Prescription For Life

[Music] drugs to stimulate the heart and to combat acidosis should be administered as quickly as possible heart lung resuscitation must be continued without interruption until an effective heartbeat is restored the return of normal color palpable peripheral pulses reactive pupils in a regular electrocardiogram indicate that the resuscitation emergency has been successfully treated although the emergency is over the patient must have careful monitoring and intensive follow-up care to determine the underlying causes of the cardiac arrest and to guard against any recurrence in order to ensure immediate and Optimum cardiopulmonary resuscitation in all emergency situations every Medical Institution must provide a continuing program of Education with training and retraining in the principles and practice of heart lung resuscitation for its entire medical and nursing staff this requires educational materials and training aids for teaching the diagnosis and treatment of cardiac arrest Cardiac Arrest is a sudden cessation of circulation or a sudden inadequacy of circulation in a patient who is not expected to die at that time there are three types of cardiac arrest in the unconscious patient with death-like appearance all of them can be recognized by three Vital Signs and all of them must be treated immediately by applying the ABCs of emergency heart lung resuscitation A and B provide artificial respiration which can be performed anywhere by non-medical or medical persons and without adjunctive equipment the addition of artificial circulation requires special training and intensive supervised practice it should be restricted to specially trained Personnel or to Professional paramedical Medical and nursing personnel definitive procedures include exact diagnosis and treatment they are limited to medical personnel or to paramedical Personnel under medical supervision the medical dental and nursing professions must be well trained in performance of all of the ABCDs the first consideration is always a the airway is open x-rays show the tongue attached to the floor of the mouth and the mandible in the unconscious patient the mandible drops back and the tongue obstructs the pharynx lifting the neck and extending the head draws the mandible and tongue forward and opens the airway as demonstrated in this cadaver dissection obstruction of the pharynx by the Tongue can be corrected in several ways the mandible can be grasped and lifted in order to elevate the tongue another way to accomplish the same result is to push the jaw forward in this manner but the simplest method is to tilt the head backwards into maximum extension if spontaneous breathing does not presume after the airway has been opened begin B breathing for the patient to perform mouth-to-mouth resuscitation pinch the nose open your mouth widely make a Tight Seal around the patient's mouth and inflate his lungs until you see the chest rise remove your mouth to allow exhalation then take a deep breath and repeat the cycle approximately every five seconds for mouth to nose resuscitation keep the head extended seal the patient's mouth take a deep breath and inflate the lungs by blowing into the nose with each breath you will feel the lungs expand and see the chest rise if breathing does not presume check the Carotid pulse and the status of the pupil a normal pupil constricts when exposed to light following Cardiac Arrest the pupil dilates but temporarily remains reactive a dilated and fixed pupil indicates serious brain damage when there is apnea of death-like appearance imperceptible pulse and widening pupils The Rescuer must immediately begin C circulation for the patient external cardiac compression results in effective artificial circulation because the heart is compressed between the sternum and the spine the heel of one hand is placed over the lower one half of the sternum but not on the xiphoid process the other hand is positioned on top of it and the lower sternum is compressed one and one-half to two inches at a rate of once a second this requires 80 to 120 pounds of pressure exerted almost vertically downward uniformly and without interruption note that only the heel of one hand compresses the lower sternum and that the fingers do not touch the chest proper hand position avoids pressure over the xiphoid portion of the sternum and minimizes the danger of laceration of the liver rhythmic compression of the heart moves blood through both the pulmonary and systemic circuits when artificial circulation is required it must be combined with artificial respiration in order to assure effective resuscitation when there are two Rescuers the lungs should be inflated after each five chest compressions the superimposed airway pressure tracings illustrate this five to one ratio of compression to ventilation ideally the ventilation should be interposed quickly between each five compressions so that the rhythm of compression remains regular uniform and uninterrupted one and one half to two inches movement of the sternum can provide a carotid blood pressure of over 100 millimeters of mercury and one third of the normal blood flow to the brain during Cardiac Arrest any pause in external cardiac compression results in a precipitous drop in blood flow and blood pressure this demonstration of five second pauses emphasizes the necessity for a continuous uniform uninterrupted rhythm 80 to 120 pounds of pressure is required to depress the sternum one and one-half to two inches on an adult less than this is usually inadequate and results in a significant reduction in blood flow and blood pressure a chest compression rate of once a second should