2015, vol. 15, br. 2, str. 34-40
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Kardiopulmonalno-cerebralna reanimacija u slučaju srčanog zastoja na terenu u prisustvu ekipe Službe hitne medicinske pomoći - prikaz slučaja
Cardiopulmonary cerebral resuscitation in the case of out-of-hospital cardiac arrest witnessed by emergency medical team: A case study
Sažetak
Uvod: Kardiopulmonalno -cerebralna reanimacija (KPCR)- predstavlja jasno određene postupke i primenu određenih lekova sa ciljem da se kod osobe sa srčanim zastojem omogući oksigenacija tkiva, uspostavi spontana cirkulacija i izvrši restitucija cerebralne funkcije i ostalih vitalnih sistema u organizmu.Srčani zastoj je nagao i neočekivani prestanak cirkulacije krvi izazvan funkcionalnim prestankom rada srca-prekid mehaničke aktivnosti srca i nesposobnost da ispumpa dovoljno krvi da bi se održala adekvatna perfuzija i ishrana mozga. Cilj rada: Da se prikažu mere KPCR prehospitalno na mestu nastanka događaja, neophodnost blagovremenog i adekvatnog započinjanja KPCR.Da se utvrdi prehospitalno preživljavanje pacijenata kod kojih su ekipe hitne medicinske pomoći preduzele mere KPCR, kada se iznenadni srčani zastoj desio u prisuslvu ekipe HMP. Materijal i metode: Deskriptivni prikaz podataka dispečerski protokol, lekarski protokol i smernice ERC iz 2010. godine, otpustna lista pacijentkinje. Prikaz slučaja: U 7,03h dispečer prima poziv da je ženska osoba starosti 73 godine izgubila svest. U roku od dva minuta ekipa krece na lice mesta po protokolu za prvi red hitnosti. Nakon 4 minuta ekipa se nalazi na prijavljenoj adresi.Sin daje podatak da je pacijentkinja kratkotrajno izgubila svest ali da se trenutno dobro oseća. Pacijentkinja zatečena svesna orijentisana, eupnoična u sedećem položaju na krevetu. Pri pregledu konstatovan normalan disajni sum, sinusnu bradikardija 40 otkucaja u minutu i TA 160/80mmHg. U toku pripreme za snimanje EKG zapisa urađena pulsna oksimetrija koja pokazuje SaO2 93%. U tom momentu pacijentkinja gubi svest, prestaje da diše, puls nije bio palpabilan. Postavljena je u ležeci položaj na pod uz pomoć ostalih članova tima i započeta je spoljašnja masaža srca.Obezbeđen je venski put. Na monitoru defibrilatora registrovana VF. Pacijentkinja defibrilirana bifaznim defibrilatorom energije 200J. Na monitoru registrovana tahiaritmija oko 100/min. Pri uvodjenju laringoskopa radi uspostavljanja disajnog puta pacijentkinja pravi jednu spontanu respiraciju. Nastavlja da diše spontano oko 10 respiracija/min. Nad karotidama se palpira puls. Preduzimaju se mere za hitan transport na Prijemno odeljenje valjevske bolnice.U sanitetskom vozilu uključen je infuzioni rastvor 0.9% NaCl 500ml i kiseonik na masku 8 l/min. Pacijentkina dolazi svesti u toku transporta. Stabilnih vitalnih parametara primljena u koronarnu jedinicu valjevske bolnice. Zaključak: Za uspešnost KPCR neophodno je u što kraćem vremenskom intervalu od nastanka cardiac aresta zapoceti mere reanimacije radi očuvanja cerebralne funkcije i ostalih vitalnih sistema u organizmu.
Abstract
INTODUCTION: Cardiopulmonary cerebral resuscitation (CPCR) represents clearly defined procedures and administration of definite medicines with the purpose of enabling the person with cardiac arrest to oxygenate the tissue, reestablish spontaneous circulation and perform restitution of cerebral function and other vital systems of the organism. The cardiac arrest is a a sudden and unexpected stop in blood circulation caused by the functional loss of heart operation - the cessation of the heart mechanical activity, and inability to pump enough blood to maintain adequate perfusion and nourishment of the brain. AIM: Present CPCR measures taken prehospitally at the scene of event, and the necessity of a timely and adequate CPCR inititation. Determine prehospital survival of patients for whom emergency medical service (EMS) teams take CPCR measures when a sudden cardiac arrest occurs in the presence of emergency medical service (EMS) team. MATERIALS AND METHODS: A descriptive overview of data, dispatcher's Protocol, Physician's Protocol and ERC Guidelines from 2010, Patient's Discharge Note. CASE REPORT: At 7:03 a.m. the dispatcher received a call reporting that a 73 year old female had lost consciousness. Within two minutes, the team set out for the scene in accordance with the first degree of urgency protocol. After four minutes the team arrived at the reported address. The son gave the information that the patient had lost consciousness for a short time but that she was feeling well at the moment. The patient was found conscious, oriented, eupnoic, in the sitting position on the bed. On examination, normal breath sounds were observed, sinus bradychardia of 40 beats per minute and BP 160/80mmHg. During preparation for ECG recording, a pulse oxymetry was performed, which showed 93% SaO2. At that moment, the patient lost consciousness, stopped breathing, and the pulse was not palpable any more. She was positioned in the lying position, with the help of other team members, and an external heart massage was started. A venous pathway was established. VF was displayed on the defibrillator monitor. The patient was defibrillated using a biphasic defibrillator with a 200J energy level. A tachyarrhythmia of about 100/min was displayed on the monitor. On insertion of laryngoscope in order to establish an airway she made one spontanous respiration. She continued to breathe spontaneously at about 10 respirations/sec. A pulse was palpated over the carotids. Measures were taken for an urgent transport to the Admission Ward of Valjevo Hospital. In the transport vehicle, 500 ml 0.9% NaCl solution and 8l/min oxygen via mask were included. The patient regained consciousness during the transport. She was admitted with stable vital parameters to the Coronary Unit of Valjevo Hospital. CONCLUSION: In order to achieve CPCR efficacy it is necessary to initiate resuscitation measures in the shortest possible time from the moment of cardiac arrest occurrence so that the cerebral functions and other vital systems of the organism could be preserved.
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