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Resuscitation
1. Resuscitation
and airway
management
By: Dr Basma Mohamed Ghoniem
Lecturer of Anesthesia and Surgical ICU
MD of Anaesthesia and Surgical ICU
Faculty of Medicine
Kafr El Sheikh University
2. Chain of survival
Early recognition prevents:
Cardiac arrests and deaths
Admissions to ICU
Inappropriate resuscitation
attempts
3. The ABCDE approach to
the deteriorating patient
Airway
Breathing
Circulation
Disability
Exposure
4. Airway
The aim of the airway assessment is to establish
and maintain patent airway
The patient’s airway can be clear (if the patient is
talking), partially obstructed (if air entry is
diminished and often noisy) or completely
obstructed (if there are no breath sounds at the
mouth or nose)
5. Airway
Causes of airway obstruction:
CNS depression
Blood
Vomit
Foreign body
Trauma
Infection
Inflammation
Laryngospasm
Bronchospasm
18. Obstructed Airway
A patient who is choking typically has a panicked,
confused or surprised facial expression.
They may run about, flail their arms or try to get
another’s attention.
The patient may place one or both hands on their
throat. This act of clutching the throat is commonly
referred to as the universal sign of choking
20. Obstructed Airway
Encourage coughing forcefully.
If the patient cannot breathe or has a weak or
ineffective cough perform abdominal thrust or
back blows
21. Stand behind the patient, with one foot in front of the other and if possible,
between the patient’s feet. Place the thumb side of your fist against the
middle of the abdomen, just above the navel, and grab the fist with your
other hand.
22. For effective back blows, bend the patient forward at the waist so that the
patient’s upper body is parallel to the ground. Give 5 firm back blows
between the patient’s scapulae.
24. Recognition of circulation problems:
•Look at the patient
•Pulse - tachycardia, bradycardia
•Peripheral perfusion - capillary refill time
•Blood pressure
•Organ perfusion
–Chest pain, mental state, urine output
•Bleeding, fluid losses
25. Treatment of circulation problems:
Airway, Breathing
Oxygen if needed
IV/IO access, take bloods
Call for help
Treat cause
Fluid challenge
26. Acute myocardial infarction
Refers to the necrosis (death) of heart
tissue as a result of insufficient delivery of
oxygenated blood to the heart.
The sooner the signs and symptoms are
recognized and treated, the lesser the
degree of damage to the heart.
Symptoms: chest pain, dyspnea ,nausea
,vomiting, sweating and dizziness
33. CPR for Adults
Conduct a rapid assessment :
check for responsiveness
open the airway, and simultaneously check
for breathing and a carotid pulse for at least 5
seconds but no more than 10.
If no pulse no breath , begin CPR
35. Chest compression
30:2
Compressions
– Centre of chest
– 5-6 cm depth
– 2 per second (100-120 min-1)
Maintain high quality compressions with minimal
interruption
Continuous compressions once airway secured
Switch compression provider every 2 min to
avoid fatigue
38. Automated External
Defibrillators (AED)
1st expose chest , remove hair
Attach pads
anterior/lateral pad
• one pad on the upper right chest, below the right clavicle to the right of
the sternum.
• Place the other pad on the left side of the chest along the midaxillary line
a few inches below the armpit.
anterior/posterior placement
Place one pad to the center of the patient’s chest on the sternum.
Place one pad to the patient’s back between the sc
40. Prepare to let the AED analyze
the heart’s rhythm
plug in the connector and push the analyze
button.
Instruct everyone to stand clear while the AED
analyzes. No one, including you, should be
touching the patient.
As the AED analyzes, switch positions if you are
working with a team. The provider giving
compressions should hover their hands above the
patient’s chest.
41. AED
If the AED advises a shock, again instruct
everyone to stand clear.
The compressor should continue to hover their
hands over the patient’s chest in preparation for
CPR.
Press the shock button to deliver the shock.
47. During CPR
Ensure high-quality CPR: rate, depth, recoil
Plan actions before interrupting CPR
Give oxygen
Consider advanced airway and capnography
Continuous chest compressions when advanced airway
in place
Vascular access (intravenous, intraosseous)
Give adrenaline every 3-5 min
Correct reversible causes
48. summary
Early recognition of the deteriorating patient may
prevent cardiac arrest
Most patients have warning symptoms and signs
before cardiac arrest
Airway, breathing or circulation problems can
cause cardiac arrest
ABCDE approach to recognise and treat patients
at risk of cardiac arrest
Criteria of effective chest compression
Shockable and non shockble rhythm