvoid and immediately correct
hypotension (SBP <90 mm HG, MAP <65 mm Hg)
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Prognostication after cardiac arrestpt not treated with TTM: 72 hr after
cardiac arrestpt treated with TTM: 72 hr after
return to normothermia
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Organ donationAll pt who are resuscitated from
cardiac arrest but who subsequently progress to death or brain death should be evaluated as potential organ donors.
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THANK YOU