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1. Airway Management
2. Basic Life Support (BLS)
3. Advanced Cardiac Life Support (ACLS)
4. Advanced Trauma Life Support (ATLS)
5. CPR in special situations
6. Ethical Issues
 - 

1966 :
National research council conference
(generated standards).
2005 :
American Heart Association (AHA).
 |  
CPR:
Systematic efforts for relief patient from
situation which threatened the life.
Effective CPR:
Artificial delivery of oxygenated blood to
systemic circulatory beds at rates
sufficient for preserving vital organ
function and physiologic substrates.
 
Highest survival rates and quality
of survival are attained when:

- BLS is initiated within 4 min

- ACLS is initiated within 8 min

 R 

½

It is a team effort.
Coordination of the team is the responsibility
of the team leader (Ideally Anesthesiologist).
Responsibilities of the team leader:
1- Ensure the quality of BLS.
2- Facilitate early use of electrical defibrillation.
3- Direct and monitor the adequacy of drug
therapy.
4- Ultimately, the team leader decide when
CPR should cease.
 |   

1. Unconscious (unresponsive)
2. Abnormal breathing, although there
may be brief irregular, gasping breaths
3. Pulselessness or non effective
circulation
4. Traumatic patient (electrical, drawing,
crash, car accident, «)
 
 

½

1. Avoid agitation
2. Have a good knowledge
3. Have a good physical ability
O



 
 
 

Elimination of lay rescuer assessment of

signs of circulation before beginning chest
compressions.
Simplification of instructions for rescue
breaths should be given over 1second with
sufficient volume to achieve visible chest
rise.
Elimination of lay rescuer training in rescue
breathing without chest compressions.
 
 
ëecommendation of a (universal)
compression-to- ventilation ratio of 30:2 for
single rescuers of victims of all ages (except
newborn infants).

Increased emphasis on the importance of

chest compressions: rescuers will be taught
to ×push hard, push fast (at a rate of 100
compressions per minute), allow complete
chest recoil, and minimize interruptions in
chest compressions.
 
 
ëecommendation for provision of about 5
cycles (or about 2 minutes) of CPë between
rhythm checks during treatment of
pulseless arrest. ëescuers should not check
the rhythm or a pulse immediately after
shock deliveryDthey should immediately
resume CPë, beginning with chest
compressions, and should check the
rhythm after 5 cycles (or about 2 minutes)
of CPë.
 
 
ëecommendation that all rescue efforts,
including insertion of an advanced airway (eg,
endotracheal tube, esophagealtracheal
combitube [Combitube], or laryngeal mask
airway [LMA]), administration of medications,
and reassessment of the patient be performed
in a way that minimizes interruption of chest
compressions.

ëecommendation of only 1 shock followed

immediately by CPë (beginning with chest
compressions) instead of 3 stacked shocks
for treatment of ventricular fibrillation/
pulseless ventricular tachycardia.
 ?

 

 
 



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eneral anesthesia

ëespiratory failure

Airway obstruction

CPë

  

Nose
1.Nasopharynx
Pharynx
2.Oropharynx
Larynx
Trachea

  

  
 

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Level of consciousness
-Alert
-ëesponds to verbal stimuli
-ëesponds to painfull stimuli
-Unresponsive
Airway
-Patent
-Clear
Trauma to cervical spine
 


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Non-invasive
-Head positioning
-ëemoval of foreign body
-Suctioning
-Mask ventilation
Invasive
-ETT
-LMA
-Combitube

   
Head tilt chin lift & Head tilt jaw trust
Mask ventilation
÷ne hand mask holding
Two hand mask holding


Disposable Berman Airways
Hudson Cath-Guide Airways
Rusch Berman Airways
Rusch Color Coded Guedel Airways


Nasopharyngeal Airway
Rusch Latex Free Nasopharyngeal
Airway
Nasopharyngeal Airway
  

|   
 |   


  
   
1. Provides relative protection against
pulmonary aspiration.
2. Maintains a patent conduit for respiratory
gas exchange.
3. Provides a means for coupling the lungs to
mechanical ventilators.
4. Establishes a route for clearance of
secretions.
5. Provides a route for drug administration.
Equipments

