AHA Update 2010

Welcome to the American Heart Association 2010 Update for CPR.
2010 AHA Update for CPR
1.0 5/24/2011 This module provides the audience with an overview of the American Heart Associations 2010 changes to CPR procedures for healthcare professionals. The module contains 45 slides and should take ~25 minutes to complete. None
404-785-6767 Shannon Dunlap
Clinical staff all levels
shannon.dunlap@choa.org Mark Guerrein
05/24/2011
2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.
Childrens Healthcare of Atlanta has developed this module to present the updated CPR protocol from the American Heart Association (AHA) to clinicians who perform CPR. On April 1, 2011, we will begin utilizing this new protocol when CPR is performed in our hospitals and neighborhood locations. You will be thoroughly instructed in this protocol during your next CPR recertification or your initial CPR certification course. Meanwhile, there are some important points you must know so that you and all those performing CPR are using the same protocol. If you have any questions about any of these points you can ask your educator or contact Shannon Dunlap.
Note: The new guidelines are highlighted in red throughout the CBT.
05/24/2011
At the completion of this module you will be able to describe the American Heart Associations 2010 revisions to providing basic life support (including CPR) for: Adult victims Infant and child victims Victims with foreign body obstructions in their airways
05/24/2011
Lesson 1: CPR Overview
In late 2010, the American Heart Association or AHA modified its recommendations on Cardio Pulmonary Resuscitation (CPR) procedures to improve survival rates of adult and pediatric victims. These recommendations were based upon empirical studies that indicated improved survival. They include:
Changes to the Chain of Survival Changes to the CPR sequence

In this lesson you will be presented with an overview of these changes.
05/24/2011
CPR Overview
Successful resuscitation following cardiac arrest requires several key actions also know as the Chain of Survival. These are: Immediate recognition of cardiac arrest and activation of the emergency response system Early CPR emphasizing chest compressions Rapid defibrillation Effective advanced life support
Integrated post-cardiac care
05/24/2011
Change in Sequence
The new AHA guidelines recommend a fundamental change in CPR sequence from A-B-C to C-A-B C-A-B Compressions: Push hard and fast on the center of the victims chest. Airway: Tilt the victims head back and lift the chin to open the airway.
Breathing: Give mouth-to-mouth or bag/mask rescue breathing.
05/24/2011
Change in Sequence continued

The new AHA guidelines have also eliminated Look, Listen, and Feel from the CPR sequence because performing it is inconsistent and time consuming.
05/24/2011
Cardiac Arrest
Cardiac arrest in adults is usually sudden, and the primary cause is cardiac related. Therefore circulation produced by chest compressions is crucial. Cardiac arrest in children is mostly asphyxial which requires both compressions and ventilations.
Rescue breathing may be more important for children than adults in cardiac arrest.
05/24/2011
Lesson 1: CPR Overview
In this lesson you learned about general changes to CPR guidelines that the AHA has recommended: Changes to the Chain of Survival Changes to the CPR sequence from A-B-C to C-A-B In the next lesson you will be presented the specific changes to the AHA CPR guidelines for adults.
05/24/2011
10
Lesson 2: Adult Basic Life Support for Healthcare Providers
In this lesson you will learn about changes to the CPR procedures for adults that are provided by our caregivers here at Childrens. These include revisions to: Chest compressions Pulse checks Rescue breaths You will also learn about revisions on using an Automated External Defibrillator (AED) in conjunction with CPR.
05/24/2011
11
Adults / Adolescents Basic Life Support (BLS) for Healthcare Providers

The rescuer recognizes that the patient is unresponsive no breathing or no normal breathing. Activate the emergency response system and get AED/defibrillator if second rescuer is available send her or him to do this.
Check the pulse if definite pulse within 10 seconds give 1 breath every 5 to 6 seconds and re-check carotid pulse every 2 minutes.
05/24/2011
12
Adult BLS for Healthcare Providers

If there is no pulse, begin CPR starting with 30 compressions. Then open the airway and give 2 breaths. When the AED/defibrillator arrives, check rhythm.
If rhythm is shockable, give 1 shock and resume CPR immediately for 2 minutes.
If rhythm is not shockable, resume CPR for 2 minutes; check rhythm every 2 minutes and continue until advanced life support providers take over or the patient starts to move. The AED will automatically prompt you to perform the above actions.
2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved. 13
05/24/2011
Chest Compressions in Adults

