stopul cardio resp resuscitare
TRANSCRIPT
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Dr. Cobzariu Iosif Florin - 2012
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STRESSCR
CATECOLAMINE
VASOCONSTRICŢIE
(HIPOXEMIE)
ANOXEMIE
METABOLISM AEROB METABOLISM ANAEROB
TOXINEAc. PiruvicAc. Lactic
NH3
RO
INTOXICAŢIE,DECES CELULAR
PREMIZE
3 ATP 2 ATP
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MAX. 80% din spontan
Oferta şi consumul tisular de oxigen (activitate spontană C-P):
Debitul cardiac = 5 L/min.Hemoglobină = 150 g/L.
sânge arterial sânge venos
DO2 = 1000 ml/min
SaO2 = 100%
PaO2 = 20 vol%
SvO2 = 75%
PvO2 = 15 vol%
Consum tisular de O2 = 250 ml/min.
O2
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RCP
• Ansamblu de metode prin care se asigură un minim aport de oxigen în axul vital central: cord-pulmon-cortex.
• “Per se”, nu restartează cordul sau pulmonul !
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RCP• Eficacitate optimă = maxim 80% din
valoarea activităţii spontane C-P !
• Cu cât este mai precoce, cu atât se pierd mai puţini neuroni şi se evită leziuni ireversibile ale miocardului şi pulmonilor !
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RCP• Are două componente:
SVB = RCP “cu mâinile goale”
SVA = SVB + tehnici specifice:de ex. – AbVP (C), SEE, IO(N)T...
+ suportul material al lor:de ex. – perfuzor, DEFI, tub traheal ...
+ medicamente:de ex. – adrenalină, amiodaronă ...
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LANŢUL SUPRAVIEŢUIRII
OXIGEN – DA ! TIMP PIERDUT – NU !
112 SVB DEFI SVA
DG
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SUPORTUL VITAL DE BAZĂ (SVB)
RESUSCITARE CARDIO-PULMONARĂ“CU MÂINILE GOALE”
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SVB ASIGURARECONSTIENŢA ?
Ajutoooor !!!RESPIRAŢIE ?
PULS ?(+/- PLS)
!!! ALARMARE (112, 961) DOUĂ INSUFLAŢII
RESTARTARE CAS LIBERE CAS OBSTRUATE
MONITORIZARE RCP DEZOBSTRUCŢIE
RCP
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SVBASIGURARE
CONSTIENŢA ?Ajutoooor !!!
RESPIRAŢIE ?PULS ?(+/- PLS)
!!! ALARMARE (112, 961) DOUĂ INSUFLAŢII
RESTARTARE CAS LIBERE CAS OBSTRUATE
MONITORIZARE RCP DEZOBSTRUCŢIE
RCP
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SVB - ASIGURARE
ASIGURAREA SALVATORULUI
+/-ASIGURAREA
VICTIMEI
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SVBASIGURARE
CONSTIENŢA ?Ajutoooor !!!
RESPIRAŢIE ?PULS ?
(+/- PLS)!!! ALARMARE (112, 961)
DOUĂ INSUFLAŢII
RESTARTARE CAS LIBERE CAS OBSTRUATE
MONITORIZARE RCP DEZOBSTRUCŢIE
RCP
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SVB – CONŞTIENŢA ?
AFLAREA STĂRII DE CONSTIENŢĂ
PĂSTRATĂPIERDUTĂ PLS
(SALVATOR UNIC)
Stimuli: vizuali, auditivi !!!
OBSERVARE
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SVBASIGURARE
CONSTIENŢA ?
Ajutoooor !!!RESPIRAŢIE ?
PULS ?(+/- PLS)
!!! ALARMARE (112, 961) DOUĂ INSUFLAŢII
RESTARTARE CAS LIBERE CAS OBSTRUATE
MONITORIZARE RCP DEZOBSTRUCŢIE
RCP
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SVB – Ajutooor !
AL DOILEA SALVATOR ?!
DA NU
PLS
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SVBASIGURARE
CONSTIENŢA ?Ajutoooor !!!
RESPIRAŢIE ?PULS ?
(+/- PLS)!!! ALARMARE (112, 961)
DOUĂ INSUFLAŢII
RESTARTARE CAS LIBERE CAS OBSTRUATE
MONITORIZARE RCP DEZOBSTRUCŢIE
RCP
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SVB – RESPIRAŢIE ?
PRIVEŞTE !
SIMTE ! ASCULTĂ !
PREZENTĂ ABSENTĂ
OBSERVARE RESPIRAŢIEARTIFICIALĂ
R
10’’
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SVBASIGURARE
CONSTIENŢA ?Ajutoooor !!!
RESPIRAŢIE ?
PULS ?(+/- PLS)
!!! ALARMARE (112, 961) DOUĂ INSUFLAŢII
RESTARTARE CAS LIBERE CAS OBSTRUATE
MONITORIZARE RCP DEZOBSTRUCŢIE
RCP
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SVB – PULS ?
