Professional Documents
Culture Documents
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DEFINITIONS
Respiratory arrest =
Cardiac arrest =
Clinical death =
Biological death =
Cerebral death =
Persistent vegetative state =
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understanding physiopathology
of cardio-pulmonary arrest correct CPR
efficient CPR
RESPIRATORY ARREST
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Oxygen reserve in the moment of respiratory arrest (PAO2 şi PaO2)
Miocardial capacity to sustain hypoxemia
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CARDIAC ARREST
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INDICATIONS of CPR:
Respiratory arrest
Cardiac arrest
Cardio-respiratory arrest
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DEFINITION
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Phases of CPR:
Basic life support
± First phase of CPR;
± Goals:
Artificial delivery of oxygenated blood to systemic circulatory beds;
Prevention of irreversible brain damage;
Preservation of chances for successful resuscitation;
Return of spontaneous circulation;
± Provided without medical equipment (³with bare hands´);
Advanced life support
± The second/first phase of CPR;
± Goals:
Preservation of vital organ function;
Return of spontaneous circulation;
Postresuscitation stabilization;
Cerebral protection;
± Provided using equipment, drugs and medical devices.
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BLS ALGORHYTHM
1. Evaluation of consciousness
2. Activation of emergency medical system
3. Victim positioning
4. Airway maneuvers
5. Assessment of spontaneous breathing
6. Artificial ventilation Artificial ventilation
7. Assessment of circulation
8. Chest compresion
9. CPR sequence: 15 chest compressions /2 artificial breath
(no matter the number of rescuers)
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Y
± for a pulmonary gas exchange (pulmonary blood flow decreased)
± encrease the intrathoracic pressure
± decrease the cardiac upload
± decrease the efficience of chest compresions
± stomach insuflation (encrease the risk of regurgitation/aspiration, push up the
diaphragm and encrease the intrathoracic pressure)
Y
± CPR performed by trainned medical team ± total time of interupting chest
compresions 24-49% of the cardiac arrest duration.
± Any interuption in chest compresions means the decrease of coronary
perfusion pressure, which slowly rises when the chest compresions are
delivered once again, and so the chances of returning to spontaneous
circulation are decreased.
± In the first minutes of cardiac arrest (VF) the artificial ventilation is not so
important as the chest compresions because the hipoxy is primary caused by
the lack of tissulary perfussion, and there are sufficiently blood O2 rezerves
in the first minutes. That is why the rescue person should concentrate in
delivering efficient chest compresions. The new recommendations regarding
the sequence chest compresions/ventilation 30:2 are made to minimalise the
time of chest compresion interuptions.
Y AIRWAY MANEUVERS:
± Should be applyied in case of any unconscious victim;
± Should preceed assessment of spontaneous breathing;
± Should be maintained during assessment of spontaneous breathing;
± Should preceed artificial ventilation;
± Should be maintained during artificial ventilation;
Y AIRWAY MANEUVERS:
DURING BASIC LIFE SUPPORT:
± Safety position
± Head tilt
± Chin lift
± Head tilt and chin lift
± Subluxaţia anterioară a mandibulei
± Subluxaţia anterioară a mandibulei şi deschiderea gurii
± Hiperextensia capului, subluxaţia anterioară a mandibulei şi deschiderea gurii (tripla
manevră Safar);
± Îndepărtarea corpilor străini solizi (deget cârlig) sau lichizi (poziţie laterală a capului şi
deget înfăşurat în pânză)
DURING ADVANCED LIFE SUPPORT:
± Airway devices
± Tracheal intubation
Y AIRWAY MANEUVERS:
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Know the mechanism of injury
± Strangulation
± Cădere de la înălţime
± Deceleration or acceleration s.o.
Traumaticsigns
± At the cephalic extremity
± In the cervical region
± In the region of thorax (the superior 1/3)
± So, superior to the intermamelonary line
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Y AIRWAY MANEUVERS:
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BASIC LIFE SUPORT:
± Safety position
± Hiperextension of the had
± Chin lift
± Head tilt and chin lift
± Subluxaţia anterioară a mandibulei
± Subluxaţia anterioară a mandibulei şi deschiderea gurii
± Hiperextensia capului, subluxaţia anterioară a mandibulei şi deschiderea gurii
(tripla manevră Safar);
± Îndepărtarea corpilor străini solizi (deget cârlig) sau lichizi (poziţie laterală a
capului şi deget înfăşurat în pânză)
ADVANCED LIFE SUPPORT: :
± Airway devices
± Traceal intubation
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± visualising the endotrachel tube passing through vocal
cords
± simetrical thoracic expansions
± equal respiratory sounds on bouth lungs
± water vapors on the inside surface of the endotracheal tube
± the abscence of aeric sounds in epigastric region
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± Current volume 6-8ml/kg
± Frecquence 8-10/minute
± Oxigen 100%
± No PEEP
± No interuptions of chest compressions for
ventilation
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ADULT
| MEDICATION:
Routes for drug administration
± Peripheral intravenous access ± standard route
± Central intravenous access
± Intratracheal administration
± Intraosseous administration
± Intracardiac administration
Drugs:
± Oxygen
± Epinephrine
± Atropine
± Lidocaine
± Vasopresine
± Sodium bicarbonate
± Amiodarone
± Procainamide
± Magnesium sulphate
± Dopamine
± Volume solutions
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ELECTROCARDIOGRAPHY:
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DEFIBRILAREA:
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DEFIBRILLATION:
± Goal
± Defibrillation technique:
Patient position
Rescuer position
Paddles preparation and position
³Clear´ order
Energy
Checking for efficiency
± Indications
± Differences cardioversion/defibrillation:
Synchronic/asynchronic shock
Preparations
Energy
Indications
TEHNICA DEFIBRILĂRII:
± Poziţia pacientului
± Poziţia resuscitatorului
± Pregătirea şi poziţionarea padelelor
± Atenţionarea
± Energia utilizată
± Verificarea eficienţei
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