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In Hospital CPR

The document outlines the steps for performing in-hospital CPR, including checking for danger, response, shouting for help, opening the airway, checking breathing, and starting chest compressions. It then describes using a defibrillator to shock if needed, continuing CPR for 2 minutes between shocks. The document provides details on airway management, medication administration, and post-ROSC care and fluid resuscitation.

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Daniel Yap
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25 views4 pages

In Hospital CPR

The document outlines the steps for performing in-hospital CPR, including checking for danger, response, shouting for help, opening the airway, checking breathing, and starting chest compressions. It then describes using a defibrillator to shock if needed, continuing CPR for 2 minutes between shocks. The document provides details on airway management, medication administration, and post-ROSC care and fluid resuscitation.

Uploaded by

Daniel Yap
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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⚕️ MEDICINE Emergency Medicine Advanced Life support

IN HOSPITAL CPR
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Steps -
D - Danger
R - Check response
S - Shout for help
A - Airway - head tilt (4 fingers), chin lift (2 fingers on mandible)
B - Breathing - check - 1 in 1000 x till 10 in 1000
C - circulation - start high quality CPR
30 compressions : 2 breaths from ambu bag ( C around the cuff, E
near mandible and tilt head)
minimal interuptions
5 to 6cm depth, 100 to 120 rate, good recoil
D - Defibrillator
IN the outside setting - AED to shock -
Power - green button
Patches - 2 patches - one on the right precordium, one on the
left axillary area (do not stop CPR)
Plug - Yellow plug
Clear Clear Clear Clear
Analyzing rhythm
Clear Clear Clear Clear
Shock
IN Hospital - once the Rhesus trolley is brought do 4 steps - ?
Pulse oximeter
Pulse
BP
cardiac monitoring - 3 patches
SHOCK if -
Defibrillator or unsynchronized shock - V fib and Pulseless V
tach
Synchronized shock - A fib, SVT, V tach sustained, etc
NOT SHOCKABLE - Asystole (flat line), Pulseless electrical
activity
After shock - keep doing CPR for 2 mins = 5 rounds of 30:2 CPR (1
cycle)
Switch can be done after the 4th cycle - tell switch in the 5th cycle
(switch & 2 & 3 &, etc)
After 5th round (last round in cycle) - that is after 2 mins - check
pulse
Keep on doing cycles but remember to do this in each cycle
1 - I - IV line insertion (2 large more bore needles)
2 - A A - Airway, Adrenaline
Airway
- Use Laryngoscope (Macintosh) and put Endotracheal tube (
Laryngoscope to the valleculae)
If can not do it ⇒ Larygeal Mask Airway (LMA) or I gel ( which
is more harder, and has a tube for Ryles tube insertion)
If can not do ⇒ Oropharyngeal airway (measure from angle of
mouth to angle of mandible) ⇒ ⇒ At this point - also call ENT
team
If can not do ⇒ Nasopharyngeal airway (measure from tip of
nose to lobule of the ear)
ENT team ⇒ Crico-thyrodotomy or tracheostomy as last
resort ?
*After inserting Airway - Airway is not synchronized with
compressions - Keep giving Ambu bag in each 6 secs
Adrenaline - 1 in 10,000 concentration
3 - AM 300 - Amiadarone 300 ml
4 - Epi - Epinephrine
5 - AM 150 - Amiadarone 150 ml
6 - Epi - Epinephrine
7 - NONE
8 - Epi - Epinephrine
How to know if the CPR are good?
ETCO2 have to be 20 to 30 range
If not change the person giving compressions
Keep doing until ROSC - Return of Spontaneous Circulation
Check by pulse
Check ETCO2 - End Tidal Carbon Dioxide - 30 to 40
After ROSC what to do?
CHECK for reversible causes of cardiac arrest -
5Ts -
Thrombus coronary ⇒ ECG
Thrombus pulmonary - PE ⇒ C Xray
Tamponade ⇒ C Xray and Echo
Tension pneumothorax ⇒ C Xray
Toxins ⇒ Toxicology
5Hs -
Hypoxia ⇒ SpO2 and ABG
Hypovolemia ⇒ BP
Hypothermia ⇒ Temp ?
Hyperkalemia or Hypokalemia ⇒ U and E and RP
High H+ - Acidosis ⇒ ABG
IF FLUID RESUSCITATION WAS NEEDED -
1L in 1 hr
1L in 2 hr
1L in 2 hr
1L in 4 hr
1L in 4 hr
1L in 6 hr
IF INSULIN NEEDED BOLUS -
0.1 units/kg/hr bolus dose given
Types of defibrillators -

In Document - 1 Hide

March 21st, 2023


P2S3 Study
Medicine posting - Sem 10 1

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