Cardiac arrest ka treatment step by step bto
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Ab mere paas poori jankari hai. Yahan ek detailed, step-by-step guide hai:
❤️ Cardiac Arrest Ka Treatment - Step by Step
🔴 STEP 1 - Scene Safety aur Recognition (Pehle 10 Seconds)
| Action | Detail |
|---|---|
| Scene safe karo | Danger check karo (traffic, bijli, paani) |
| Response check karo | Shoulder pe tap karo - "Kya aap theek hain?" |
| Breathing check karo | Chest movement dekho (max 10 seconds) |
| Pulse check karo | Carotid pulse (adults) / Brachial (infants) |
| Help bulao | 112 call karo ya kisi ko shout karo "Call 112 and get AED!" |
Yad rakho: Agar koi unconscious hai, normal breathing nahi hai, aur pulse nahi hai - yeh cardiac arrest hai. Action lene mein 1 second bhi waste mat karo.
🔵 STEP 2 - High-Quality CPR Shuru Karo (Chain of Survival)
Chest Compressions (C - Circulation)
| Parameter | Adult | Child (1-8 yr) | Infant (<1 yr) |
|---|---|---|---|
| Rate | 100-120/min | 100-120/min | 100-120/min |
| Depth | 2 inches (5 cm) | 2 inches | 1.5 inches |
| Technique | 2 hands | 2 hands | 2 fingers / encircling |
| Pulse Check | Carotid | Carotid | Brachial |
| Ratio (no airway) | 30:2 | 30:2 (single) / 15:2 (2 rescuers) | 30:2 |
Key Points:
- Chest ko poora recoil karne do (lean mat karo)
- Interruptions minimize karo - pause 10 seconds se zyada nahi
- Har 2 minute mein compressor switch karo (quality drop hoti hai)
Airway aur Breathing (A-B)
- Head-tilt chin-lift se airway open karo
- Bag-mask se oxygen do (ya mouth-to-mouth)
- Advanced airway (ETT) lagane ke baad: 10 breaths/minute (compressions se alag, continuous)
⚡ STEP 3 - AED / Defibrillator Lagao
Jaise hi AED milta hai, TURANT lagao:
- AED on karo
- Pads chest pe lagao (right clavicle ke neeche + left axilla)
- "Rhythm shockable hai?" - AED analyze karta hai
- Agar shockable (VF/pVT) - SHOCK DO (sabko door karo!)
- Immediately CPR resume karo (2 min)
Adult Defibrillation Dose: 200J (monophasic) | Biphasic: manufacturer ke anusar
💊 STEP 4 - ACLS Algorithm (Rhythm ke Anusar)
Yahan ACLS ka full flowchart hai (Rosen's Emergency Medicine se):
🔀 Path A: SHOCKABLE Rhythm (VF / Pulseless VT)
CPR shuru → Shock → CPR 2 min (IV/IO access)
→ Rhythm check → Shock → CPR 2 min
→ Epinephrine 1mg IV har 3-5 min dena shuru karo
→ Advanced airway consider karo
→ Rhythm check → Shock → CPR 2 min
→ Amiodarone 300mg IV (ya Lidocaine 1-1.5 mg/kg)
→ Reversible causes treat karo
→ ROSC check
Antiarrhythmic Drugs (Shockable rhythm mein):
- Amiodarone: Pehle 300mg IV bolus, phir 150mg IV bolus
- Lidocaine (alternative): 1.0-1.5 mg/kg IV bolus, 2 min mein repeat
- Agar ischemia-related arrest hai toh Lidocaine prefer karein
🔀 Path B: NON-SHOCKABLE Rhythm (Asystole / PEA)
CPR shuru karo → IV/IO access
→ Epinephrine 1mg IV ASAP - har 3-5 min
→ Advanced airway + capnography
→ Reversible causes dhundho aur treat karo
→ Rhythm shockable hua? → Shockable path pe jao
→ Nahi hua? → CPR continue + reversible causes treat karo
🅗 STEP 5 - Reversible Causes Dhundho (H's and T's)
Yeh cardiac arrest ke treatable causes hain - inhe miss mat karo!
| 4 H's | 4 T's |
|---|---|
| Hypovolemia (blood loss) | Tension pneumothorax |
| Hypoxia | Tamponade (cardiac) |
| Hypo/Hyperkalemia + acidosis | Toxins (drug overdose) |
| Hypothermia | Thrombosis (MI / PE) |
💉 STEP 6 - Drugs aur Doses Summary
| Drug | Indication | Dose |
|---|---|---|
| Epinephrine | VF, PEA, Asystole sab mein | 1 mg IV har 3-5 min |
| Amiodarone | Shockable rhythm (VF/pVT) | 300mg IV, phir 150mg |
| Lidocaine | Amiodarone alternative | 1-1.5 mg/kg IV |
| Magnesium Sulfate | Torsades de Pointes (polymorphic VT) | 1-2g IV 1-2 min mein |
| Calcium Gluconate | Hyperkalemia, Ca-blocker OD | 5-20mL IV (2-4 mL/min) |
| Sodium Bicarbonate | Severe acidosis, hyperkalemia | 1 mEq/kg IV |
| Atropine | Bradyarrhythmia only (NOT asystole/PEA) | 1mg IV repeat kar sakte ho |
🟢 STEP 7 - ROSC ke Baad (Return of Spontaneous Circulation)
Jab pulse wapas aaye:
- Airway: ETT confirm karo, capnography lagao
- Breathing: O₂ titrate karo - SpO₂ 94-98% target
- Circulation: BP maintain karo - systolic >90 mmHg
- Targeted Temperature Management (TTM): 32-36°C rakho (neurological protection ke liye)
- 12-lead ECG: STEMI rule out karo - agar hai toh cath lab
- Blood glucose: Hyperglycemia avoid karo
- ICU transfer: Monitoring continue karo
⛔ CPR Kab Rok Sakte Hain?
- DNR (Do Not Resuscitate) document verified ho
- Obvious lethal injury (decapitation, rigor mortis)
- Prolonged asystole with no reversible cause
- ETCO₂ <10 mmHg consistently after 20 min CPR (poor prognosis marker)
Sources:
- Rosen's Emergency Medicine, Chapter 158 (Pediatric Cardiac Arrest Algorithm 2020)
- Goldman-Cecil Medicine (Asystole, PEA, Bradyarrhythmia Algorithm)
- Braunwald's Heart Disease (OHCA & IHCA outcomes)
- Roberts & Hedges' Clinical Procedures in Emergency Medicine (Hypothermic Cardiac Arrest)
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