be maintained at all times when the compression rate is too slow even though the chest pressure is adequate the mean blood flow and pressure will be reduced these errors can be avoided by following the recommended technique for heart lung resuscitation Optimum Effectiveness can be achieved by use of proper rate 60 chest compressions and 12 lung ventilations per minute the ratio should be one ventilation into poles without a pause between each five chest compressions the Rhythm should be smooth even regular and uninterrupted with compression and relaxation of equal duration external cardiac compression may not be effective in some conditions these include crushing injuries of the chest cardiac tamponade severe emphysema tension pneumothorax in such cases direct internal cardiac massage should be used in conjunction with artificial respiration for this the chest is quickly opened in the left fourth intercostal space the heart can then be squeezed between the heel and fingers of one hand between the two hands or between one hand and the sternum internal massage should also be regular smooth and uninterrupted it is mandatory that all Personnel have adequate training on lifelike mannequins in the ABC principles of heart lung resuscitation training mannequins must be designed to stress the important details of heart lung resuscitation lift the neck tilt the head open mouth widely pinch the nose make a Tight Seal inflate through the mouth or inflate through the nose when there are two Rescuers interpose one breath between each five chest compressions compress the chest one and one half to two inches to produce a manometer reading of 100 millimeters of mercury when there is only one rescuer present he must compress the chest 15 times and then quickly inflate the lungs twice an infant mannequin can also be used for training in resuscitation the principles are similar except that The Rescuer covers the mouth and nose and uses only small puffs of air to inflate the lungs 20 to 25 times per minute artificial circulation is produced by using two fingers to compress the middle third of the sternum the other hand can be slipped onto the thorax to provide Firm support the compression rate should be faster about 100 times per minute with breaths interposed after each five compressions endotracheal intubation is useful during resuscitation emergencies however it requires a thorough anatomic knowledge of the upper Airway and larynx it should be reserved only for those who are trained and competent in the procedure an intubation mannequin with anatomic details of the upper Airway can be used to practice endotracheal intubation and to develop the speed and proficiency which are required in a resuscitation emergency of various types of mechanical breathing devices can also be used to produce artificial respiration bag valve mask units are effective for inflating the lungs manually they deliver a specific volume to the lungs with each breath and duplicate mouth to mouth resuscitation the superimposed tracing show the effectiveness of volume cycle units for ventilation of the lungs when external chest compression is applied mouth-to-mouth breathing and bag valve bass devices deliver a specific volume and allow breath to be interposed between compressions without any pauses when Hospital types of automatic pressure cycle breathing devices or rescue types of automatic pressure cycle devices are used they work effectively for either assisted breathing or artificial respiration only however when external cardiac compression is used in conjunction with pressure cycle devices the unit is triggered with every compression and adequate lung inflation is never achieved therefore do not use pressure cycle devices during external cardiac compression unless they are manually triggered to provide interposed ventilation when mechanical resuscitators are available they assure uniform performance without interruption for prolonged resuscitation and transportation the unit provides backward tilt of the head and volume cycled artificial respiration artificial circulation is produced by a compressor mounted on a chest strap which secures the patient to the shoulder lift and prevents movement and malposition one rescuer must always remain at the patient's head when they are used as soon as the ABCs have been started attention should be directed to D definitive procedures diagnosis of the exact status of the heart is made from an oscilloscopic or electrocardiographic tracing the normal heartbeat produces a well-known electrocardiogram and blood pressure tracing when cardiovascular collapse occurs the heartbeat is weak and the pulse and blood pressure may be imperceptible even though the electrocardiogram maintains a rhythmic pattern ventricular fibrillation is an uncoordinated and ineffectual beating of the individual muscle fibers of the heart it is diagnosed by an erratic and uncoordinated electrocardiogram with absent pulse and blood pressure in cardiac standstill there is no effective heartbeat blood pressure and flow are absent and there is no electrical activity of the heart the treatment of cardiac arrest usually requires the administration of drugs emergency drugs can be given before or after the diagnosis is established the pH of arterial blood Falls rapidly following Cardiac Arrest even during effective and continuous heart lung resuscitation this is shown here by the black tracing to prevent this acidosis sodium bicarbonate should be administered throughout the resuscitation emergency as shown in the red tracing sodium bicarbonate also produces an increase in blood flow in the Carotid circulation to the brain with minimal