Advanced resuscitation measures
Step 1. Check sasafety: inspect surroundings for danger and wear gloves.
Step 2.
Primary Survey(“C'ABCDE” scheme): to check patient's condition. :-
quick 10 seconds assessment
AVPU Scale Consciousness; Restore airway patency if patient is unconscious;
Breathing - see, hear, feel; Check pulse on the main vessels.
Step 3: Call for help
If there are people around send them to call emergency eg 911 and bring an
Artificial External Defibrillator.
Step 4: CPR
Start of resuscitation : CPR 30:2 (30 chest compressions, then 2 ventilation , repeat
cycle continuously); usually no pulse keys
-The victim is placed on a firm surface (if possible to raise the lower extremities);
begin CPR with quality chest compressions (CC):
-compression is done on the border of the middle and lower third of the sternum;
-to perform compression with perpendicular movements from top to bottom;
-elbows straight, palms one on top of the other;
-fingers raised up ("European castle");
-the frequency of CC - 100-120 min-1;
- Thedepth of CC - 5 (not more than 6 cm).
Use protective devices :- protective film and pocket mask.
Step 5: Start working with AED
Turn on the AED and follow audio instructions.
Remove all clothing surrounding the patient’s chest (including bra).
Apply the included electrode pads to the person’s bare skin. Make sure the
person’s chest is dry.
Allow the AED to analyze the person’s heart rhythm. Make sure no one, including
you, is touching the victim. Touching the victim can interrupt the AED’s analysis.
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Deliver a shock (if needed)
Step 6: Continue CPR and reanalyze
Step 7: if victim recovers place them in Stable Lateral Position
If victim doesn't recover continue listening to the AED until EMS arrives and
takes over the rescue.
When not to use a defibrillator
Heart rhythm disorders that do not require defibrillation:
Asystole recorded on the ECG in the form of an isoline.
Pulseless electrical activity (PEA), which is diagnosed in cases of absence of
pulsation on the main arteries during palpation and lack of consciousness in
combination with the presence of electrical activity of the heart (other than
ventricular tachycardia and ventricular fibrillation).
Heart rhythm disorders requiring defibrillation:
Ventricular fibrillation (VF) - rapid, uncoordinated, and ineffective contractions
of individual groups of ventricular muscle fibers with a frequency of more than
300 / min resulting from multiple chaotic electrical iimpulses RUI of I freq 300
from MCEI
Pulseless ventricular tachycardia (PVT) - characterized by wide QRS complexes
> 0.12 seconds and undifferentiated PR interval.
In children - In the case that VF or PVT is detected, defibrillation with a discharge
of 4 J / kg should be performed. The maximum discharge power for defibrillation
in children should not be more than 10 J / kg.
5. Medical support
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All medications during professional CPR in adults are injected intravenously
(IV) or intraosseously (IO), using a Bone Injection Gun (BIG), EZ-IO or Fast
device.
Medications used
Adrenaline - in the form of a solution of adrenaline hydrochloride (0.1%
solution of 1 ml - 1 mg / ml) or adrenaline hydrotartrate (0.18% solution of 1 ml
- 1.8 mg / ml). Indications and doses: for heart rhythm disorders that do not
require defibrillation - 1 mg, every 2-3 minutes; for heart rhythm disorders
requiring defibrillation - 1 mg after the third ineffective defibrillation, and every
2-3 minutes thereafter.
Indications and doses. For CPR in children use a solution at a dilution of 1: 10000
at a dose of 0.01 mg / kg (0.01 ml / kg). For heart rhythm disorders that do not
require defibrillation - 0.01 ml / kg, every 2-3 minutes; for cardiac arrhythmias
requiring defibrillation - 0.01 ml / kg after the third ineffective defibrillation, and
every 2-3 minutes thereafter.
Amiodarone (Cordarone) - in the form of a solution of amiodarone hydrochloride
(3 ml ampoule - 50 mg / ml). The manufacturer recommends diluting amiodarone
in 20 ml of 5% glucose ssolution Indications and doses: for cardiac arrhythmias
requiring defibrillation at a dose of 300 mg (5 mg / kg) is used simultaneously after
the third ineffective defibrillation, subsequently according to the protocol.
Lidocaine( local anesthetic) - in the form of a solution of lidocaine hydrochloride
(ampoule of 2 ml - 20 mg / ml or 100 mg / ml). Indications and doses: used when
amiodarone is absent at a dose of 1-1.5 mg / kg body weight.
Sodium bicarbonate. To date, the use of this drug is significantly limited.
Thus, according to the latest ERC recommendations, its routine use during CPR is
not recommended, because sodium bicarbonate is a powerful, osmotically active
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burden of sodium on insufficient blood circulation and on the brain, enhances
intracellular acidosis, causes displacement of the left curvature of the left. ffabrics
Indications and doses: 50 mmol (100 ml of 4.2% solution) with prolonged
stopping of circulation (more than 20-30 minutes); with confirmed metabolic
acidosis; at stopping of circulation against the background of hyperkalemia and
poisoning by tricyclic antidepressants.
Calcium chloride. Indications for the use of this drug are sufficiently minimized.
It is recommended for use only if the cardiac arrest is due to possible hyperkalemia
or hypocalcemia and when overdosed with calcium antagonists. Introduced IV
quickly with the possibility of repeated administrations.
During the professional CPR, consideration should be given to the use of
mechanical CC devices in the transportation / treatment of the patient. So, in order
to continue the quality of CC is possible to use a cardio pump(automated cpr
machine).
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Neonatal CPR algorithm:
1. Respiratory depression, decreased muscle tone at heart rate <100 min-1:
- ensure the correct position;
- suck in the contents of the upper airway (if not done before)
- initiate ventilation or lung filling with a mask using air (gestation time
≥ 32 weeks) or 30% oxygen (gestation time <32 weeks);
- assess the child's condition within 30 seconds by criteria (HR, presence
and adequacy of self-breathing, SpO2 / color determination).
2. Respiratory depression, decreased muscle tone at heart rate <60 min -1
against ventilation or lung filling:
- initiate CC (See section 4.2. Algorithm for basic CPR in children) at a
frequency of 90 / min;
- depth of pressing (1/3 of anterior posterior diameter of chest);
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- ratio CC / lung ventilation ratio (3: 1);
- assess the child's condition within 30 seconds.
3. HR <60 min-1 against the background of ventilation and CC:
- introduction of 0.5-1.0 ml / kg 0.01% solution of adrenaline into the
trachea or umbilical vein;
- slow administration of 10 ml / kg 0.9% sodium chloride solution (no
signs of improvement of the newborn, despite the correct and timely
completion of all previous stages of resuscitation; the presence of
symptoms of possible hypovolemia (pallor of skin / mucous
membranes, weak pulse, bradycardia) "White spot"> 4 c) or history of
possible blood loss
(vaginal bleeding, abruption / placental
presentation, etc.);
- assess the child's condition within 30 seconds.
Apgar Score interpretation:
7 - 10 points - good, baby needs standard care;
5 - 7 points - indicates mild asphyxia;
4 - 6 points indicates that these children can be rescued;
1 - 3 indicates - indicates severe asphyxia, this is a clear indication for CPR;
0 points - corresponds to the concept of "stillbirths".
A score of 1 minute after birth (or earlier) should reveal infants need
immediate assistance, evaluation after 5 minutes correlates with rates of neonatal
morbidity and disability. A good prognosis is the dynamics towards increasing the
index by 1-2 points.