PREZENT ABSENTOBSERVARE CT
Adult → A. CarotidăCopil → A. BrahialăS + NN → A. Femurală
Laici: TOTALA NEMIŞCARE A VICTIMEI !
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SVBASIGURARE
CONSTIENŢA ?Ajutoooor !!!
RESPIRAŢIE ?PULS ?
(+/- PLS)!!! ALARMARE (112, 961)
DOUĂ INSUFLAŢII
RESTARTARE CAS LIBERE CAS OBSTRUATE
MONITORIZARE RCP DEZOBSTRUCŢIE
RCP
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SVB – +/- PLS ?
POZIŢIA LATERALĂ DE SIGURANŢĂ
Dacă: - B. INCONŞTIENT,- EXISTĂ DOAR UN SINGUR SALVATOR
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SVB – +/- PLS ?
Indicaţii:- toţi b. inconştienţi neintubaţi;- poziţie de aşteptare şi transport pentru b. inconştienţi neintubaţi;- poziţie de examinare pentru pacienţi în status convulsiv;
!!! Pentru prevenirea
BRONHOPNEUMONIEI DE ASPIRAŢIE
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SVBASIGURARE
CONSTIENŢA ?Ajutoooor !!!
RESPIRAŢIE ?PULS ?
(+/- PLS)
!!! ALARMARE (112) DOUĂ INSUFLAŢII
RESTARTARE CAS LIBERE CAS OBSTRUATE
MONITORIZARE RCP DEZOBSTRUCŢIE
RCP
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SVB – ALARMARE !!! (112)
60 ’’• Foarte importantă !!!• Un singur salvator – RCP ~ 10-12` (15)` (??)• Doi salvatori – zeci de minute !• Comunic: LOCAŢIE, caz, +/- date personale
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SVB ASIGURARECONSTIENŢA ?
Ajutoooor !!!RESPIRAŢIE ?
PULS ?(+/- PLS)
!!! ALARMARE (112, 961)
DOUĂ INSUFLAŢII
RESTARTARE CAS LIBERE CAS OBSTRUATE
MONITORIZARE RCP DEZOBSTRUCŢIE
RCP
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SVB – DOUĂ INSUFLAŢII
• Pot restarta cordul şi pulmonul• Tehnica: (este tehnica RA)
- tripla manevră Saffar:1. Heper-extensia capului2. Subluxaţia mandibulei (+/-)3. Pensarea narinelor- 2 insuflaţii (2 sec. cu pauză 4 sec.):1. Inspir profund (la capacitate)2. Apnee + ocluzie perfectă3. Exhalare cu glota deschisă
(refren)
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SVB – DOUĂ INSUFLAŢII
• Decelează eventuala obstrucţie a CAS:
LIBERE + S.R. OBSTRUATE
RA DEZOBSTRUCŢIE
ET. 1 (CAVITATE BUCALĂ) – VIZUAL + MANUALET. 2 (SUPRAGLOTIC) – HEIMLICH + VARIANTEET. 3 (SUBGLOTIC) – TIRO-CRICOTOMIEET. 4 (TRAHEAL) – TRAHEOSTOMIE 4×15
s
A
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SVBBreathing (respiraţie):- recunoaşterea SR: PAS- respiraţie artificială (tehnica anterior):- gură la gură- gură la nas (nas-gură)- gură la stomă- gură la obiecte intermediare- frecvenţă recomandată: 18 - 20 vc / min.
IDEAL = 24 vc / min. ! ⇒ 12 insuflaţii/min.
B
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SVBStop cardiac:clase:
FV / TVFP NU FV / TVFP(bradi-asistolie)(act. el. fără puls)Compresiuni toracice:- unde ?- cum ?- profunzime ?- frecvenţă: 100 (adult), 120 (c,s,nn) / min.
C
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RATA v/c
Adult = 2 / 30
Copil = 2 / 15 (doi salvatori)1 / 5 (un salvator)
S + NN = 1 / 3
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RATA v/c
IDEAL 1 / 6 (1 / 7)( 2” / 3” = 5” 12 cicluri/min.)
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... CERCETĂRILE CONTINUĂ !!! ...
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Întrebări ???
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SVB – DEFI PRECOCE
• Restart cord (TMR) → 34% (50%-75%) cazuri;• Date tehnice: generaţii, tipuri de şoc (sinc., asinc.)• Un singur şoc - monofazic – (actual în dotare),
- bifazic - ideal (tensiune scăzută) Distanţa între şocuri: = 2 minute → RCP.• Comentarii: - lovitura precordială (stim. fiz. mec.)
- pace-maker extern (discrepanţă)• Concluzii: cercetări în curs !?