Rescuers should focus on delivery of high quality CPR Push Hard and Push Fast
Provide chest compressions at an adequate rate (at least 100/min)

Provide Chest compressions to adequate depth
o o Adults: Compression depth of at least 2 inches (5cm) Allow complete chest recoil after each compression
Minimize interruptions in compressions Avoid excessive ventilations If multiple rescuers are available, they should rotate the task of compressions every 2 minutes
05/24/2011
14
Pulse Checks
Studies have shown that healthcare providers and lay rescuers have difficulty detecting pulses. To avoid delay in CPR, healthcare providers should take no more than 10 seconds to check for a pulse. If a pulse is not detected within 5-10 seconds then compressions should be started.
05/24/2011
15
Rescue Breaths
The 2010 AHA Guidelines recommend the initiation of compressions before ventilations. Once compressions have been started, a trained rescuer should deliver rescue breaths by mouth-to-mouth or bag/mask.
05/24/2011
16
Rescue Breaths
Rescue breaths should be delivered over 1 second. Give sufficient tidal volume to produce visible chest rise. Use compression to ventilation ratio of 30 compressions to 2 ventilations. If there is a pulse give 1 breath every 5-6 seconds.
05/24/2011
17
AED/Defibrillation
Defibrillation sequence Turn on the AED. Follow the AED prompts. Resume chest compressions immediately after the shock; minimize interruptions. Pad placement The 4 pad positions are anterolateral, anteroposterior, anterior-left infrascapular, and anterior-right infrascapular. All of these positions are equally effective.
05/24/2011
18
Adult BLS for Healthcare Providers

The following slide displays a flow chart of the steps to follow when providing Adult BLS.
05/24/2011
19
1 Victim is unresponsive. No breathing or no normal breathing (i.e., only gasping).
2 Activate the emergency response

system and get AED/defibrillator.
Adult / Adolescent BLS for Healthcare Providers
3
Pulse
Check pulse: DEFINITE pulse within 10 secs.?
No Pulse
3a Give 1 breath every 5 to 6 secs.

Re-check pulse every 2 mins.
4 Begin cycles of 30 compressions

and 2 breaths.
* Indicates a change to AHA protocol
High Quality CPR

Rate at least 100/minute Compression depth at least 2 inches (5cm) Allow complete chest recoil after each compression. Minimize interruptions in chest compressions. Avoid excessive ventilations.
5 AED/defibrillator arrives.
6 Shockable rhythm? YES 7

Shockable rhythm: Give 1 shock and resume CPR for 2 mins.
No 8 No shockable rhythm: Resume

CPR immediately for 2 mins. Check rhythm every 2 mins. Continue until ALS providers take over or victim starts to move.
Lesson 2: Adult Basic Life Support for Healthcare Providers
In this lesson you learned about revisions to CPR procedures for adults including: Chest compressions Pulse checks Rescue breaths You also learned about revisions on using an Automated external defibrillator (AED) in conjunction with CPR. In the next lesson information about BLS for children and infants is presented.
05/24/2011
21
Lesson 3: Child and Infant CPR
This lesson presents information about revisions to the CPR procedures for infants and children.
These include:
The differences between CPR for infants and children Inadequate breathing issues Poor Perfusion You will also learn about revisions on using an Automated External Defibrillator (AED) in conjunction with CPR for children and infants.
05/24/2011
22
Child and Infant CPR

Infant BLS guidelines apply to infants less than approximately 1 year of age. Child BLS guidelines apply to children approximately 1 year of age until puberty. For teaching purposes, puberty is defined as breast development in females and presence of axillary hair in males.
05/24/2011
23
Child and Infant CPR

The AHA recommends that the sequence of CPR for adults and infants/children be the same
Rationale for making the changes in CPR sequence to C-A-B in infants and children: The majority of victims who require CPR are adults. They have a better outcome if compressions are started as early as possible. Beginning CPR with compressions rather than ventilations leads to a shorter delay to the first compression. All rescuers should be able to start chest compressions almost immediately. Whereas positioning the head and making sure there is a seal for mouth-tomouth or bagmask resuscitation takes time and delays the initiation of chest compressions This also offers the advantage of consistency in education whether the victims are adult, children or infants.
05/24/2011
24
Pediatric Chain of Survival

