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Chapter: Clinical Anesthesiology: Perioperative & Critical Care Medicine: Cardiopulmonary Resuscitation

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Cardiopulmonary Resuscitation

One goal of anesthesiology is to maintain the function of vital organ systems during surgery.

Cardiopulmonary Resuscitation

One goal of anesthesiology is to maintain the function of vital organ systems during surgery. It is not sur-prising, therefore,  that anesthesiologists have played a major role in the development of cardiopulmonary resuscitation techniques outside the operating room. Cardiopulmonary resuscitation and emergency cardiac care (CPR-ECC) should be considered any time an individual cannot adequately oxygenate or perfuse vital organs—not only following cardiac or respiratory arrest.

The 2010 CPR-ECC guidelines have been updated with new evidence-based recommendations. Still of import to the layperson are that the pulse should not be checked, and chest compression without ventila-tion may be as effective as compression with venti-lation for the first several minutes. If a lay rescuer is unwilling to perform mouth-to-mouth ventilation, chest compressions alone are preferred to doing nothing. For the health care provider, defibrillation using biphasic electrical current works best and tra-cheal tube (TT) placement should be confirmed with a quantitative capnographic waveform analysis. More importantly, in the new guidelines, emphasis has been placed on the quality and adequacy of compressions, minimizing interruption time of compressions and the preshock pause (the time taken from the last com-pression to the delivery of shock).

 

The sequence of steps in resuscitation has been changed in the 2010 guidelines from ABC (air-way and breathing f rst,i before compression) to CAB (compressionf irst, withairwayand breath-ing treated later). Emphasis has also been placed on physiological monitoring methods to optimize CPR quality and return of spontaneous circula-tion (ROSC). The rule of tens and multiples can be applied: less than 10 s to check for pulse, less than 10 s to place and secure the airway, target chest com-pression adequacy to maintain end-tidal pressure of carbon dioxide (Petco2) greater than 10, and tar-get chest compression to maintain arterial diastolic blood pressure greater than 20 and central venous oxygen saturation (Scvo2) greater than 30. Changes in drug recommendations are notable for exclusion of atropine in the settings of pulseless electrical activity (PEA) and asystole, addition of the use of chronotropic drug infusions as an alter-native to pacing in unstable/symptomatic bradycar-dia, and recommendation for use of adenosine in the management of wide-complex monomorphic tachycardia.

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