alteration in blood pressure epinephrine produces a marked increase in blood pressure and pulse pressure in the carotid arteries it also improves myocardial tone as shown by increased pulse pressure the simultaneous administration of sodium bicarbonate and epinephrine enhances both blood flow and blood pressure in the Carotid circuits these are the two most effective drugs in the immediate treatment of cardiac arrest calcium gluconate improves myocardial tone and increases the pulse pressure this is especially useful in re-establishing effective perfusion after the heartbeat has been restored these emergency drugs can be administered directly into the left ventricle however this route requires an interruption in external cardiac compression which should be avoided a cut down can be performed quickly at the ankle in front of the medial malleolus this can be accomplished without any interruption in external cardiac compression if the heart is in ventricular fibrillation it must be defibrillated this can be done with defibrillators of the alternating current or direct current type this direct current defibrillator is provided with a meter for setting the electrical charge and with large external electrodes for delivering the shock external cardiac compression is continued without interruption while preparations are made to defibrillate the heart saline soaked gauze pads are placed over the standard position where the electrodes are to be applied quickly apply the electrodes with 15 to 25 pounds pressure and deliver the shock quickly resume resuscitation and continue it until a peripheral pulse can be palpated repeated shocks May sometimes be required in addition to the ABCD principles of resuscitation there is one rule that applies to all cardiopulmonary resuscitation emergencies never interrupt heart-lung resuscitation for more than five seconds for any reason now to assure proper performance a complete training program in cardiopulmonary resuscitation must include well-supervised practice on training mannequins by all personnel [Music] resuscitation emergencies can occur anywhere in the hospital not just in the operating room emergency room or intensive care unit therefore it is important that every hospital set up a program so that all doctors nurses and professional paramedical Personnel are trained as part of the resuscitation team which may be called into action at any time foreign help remove the pillow stand the head begin mouth-to-mouth resuscitation keep the nose pinched take deep breaths watch the chest rise [Music] the alert is started pre-arranged auditory and visual signals are flats [Music] special team is called [Music] when there is only one rescuer compress the chest 15 times and then quickly inflate the lungs twice [Music] as soon as possible a bed board should be used to provide a Firm support beneath the patient when available in ordinary serving tray can be used for this purpose when there are two Rescuers use a five to one ratio of compression to ventilation press straight downward over the lower half of the sternum as soon as manual resuscitation has been started and is being performed effectively a Buck could be performed and the oscilloscope connected in order to determine the cardiac status sudden collapse after a leg injury suggests the possibility of a pulmonary embolism resulting in a circulatory insufficiency [Music] an anesthetist is dispatched from surgery and the trachea is incubated remember never pause more than five seconds resume resuscitation immediately [Music] the cut down is complete drugs are being administered [Music] foreign check the Carotid pulse check the oscilloscope there is a weak regular tracing but no pulse it's probably a pulmonary embolism with cardiovascular collapse memory resuscitation is continued while additional drugs are given there is a weak pulse now and the electrocardiogram has improved the patient has been successfully resuscitated artificial respiration and artificial circulation can be discontinued while preparations are made for further diagnostic tests and treatment [Music] effective cardiopulmonary resuscitation can be started outside of a hospital by a well-trained team of professional paramedical personnel and the same ABC principles are used extend the head begin artificial ventilation check the pulse check the pupils begin external cardiac compression interposed breaths after each five chest compressions a bag and mask device can be used when available [Music] manual heart lung resuscitation is continued while preparations are made to move the victim [Music] a portable mechanical unit can provide effective resuscitation during movement and transportation of the victim every effort must be made to avoid interruptions in resuscitation all right [Music] [Music] foreign [Music] must always remain with a victim to keep the head extended and the airway open to check the pulse and the pupils and to assure adequate ventilation and compression during transportation to the hospital [Music] artificial respiration and artificial circulation are continued as preparations are made for Divinity treatment the trachea is incubated with only a brief interruption in pulmonary ventilation [Music] the oscilloscope shows the patient to be in ventricular fibrillation sodium bicarbonate and epinephrine are administered intravenously saline pads are applied to the standard chest positions and the defibrillation charge is delivered a palpable pulse when external compression is discontinued signals a successful resuscitation [Music] remember these principles careful adherence to them will help you fulfill the prescription or life thank you