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American Heart Association Guidelines for CPR 2015 Wanida Chongarunngamsang, MD. Faculty of Srinakarinwirot University American Heart Association Guidelines for CPR 2015 • BLS • ACLS – Pulseless Arrest – Bradycardia – Tachycardia • Post cardiac arrest care Chains of Survival 2015 (New): Separate Chains of Survival (Figure 4) have been recommended that identify the different pathways of care for patients who experience cardiac arrest in the hospital as distinct from out-of-hospital settings “Chain of Survival” in-hospital cardiac arrest (IHCA) • • • • • Surveillance for cardiac arrest Activate code (multidisciplinary team) Initiate CPR by professional providers Early defibrillation Integrated post cardiac arrest care “Chain of Survival” out-of-hospital cardiac arrest (OHCA) • Immediate recognition of cardiac arrest and activation of the emergency response system • Early CPR that emphasizes chest compressions • Rapid defibrillation if indicated • Effective advanced life support • Integrated post cardiac arrest care Adult Basic Life Support (BLS) Basic Life Support – Used for patients with life-threatening illness or injury before the patient can be given full medical care. – Generally used in the pre-hospital setting, and can be provided without medical equipment. – Generally does not include the use of drugs or invasive skills. . unresponsesive Breathing and pulse 30:2 Check pulse :carotid artery Start Chest compression if no definite pulse within 10 seconds Chest compression Push hard, Put fast กดลึก-- ปล่ อยสุ ด -- อย่ าหยุด-- กดบ่ อย Chest compression Chest compression Chest compression กดลึก 5 cm (2 inches) Full chest recoid Minimal interruption • หลัง defibrillation หรื อ shock ให้ กดหน้ าอกต่อ ไม่ต้อง คลาชีพจร • minimize the frequency and duration of interruptions in compressions • CPR without an advanced airway, goal of a chest compression fraction as high as possible, with a target of at least 60%. Chest compression กดต่อเนื่องด้ วยความเร็ว 100-120 ครัง้ ต่อนาที Airway Head tilt Chin lift Jaw thrust ถ้ าสงสั ย C-spine injury Breathing BLS Dos and Don’ts of Adult High-Quality CPR Rescuers Should Rescuers Should Not perform chest compressions at a Compress at a rate slower than 100/min or faster than 120/min rate of 100-120/min Compress to a depth of at least 2 inches (5 Compress to a depth of less than 2 inches (5 cm) or greater than 2.4 inches (6 cm) cm) Allow full recoil after each compression Lean on the chest between compressions Minimize pauses in compressions Interrupt compressions for greater than 10 seconds Ventilate adequately (2 breaths after 30 Provide excessive ventilation (ie, too many breaths or breaths with excessive force) compressions, each breath delivered over 1 second, each causing chest rise) AED (Automated External Defibrillator) 1. เปิ ดเครื่ อง AED 2. ติด paddle ตามรูป 3. เครื่ องจะทาการวิเคราะห์ว่าให้ shock ได้ หรื อไม่ 4. ถ้ าเครื่ องให้ shock ได้ ให้ กดปุ่ มshock ที่เครื่ อง AED (Automated External Defibrillator) AED ON กดปุ่ มเครื่ องเปิ ด และหมุนปุ่ มAED on AED (Automated External Defibrillator) ติด pad ที่ sternum /apex AED (Automated External Defibrillator) ต่ อสาย electrode pad ต่ อเข้ ากับ electrode cable ของตัวเครื่ อง AED (Automated External Defibrillator) • เครื่ องวิเคราะห์คลื่นไฟฟ้าหัวใจเมื่อเครื่ องวิเคราะห์จะรายงานขึ ้นบน จอภาพว่าเป็ นคลื่นไฟฟ้าหัวใจแบบไหนและจะแนะนาว่าให้ ทา defibrillation ถ้ าคลื่นไฟฟ้าหัวใจเป็ นชนิดVF หรื อVT • ห้ ามสัมผัสผู้ป่วยเนื่องจากเครื่ องจะอ่าน EKG ผิด • ถ้ า EKG เป็ นชนิดVF หรื อVT เครื่ องจะให้ charge พลังงาน • ถ้ า EKG เป็ นชนิด asystole เครื่ องจะให้ CPR ต่อไป 2 นาทีแล้ วจะ analyze EKG ใหม่ AED (Automated External Defibrillator) กดเพื่อทาการ shock Simplified Adult BLS High-quality CPR Adequate rate (100120/minute) Adequate depth Adults: at least 2 inches (5 cm)-2.4 inches (6 cm) Complete chest recoil Minimizing interruptions in compressions Avoiding excessive ventilation Advanced Cardiovascular Life Support: ACLS Advanced Cardiovascular Life Support: ACLS • Pulseless Arrest • Bradycardia with Pulse • Tachycardia with Pulse Pulseless Arrest shock ? Epinephrine 1mg (IV/IO/ET) Hypovolemia Biphasic 120-200j Toxins Monophasic 360j Hypoxia Tamponade Hydrogen ions (acidosis) Tension PTX Hyper/hypokalemia Thrombosis (coronary) Hypothermia Thrombosis (pulmonary) Amiodarone 300 mg—150 mg Pulse/BP EtCO2>40 mmHg A-line wave form 5 Hs, 5Ts > 2 inches (5 cm), < 2.4 inches ( 6 cm) and fast (100-120/min) Bradycardia with Pulse Symptomatic bradycardia Tachycardia with Pulse Narrow regular 50-100 j Narrow irregular 120-200 j Wide regular 100 j Wide irregular DF Quantitative Waveform Capnography • Confirmation and monitoring ETT placement • Evaluating the effectiveness of chest compressions ETCO2 value is at least 10-20 mmHg. • Identification of ROSC • Failure to achieve an ETCO2of greater than 10 mm Hg by waveform capnography after 20 minutes of CPR decide to end resuscitative efforts but should not be used in isolation Capnography Recommendation CPR Quality • Quantitative waveform capnography – If Petco2<10 mm Hg, attempt to improve CPR quality • Intra-arterial pressure – If relaxation phase (diastolic) pressure <20 mm Hg, attempt to improve CPR quality Defibrillator Defibrillator SBP >90 mmHg MAP>65 mmHg BT 32C-36C Ventricular tachycardia Ventricular fibrillation Pulseless electrical activity(PEA) NO PULSE Supraventricular tachycardia New and Updated Recommendations CPR Guideline 2015 • Separate Chain of Survival • Chest compressions at a rate of 100 to 120/min : extremely rapid compression rates with inadequate compression depth • Chest compressions at a depth of at least 2 inches or 5 cm for an average adult, while avoiding excessive chest compression depths (greater than 2.4 inches [6 cm]) New and Updated Recommendations CPR Guideline 2015 • Delivery 1 breath every 6 seconds (10 /min) while continuous chest compression with advance airway • Vasopressin was removed from the ACLS Cardiac Arrest Algorithm • Nonshockable rhythm ,administer epinephrine as soon as feasible (IV/IO/ET) • Targeted temperature management 32C to 36C in 24 hr • The routine prehospital cooling of patients with rapid infusion of cold IV fluids after ROSC is not recommended Thank you