“30%” if VF occurs and immediate defibrillation is perfomed
>95% if defibrillation delayed by > 12 minutes
mortality from Out-of-Hospital cardiac arrest (OHCA):
VF arrest - 66-96%
depending on bystander CPR, availability of early defibrillator use
likelihood of survival largely determined by return of spontaneous output by the time patient arrives in ED.
asystole - >99%
thus prevention is far better than the cure!
in-hospital Medical Emergency Team (MET) to attend and manage critically ill ward patients ASAP
timely assessment and Mx of patients presenting to ED with early senior doctor input to detect at risk patients.
community awareness of chest pain and need for ambulance transfers ASAP
Mx of choking victim
call for help
if effective cough:
implied mild airway obstruction thus encourage coughing and get help, remain with victim
ineffectual coughing:
implies severe airway obstruction
conscious:
call for help
give up to 5 back blows
if not effective, give up to 5 chest thrusts
if no relief but remains conscious, repeat above
unconscious:
call for help
commence CPR as below
summary of Basic Life Support (BLS) for cardiac arrest
The Zombie CPR instructional video
7 components of BLS:
D: remove from danger
R: assess patient responsiveness
S: send for help
A: clear airway
head tilt-chin lift if non-trauma, or jaw thrust if trauma
remove vomitus using suction if possible
recognition and relief of foreign body airway obstruction
B: restore breathing although no longer the priority in adult out-of-hospital arrest
cardiac compressions alone (no ventilations) recommended for adult, out-of-hospital primary cardiac arrest (not respiratory) if witnessed, and with shockable rhythm or short period (<4 minutes) of untreated arrest
cardiac compressions alone also recommended if bystander not trained in CPR, or not confident in their ability
breaths (in hospital or those trained in CPR):
bag and mask if available (and oxygen at 15L/min to deliver 85% oxygen if available)
2 effective breaths every 30 compressions with a 1 second inspiratory time (except neonates, give 40-60 breaths/min)
if unprotected airway, pause compressions during breaths
if protected airway (eg. ETT in situ), don't pause compressions, and rate should 1 breath every 15 compressions (2 breaths in children every 15 compressions)
bag size:
> 18kg or > 5yrs old, use a 1600ml adult bag
infant, use a 500ml bag
neonate, use a 240ml bag or neonatal circuit
C: establish circulation:
checking for pulses is unreliable, instead start compressions if no signs of life, for instance:
unresponsive or unconscious
not breathing or the occasional gasping breath
not moving
cardiac compressions over mid-sternum to a depth of 1/3rd chest (eg. 4-5cm in an adult) at a rate of 100 per minute for all ages, stopping to allow 2 breaths every 30 compressions if unprotected airway
early cardiac compressions may:
prevent VF deteriorating into asystole
increase the chance of successful defibrillation in VF
add to the preservation of brain and cardiac function
D: availability of semi-automatic external defibrillators:
defibrillation as soon as possible provides the best chance of survival in victims with VF or pulseless VT
if cardiac arrest occurs in the obviously pregnant woman, place in a left lateral tilt by placing a pillow or wedge under the right buttock - this will reduce compression of IVC and aid venous return.
summary of Advanced Life Support (ALS) for cardiac arrest
consider and correct:
hypoxia
hypovolaemia
hyperkalaemia, hypokalaemia and other metabolic disorders
tension pneumothorax
tamponade
toxins
thrombosis (PE/AMI)
continues the principles of BLS but then splits depending on: