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OS 213: Human Disease and Treatment 3 (Circulation and Respiration)
LEC 35: ADULT BASIC LIFE SUPPORT FOR HEALTH WORKERS
Exam 1 (MegaExam)| Dr. Paul Reganit | October 9, 2012
OUTLINE

INTRODUCTION
Objectives
To increase awareness and knowledge of CPR as a life-saving
procedure for victims of sudden cardiac arrest
To demonstrate the different steps and techniques of CPR

Burdern of CVSDiseases in the Philippines
Heart diseases are the #1 cause of death in the Philippines (DOH
data as of 2004)
Followed by vascular system disease, malignant neoplasm,
accidents, then pneumonias
There has been a change in causes of mortality (initially due to
infectious diseases) now more due to lifestyle-related causes such
as stress an epidemiologic shift
Shift is thought to be fromeffective immunizations
The middle class bears the double burden of disease
o upper 10%of society have already transitioned to non-
communicable
o the poor still at greatest risk for communicable diseases

Sudden Cardiac Death (SCD): A Health Burden
Approximately 50%of deaths fromcardiovascular diseases
single largest categoric cause of natural death in the US, and
probably also in the Philippines
most common mode of death in patients with coronary artery
disease

Sudden Cardiac Arrest
an abrupt cessation of cardiac mechanical function which may be
reversible by a prompt intervention but will lead to death in its
absence
The heart suddenly goes into very irregular fast ineffective
contractions, the heart stops beating, the victim loses
consciousness, and if untreated, dies.
It is unpredictable and can happen to anyone, anywhere at
anytime
Risk increases with age (especially individuals 60 years old and
above)
common in people with pre-existing heart disease
o but may still strike people with no history of cardiac disease or
cardiac symptoms
Rescue Breathing/CPR: Do what the patient isnt
o If not breathing, breathe for her
If sudden cardiac death occurs outside the hospital setting
o cardiopulmonary resuscitation (CPR) must begin within 4-6
minutes
o Advanced cardiac life support measures (ACLS) must begin
within 8 minutes, to avoid brain death
Only 4-6 %of sudden cardiac arrest victims survive because
majority of those witnessing the arrest do not know how to
performCPR.
Almost 80%of out-of-hospital cardiac arrests occur at home and
are witnessed by a family member.
Therefore: effective CPR done immediately after cardiac arrest
can double a victims chance of survival
o prompt recognition of the problemand swift action
(management)
vs Sudden Cardiac Death: sudden irreversible cessation of all
biologic functions



CPR AND THE CHAIN OFSURVIVAL
THE NEW CHAIN OF SURVIVAL: (MEMORIZE)
1. Early access (immediate recognition and activation)
2. Early CPR
3. Early defibrillation
4. Early advanced care
5. Integrated post-cardiac arrest care

First Link: Access
A well-informed lay person is THE key in the early access link
Recognition of signs of heart attack and respiratory failure
Call for help immediately if needed
Activate the Emergency Medical System(EMS)

Early WarningSigns Of Heart Attack
Prolonged compressing pain or unusual discomfort in the center
of the chest
Pain may radiate to shoulder, arm, neck or jaw, usually on the left
side
Pain may be accompanied by sweating, nausea, vomiting and
shortness of breath

Early WarningSigns Of Respiratory Failure
Unable to speak, breathe or cough
Clutches neck (universal distress signal)
Bluish color of skin and lips

Second Link: Early CPR
Life saving technique for cardiac and respiratory arrest
Rescue breathing and chest compressions
For lay persons and medical personnel alike

CARDIOPULMONARY RESUSCITATION (CPR)
What is CPR?
CPR =cardiopulmonary resuscitation
Emergency procedure used when someones heart stops beating.
Simple procedure that can be learned by anyone, and consists of a
manual technique using repetitive pressing to the chest and
breathing into the person's airways that keeps enough oxygen
and blood flowing to the brain
CPR requires no special medical skills and training is available for
the ordinary person nationwide.

Why Is Early CPRImportant?
CPR is the best treatment for cardiac arrest until the arrival of an
automated external defibrillator (AED) and advanced
cardiovascular (ACLS) care
Prevents ventricular fibrillation from deteriorating into asystole
May increase the chance of defibrillation
Contributes to the preservation of heart and brain function
Significantly improves survival
Prompt CPR is important: beyond 7 minutes with no CPR, you are
doomed to fail

How Does CPR Work?
All the living cells of out body need a steady supply of oxygen to
keep us alive
o Important organs of concern during acute CPR: lungs
(pulmonary), brain (cerebral), heart (cardiac)
o A clarification regarding the importance of adrenals: by giving
oxygen perfusion to the adrenals, you can reactivate circulation
of the catecholamines (Norepinephrine and Epinephrine); but
in CPR, your immediate target organ includes the lungs but not
necessarily the adrenals
CPR works because you can breathe air into the victims lungs to
provide oxygen into the blood.
When you press on the chest, you move the oxygen-carrying
blood through the body.


I. Introduction
II. CPR and the Chain of Survival
III. Cardiopulmonary resuscitation (CPR)
IV. Techniques and Steps in CPR
V. Hands-Only CPR
VI. Summary for 2010 Guidelines
OS 213 LEC 35: BASIC LIFE SUPPORT

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When Will You Do CPR?
As soon as possible!
Brain cells begin to die after 4-6 minutes without oxygen

Who May Learn CPR?
CPR is an easy and life saving procedure and can be learned by
anyone
One does not need to be a doctor to learn how to do CPR

TECHNIQUESAND STEPSIN CPR
Witnessed Cardiac Arrest
*sir: Do it to someone youve seen alive and go into cardiac arrest
(because you know the type of arrest)
**Block B trans: What to do when you find an unconscious person
on the ground
1. Check area safety
Survey the scene
See if the scene is safe to do CPR
Get an Idea of what happened

2. Check Unresponsiveness
Tap or gently shake the victim
Rescuer shouts: Are you okay?
Quick check for normal breathing
If the victim is unconscious, rescuer calls for help

3. Call for Help: ambulance, emergency services, doctor
Rescuer activates the emergency medical services
Get AED/Defibrillator
Non-responsive, no normal breathing =get a defibrillator!

Check For Consciousness
*fromBlock B trans only, not mentioned in lecture
1. Pulse Check
Palpate for carotid pulse within 10 seconds
At the same time check for breathing
For trained health care providers only!!!

2. Mouth To Mouth Breathing
Begin if there is a DEFINITE PULSE, but NO BREATHING
Give one breath every 5-6 seconds (about 12 breaths per minute)
Recheck pulse every 2 minutes

Mouth to Mouth Breathingand Pulse Check:
Deemphasized in the new guidelines
For trained healthcare providers only
As short and quick as possible
Pulse check not more than 10 seconds
If unsure, proceed directly to chest compressions

After DeterminingUnconsiousness
PROCEED TO C-A-B
Compression: Do chest compressions first
Airway: does the victim have an open airway (air passage that
allow the victim to breathe)?
Breathing: is the victim breathing

START CPR
(C-A-B)
COMPRESSION
To assist circulation
After determining unconsciousness and calling for help, proceed
immediately to do chest compressions
Procedure:
1. Kneel facing the victims chest
2. Place the heel of your hand on the center of the victims chest.
Put your other hand on top of the first with our fingers interlaced.
o Note: Avoid the xiphoid cartilage!
3. Place the heel of one hand on the sternum in the center of the
chest between the nipples then place the heel of the second hand
on top of the first so that the hands are overlapped and parallel.
4. Align shoulders over hands with elbows locked and arms straight.
5. Compress down and release pressure smoothly, keeping hand
contact with chest at all times.

Figure 1. Procedure for doingproper chest compression.

Caveats: (and important things to remember)
Give chest compressions at a rate of AT LEAST 100/minute
Compress bone at least 2 inches deep
Compress 30 times initially (takes around 15-18 seconds)
Count aloud 1,2 3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,
18,19,20,21,22,23,24,25,26,27,28,29, and ONE!
Minimize interruptions
Allow the chest to return to its normal position
Slogan: Push hard, push fast (AHA); Modified by sir to: Push hard,
push fast to reach your goal you must! (from block B)
One may choose which hand to put on chest and which one to put
over it, but sir uses dominant hand on chest

AIRWAY
Open the airway by using the Head Tilt/Chin Lift Method
(MEMORIZE)
o Place one hand on the victims forehead
o Place fingers of the other hand under the bony part of the
lower jaw near the chin
o Tilt head and lift jaw avoid closing the victims mouth
o This maneuver prevents airway obstruction by the epiglottis
If you are highly suspecting cervical spine injury, do Jaw Thrust
Method instead (sir: Just lift jaw towards you, dont lift the head)

Figure 2. The Head-tilt or chin-lift maneuver

BREATHING
Procedure:
1. Give 2 one-second breaths
2. Maintain airway
3. Pinch nose shut
4. Open your mouth wide, take a normal breath, and make a tight
seal around outside of victims mouth.
5. Give 2 full breaths (1 second per breath)
6. Observe chest rise and fall; listen and feel for escaping air
7. Repeat cycles of 30 compressions and 2 breaths (this will take
about 2 minutes=5 cycles!)

Pulse Check
Recheck pulse every 2 minutes (Equivalent to 5 cycles CPR)
Very brief pulse check should take less than 10 seconds (at
the same time check for normal breathing)
In case there is any doubt about the presence or absence of
pulse continue chest compressions
This is for trained healthcare providers only

Continue CPR until
Help arrives (emergency services, ambulance, doctor, AED)
Person is revived

If the Victimis Breathing, place him/her in the Recovery Position
Maintain open airway and position the victim
The unresponsive victim with spontaneous respirations should be
placed in the recovery position if no cervical trauma is suspected
Placement in this position consists of rolling the victim onto his
other side to help protect the airway

OS 213 LEC 35: BASIC LIFE SUPPORT

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Figure 3. The recovery position.