D
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SVB – DEFI PRECOCE DSCR adult
SVB
LOVITURĂ PRECORDIALĂ
DEFI monitor ritm cardiac ?FV/TVFP Nu FV/TVFP
DEFI-1
RCP2 min
RCP 3 min
• verifică padelele/gel/contact/poziţie
• IO(N)T, AbVP(C)• medicamente• repetă lovitura precordială• pacing extern
- 6H-6T – detectare + contracarare
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SUPORTUL VITAL AVANSAT (SVA)
SVA = SVB + tehnici specifice:de ex. – AbVP (C), SEE, IO(N)T...
+ suportul material al lor:de ex. – perfuzor, DEFI, tub traheal ...
+ medicamente:de ex. – adrenalină, amiodaronă ...
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SVA - AIRWAY
- EXPLORARE INSTRUMENTALĂ
- EXTRACŢIE CORPI STRĂINI
- IO(N)T - indicaţii- tehnica- incidente- complicaţii
A
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SVA - BREATHING
→ O2-terapia:(Puls-oximetru SaO2)SaO2% ml% l/min
100-95 - -
95-90 40-60 4-6 (3-5)
90-85 60-80 6-8
85 100 10-12
B
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SVA - BREATHING
O2-terapia:
• - oxigen umidifiat (1/3 alcool+2/3 apă)
• - oxigen intermitent:reprize de 10-15 min., + pauză 5-10 min.
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SVA – CORD
• AbVP (C)• Utilizare de medicamente:- ADRENALINA: 1 mg la 3 min. (nu peste 10 mg)
- AMIODARONA: 300 mg, bol atac, apoi 150 mg la 3-5 min.(LIDOCAINA: 1,0-1,5 mg/kgc i.v.; pentru FV refractară: se adaugă 0,5-0,75 mg în bol, cu repetare la 10-15 min, doză totală = 3 mg/kgc.)- ATROPINA: 1 mg la 3-5 min. (d.t. 30-40 mg/kgc(midriaza fixă midriaza areactivă)
C
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SVA - DG. DIFEREANŢIAL
Hipoxie ToxicHipovolemie TamponadăHipotermie Tensiune (PNO în…)Hiper H+ Tromboză (SCA)Hipo-, Hipergliemie Tromboză pulmonarăHipo-, Hiper K-emie Traumă (politraumă)
D
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DG. DIFEREANŢIAL CAUZAL
Hipoxie
O2-terapie
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DG. DIFEREANŢIAL CAUZAL
Hipovolemie
Reumplere vasculară- cu ce ?- cu cât ?- în cât timp ? - cum ?
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DG. DIFEREANŢIAL CAUZAL
Hipotermie < 35 °C
Reîncălzire- internă- externă
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DG. DIFEREANŢIAL CAUZAL
Hiper H+ = ACIDOZĂ
Bicarbonat de sodiu
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DG. DIFEREANŢIAL CAUZAL
HiperglicemieInsulină - 20 UI → A- 12 UI → C- 6 UI → S- 3 UI → NN
Hipoglicemie – glocoză 33% 6-7 f
Incertitudine → se administreză G 33%
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DG. DIFEREANŢIAL CAUZAL
HiperpotasemieFurosemid 20-40 mg atac + repetare 20 mg la fiecare 20-30 min
Hipopotasemie KCl 1 mEq / kgc.
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DG. DIFEREANŢIAL CAUZAL
Toxic (intoxicaţii)
- toxic cunoscut +/- antidot
- toxic necunoscut monitorizarea FV
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DG. DIFEREANŢIAL CAUZAL
Tamponada
- PUNCŢIA PERICARDICĂ
! (nu mai mult de 10 - 20 ml/min.)
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DG. DIFEREANŢIAL CAUZAL
Tensiune (PHO în tensiune)
- PUNCŢIA PLEURALĂ
! (nu mai mult de 30 - 50 ml / min.,
în prespital, apoi cu monitorizarea K-emiei)
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DG. DIFEREANŢIAL CAUZALTromboza coronariană (SCA)O – xigenA – spirină 300 mg PON – itrat 1-2 cp SL sau 1-2 pufA – ntalgic Algocalmin, Piafen, Fortralβ – blocant Metoprolol 50mg PO sau 5 mg IVD
Tromboliză: potenţă (?), timp “de aur”
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DG. DIFEREANŢIAL CAUZAL
Tromboza pulmonară(= tromboembolia pl, cordul pulmonar acut, infarct pl.)
Heparină: - atac cu 4000 ui. i.v.d.apoi,- 1000 ui într-o p.e.v. de 1 oră
Tromboliză: potenţă (?), timp “de aur”
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DG. DIFEREANŢIAL CAUZAL
Traumă (politraumă)
- imobilizarea cervicală – prim gest- hemostază- RCPC
- alte imobilizări- transport asistat de mare urgenţă
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Întrebări ???