Laryngoscope Lubricant
Tubes Forceps (Magill)
÷xygen source Adhesive tape
Bag & Mask Stylet
Suction Syringe
Stainless Laryngoscope Blades
Laryngoscope Blades
Tracheal Tube

  
Uncuffed Tracheal Tube
Endotrol Tracheal Tube with
Controllable Tip
EMT Emergency Medicine Cuffed Tube
with Injection Port
 
!
Male: No. 8 + 0.5

Female: No. 7 + 0.5

Age
Children: No = 4 + 4 (or 3, for cuffed)


!
" #
 
 

  

Age
Depth(cm) = + 12
2

Male: 23 cm

Female: 21 cm


 

  
Sniffing Position

35o

80o
Incorrect position
Incorrect position
Sniffing Position
| 
 
| 
  
 
 
 
Sniffing Position
Laryngeal Mask Airway
G 
R$

G 
R$

G 
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LMA-Fastrach
LMA- Fastrach
LMA- Fastrach
LMA-Fastrach
Examples of clinical airway problems
managed with the LMA
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GR

 
  
†1 <5 4
†1.5 5-10 7
†2 10-20 10
†2.5 20-30 14
†3 30< 20
†4 normal 30
†5 large 40
THE LMA IS NOT
DISPOSABLE
 

% 

GR
leaves providers hands free
patient can produce effective cough
allows spontaneous ventilation
even malpositioned can adequately
ventilate
Disadvantages of LMA over the ETT

Lower seal pressure

Higher frequency of gastric
insufflation
Increased Aspiration risk
 GR
½  

Aspiration

Coughing

Sore Throat
Combitube
½   

 
   
Retrograde Intubation«
Retrograde Intubation«
Retrograde Intubation«
Retrograde Intubation«
Retrograde Intubation«
½  
Cricothyrotomy Devices
½  
Cricothyrotomy«

Placement of
Needle
Cricothyrotomy«

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$ ! 
Cricothyrotomy«


% &
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Cricothyrotomy«


&$
âet Ventilation
â
  
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 $

 $
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1. Respiratory failure
2. Decrease L÷C
3. Difficult airway
Respiratory failure«

Status Asthmaticus
Status Epilepticus
Pulmonary Edema
Chest wall injuries
Etc

½
R
Category score
÷beys 6
Localizes 5
Withdraws 4
Flexion 3
Extension 2
None 1

½
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Category score
÷riented 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
None 1

½
  
Category score
Spontaneously 4
To speech 3
To pain 2
None 1

< 




  

Laryngoscope
Tubes
÷xygen source
Bag & Mask Drugs
Suction
Lubricant
Ventilator
Forceps (Magill)
Adhesive tape
Stylette
Syringe

A- Neuromuscular blocking drugs (NMBDs):
1- Depolarizing NMBDs-
Succinylcholine (1 ± 1.5 mg/Kg IV)
2- Non Depolarizing NMBDs-
Vecuronium (0.25 mg/Kg IV)
Cis-atracurium (0.2 mg/Kg IV)
All patients requiring airway management
are probably at risk for aspiration of gastric
contents (Sellick maneuver).

B- Sedative-hypnotics:
Sodium Thiopental
Propofol
C- Benzodiazepines:
R
 (0.5 ± 1 mg IV)
Diazepam (2 mg IV)
D- Opioids:
Morphine, ë

, ëemifentanil

E- Beta-adrenergic blocking drugs:
Esmolol (10 ± 20 mg IV)
F- Local anesthetics agents:
Lidocaine ( 1 ± 1.5 mg/Kg IV or
aerosol anesthetic sprays)
G- Nerve blocks«
 |'


  
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CS=3 None None None None

Cardiac None None None None

arrest

Shock None SCh Fentanyl None

SBP<80mmHg
1.5mg/kg 0.5-1Njg/kg
Hypotension Thiopental Fentanyl Midazolam
SCh
SBP 0.3-1mg/kg
1.5mg/kg 1-2Njg/kg 1-2mg
80-100mmHg
Head injury Thiopental SCh Fentanyl Midazolam
CS 4-9 2-5mg/kg
1.5mg/kg 1-2Njg/kg 1-2mg
Combative Thiopental SCh Fentanyl Midazolam
Normal BP 2-5mg/kg
1.5mg/kg 1-2Njg/kg 1-2mg
$(
 
 


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