SUMMARY OF STEPSIN CPR
Survey the scene.
Check responsiveness Hey, are you ok?
Call for help! Activate EMS
[Quick check pulse within 10 secs]
C (Compression): 30x; 100/min; 2 inches deep; push hard and fast
A (Airway): head tilt chin lift
B (Breathing): 2 breaths (1 second/breath)
Cycle 30:2 compression-ventilation
[Quick check pulse every 2 mins]
Continue until: EMS arrives, patient is revived/has signs of life

Indications
Not trained
Do not know mouth to mouth ventilation
Not sure about mouth to mouth ventilation
Hesitant to do mouth to mouth ventilation
Do not want to do mouth to mouth ventilation
You can do HANDSONLY CPR: It only takes two steps to save a
life:
1. Call for help
2. Do chest compressions
Hands only CPR should only be used for adult victims who have
suddenly collapsed or become unresponsive

Recommendations
All victims of cardiac arrest should receive high-quality chest
compressions
When an adult suddenly collapses, all bystanders should activate
their community EMS and provide high quality chest compression,
minimizing interruptions (Class I)
If not trained in CPR, provide hands only CPR (Class IIa) until
o AED arrives
o EMS providers take over care of the victim
If trained in CPR, provide either conventional CPR using 30:2
compression-to-ventilation ratio or hands only CPR

SUMMARY OF 2010 BLSGUIDELINES

Figure 4. Simplified Adult BLSAlgorithm(Summary)
Key Changes
CABV instead of ABC
Compress first
NO more Look, Listen and Feel
Harder at least 2 inches compression
Faster at least 100 per minute compression
Deemphasize pulse checks
o For trained healthcare providers not more than 10 secs
Check for normal breathing together with check for
unresponsiveness
Hands only CPR for the untrained lay rescuer

Important Points
There are no mistakes when you perform CPR
o The only harm is to delay responding
o Start chest compressions now viewed as the most effective
procedures
o All victims in cardiac arrest need chest compressions
Dont stop pushing
o Keep pushing as long as you can. Push until AED is in place and
ready to analyze the heart. When it is time to do mouth to
mouth, do it quick and get right back on the chest
80-90%of cardiac emergencies occur at home
Training is now simpler and more accessible (reduced steps and
simplified)
Being trained to do CPR can save a loved one
Effective CPR done immediately after cardiac arrest can double a
victims chance of survival
END OF TRANSCRIPTION

Leonard: The basic problem in human relationships is that of
freedom. We call people bad because we do not do what we want
them to do. We judge them for being themselves, for fulfilling their
wishes. We withdraw love from themwhen they do what they feel is
best for them, but it is not what we want them to do. We do the
same thing with God. We feel entitled to Gods favor, as if He has to
do what we want Him to do. How do you feel when someone asks
you for a favor but does not give you a free choice? This childish
entitlement gets many people dissatisfied with God the same way
that they are dissatisfied with others in their lives. Henry Cloud
No judgment, no controlling, only grace. =)

Jasper: Last trans of the sem. Ambilis at ang daming transes haha.
Hello nalang sa mga palagi kong ginigreet kayo parin naman ang
iggreet ko tinatamad lang ako magisa isa. Haha. :p

Patti:






HANDS-ONLY CPR
OS 213 LEC 35: BASIC LIFE SUPPORT

Lenny-caun, ScaredCruz, Jasp O Lantern UPCM 2016A: XVI, Walang Kapantay! 4 of 4

Appendix I. Summary of Key BLSComponents for Adults and
Children (CHECK FORMAT OF TABLE CAPS/TEXT PLEASE)
Maneuvers Adults Children
RECOGNITION UNRESPONSIVE
No breathing,
not breathing
normally (eg.
only gasping)
No breathing or
only gasping
CPR Sequence CAB CAB
Compression
Rate
At least 100/min
Compression
Depth
At least 2 inches
(5 cm)
At least 1/3 AP
depth
Chest wall
Recoil
Allow complete recoil between
compressions
HCP compressors rotate every 2
minutes
Compression
interruptions
Minimize interruptions in chest
compressions
Attempt to limit interruptions to less
than 10 seconds
Airway Head tilt chin lift (HCP suspects
trauma: jaw thrust)
Compression-
Ventilation
ratio
30 : 2 (one or 2
rescuers)
30:2(single
rescuer); 15:2(2
rescuer)
Ventilations:
when rescuer
untrained or
trained and not
proficient
Compressions
only
Compressions
only
Ventilations
with advanced
airway (HCP)
1 breath every 6-8 seconds (8-10
breaths/min)
Asynchronous with chest
compressions
About 1 second per breath
Visible chest rise
DEFIBRILLATION
( AED )

Attach and use AED as soon as
available. Minimize interruptions in
chest compressions before and after
shock, resume CPR beginning with
compressions immediately after each
shock


















Appendix II. BLS Flowchart