0071643192.pdf

During resuscitation of a witnessed arrest, you ensured that CPR was min-

imally interrupted and proper technique was employed. However, the

patient still suffered hypoxic cerebral and cardiac injury. Why?

Even properly performed closed chest CPR only provides 25% of pre-arrest

cardiac output. Coronary and cerebral blood flow also fall, to 5% and 10%,

respectively.

Basic Cardiopulmonary Resuscitation (CPR)

The basic tenet of CPR is to generate enough coronary perfusion pressure

(CPP)to produce the myocardial blood flow necessary for return of sponta-

neous circulation.

CPP = aortic diastolic pressure—R atrial diastolic pressure

Initial step for health care providers:

■ For sudden, collapse (all ages) →phone or call for defibrillator prior to

initiating CPR.

■ For arrest likely due to asphyxia →immediate CPR prior to calling for

help.

The technique for adult and pediatric CPR in the ED assumes that multiple

providers are present (see Table 1.9).

RESUSCITATION

TABLE 1.9. Basic CPR in the Emergency Department

PEDIATRIC ADULT

Ventilation

Rate (breaths/min) Bag-valve mask (BVM): 20 BVM: 10–12

ET tube: 12–20 ET tube: 8–10

Compression

Position Lower half of sternum Lower half of sternum

Infant: 2 thumb-encircling hands Heel of one hand, other

Child: Heel of hand or as for adults hand on top

Depth 1/3–1/2 depth of chest 11 / 2 –2 inches

Rate 100/min 100/min

Ratio to ventilation BVM: 15:2 (pause for 2 breaths BVM: 30:2

every 15 compressions) ET tube: No pauses for

ET tube: No pauses for ventilation ventilation

Defibrillation Use pediatric pads when possible. Use adult pads.

No recommendations for infants