Senin, September 28, 2009


Kamis, Agustus 27, 2009

Cardiac Arrest and Resuscitation

Cardiopulmonary arrest results in a rapid decline in oxygen delivery to the brain. Permanent disability or death results if the period of cerebral hypoxia lasts longer than 3 minutes.

Cardioplumonary resuscitation (CPR) is the term used to describe the maintenance of adequate breathing and circulation in a patient who can not do so for him or herself. The aim of CPR is to restore respiration and adequate cardiac output as soon as possible to prevent death or permanent disability. Cardiopulmonary resuscitation involves two types of protocol :

  1. basic life support (BLS) – no special equipment required.
  2. advanced ;ife support (ALS) – requires specialist skill and equipment.

In any type of resuscitation protocol the following three areas must be assessed and supported in order of priority

§ Airway

§ Breathing

§ Circulation


§ If trauma to the cervical spine is a possibility, the airway should be maintained without tilting the head.

§ If there are two operators, one should go for help as soon as possible. If there is only one it is now generally agreed that the victim can be left and the operator should go for help if it has been established that the victim is not breathing.

§ Each rescue breath is given by mouth-to-mouth inflation with the nose occluded, and should deliver approximately 700 mL expirted air into the lungs of the victim. The operator should watch the chest wall of the victim to ensure that it rises and falls with each breath.

§ Assessment of the carotid pulse should take no more than 10 s.

§ If there is no pulse, chest compression are performed by placing the heel of the hand over the lower half of the sternum two fingerbreadths above the xiphoid process. Enough pressure : depress the sternum 4-5 cm.

The rate compression should be 100/min.


Requires specialist training and equipment.

Points to note about ALS :

T he protocol of ALS consists of :

§ 1 – min cycles of CPR in the case of VT.VF.

§ 3 – min cycles in non-VT/VF

Airway ventilation and protection

During these cycles of CPR :

§ Adequate ventilation must be established.

§ The airway must be protected by an operator who remains at the patient’s head.

Placing the defibrillator paddles

§ The right paddle should be placed below the clavicle in the mid-clavicular line.

§ The left paddle should be placed on the lower rib cage on the anterior axillary line.

The VT/VF arm of the ALS algorithm

The three initial shocks are usually 200, 200, and 360 J.. Subsequent shocks are usually all 360 J. After each shock the monitor should be watched. :

§ If the rhythm remains VF/VT the the CPR and defibrillation sequence should continue.

§ If the arryhtmia persists at this stage anti arrythmics can be used.

§ If the monitor shows a flat line after defibrillation this does not necessarily mean asystole has occurred. It is not uncommon for a period of myocardial stunning to occur after defibrillation.

§ If the flat lines persists, CPR should be carried out for 1 min before adrenaline is given to allow the period of stunning to pass.

The non-VT/VF arm of the ALS algorithm

This arm include asystole, electromechanical dissociation, and profound bradyarrythmias. Defibrillation is not required unless VT/VF supervenes and 3-min cycles of CPR are given. During the 3 min, possible underlying causes must be excluded or treated :

§ Asystole is treated initially with i.v. atropine at a maximum total dose of 3 mg and i.v. adrenaline 1 mg.

Bradyarrythmias are treated initialy with atropine in the same way.