Make sure the area is safe for you and the infant/child Assess the need for CPR and start compressions lone rescuers should give about 5 cycles of compressions and ventilations before leaving the child to activate the emergency response Activate emergency response system and get the AED Effective advanced life support Integrated post-cardiac care
05/24/2011
Chest Compressions in Infants and Children

Rescuers should focus on delivery of high quality CPR Push Hard and Push Fast.
Provide chest compressions to adequate rate (at least 100/minute) Provide chest compressions of adequate depth Infants and children: a depth of at least one third the anterior-posterior (AP) diameter of the chest or about 1 inches (4cm) in infants and about 2 inches (5cm) in children Allow compete chest recoil after each compression Minimize interruptions in compressions Avoid excessive ventilation If multiple rescuers are available they should rotate the task of compressions every 2 minutes.
05/24/2011 2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.
26
Pediatric BLS for Healthcare Providers in Infants and Children

If second rescuer is available send him or her to activate the emergency response and obtain AED/defibrillator. AEDs have now been approved for use with infants. Check pulse if definite pulse within 10 seconds give 1 breath every 3 seconds. Add compressions if pulse remains less than 60/min with poor perfusion despite adequate oxygenation and ventilation. Recheck pulse every 2 minutes.
05/24/2011
27
Pediatric BLS for Healthcare Providers in Infants and Children

If no pulse is detected, begin cycles of 30 compressions and 2 breaths for one rescuer. For 2 rescuers begin cycles of 15 compressions and 2 breaths. If lone rescuer, after about 2 minutes, activate the emergency response system if not already done. Use an AED as soon as available. If rhythm is shockable, give 1 shock and resume CPR immediately for 2 minutes. If rhythm is not shockable, resume CPR immediately for 2 minutes. Check rhythm every 2 minutes. Continue until Advanced Life Support providers take over or victim starts to move.
05/24/2011
Pediatric BLS for Healthcare Providers

The following slide displays a flow chart of the steps to follow when providing pediatric BLS.
05/24/2011
29
Victim is unresponsive. Not breathing or gasping. Send someone to activate The emergency response system and get an AED/defibrillator.
Pediatric BLS for Healthcare Providers
One rescuer: For SUDDEN COLLAPSE activate the emergency response system and get AED/defibrillator
TWO rescuers: For SUDDEN COLLAPSE send someone to activate the emergency response system and get AED/defibrillator
3 Pulse
Check pulse: DEFINITE pulse within 10 secs.?
No Pulse
3a Give 1 breath every 3 secs. Add

compressions if pulse remains < 60/min with poor perfusion despite adequate oxygenation and ventilation RE-check pulse every 2 mins
High Quality CPR

Rate at least 100/minute Compression depth at least 1/3 anterior-posterior diameter of chest, about 1 inches (4cm) in infants and 2 inches (5cm) in children Allow complete chest recoil after each compression. Minimize interruptions in chest compressions. Avoid excessive ventilations.
One rescuer: Begin cycles of 30 compressions and 2 breaths Two rescuers: Begin cycles of 15 compressions and 2 breaths
* Indicates a change to AHA protocol
After about 2 mins, activate emergency response system and get AED (if not already done). Use AED ASAP to check rhythm.
6 Shockable rhythm? YES 7

Shockable rhythm: Give 1 shock and resume CPR for 2 mins.
No
8 No shockable rhythm: Resume
CPR immediately for 2 mins. Check rhythm every 2 mins. Continue until ALS providers take over or victim starts to move.
Chest Compressions for Healthcare Provider of Infants

For infants, the single rescuer should use the 2-finger chest compression technique. The 2-thumb encircling hands technique is recommended when CPR is provided by 2 rescuers. To do this, encircle the infants chest with both hands. Spread your fingers around the thorax, and place your thumbs together over the lower third of the sternum. Forcefully compress the sternum with your thumbs.
05/24/2011
31
Inadequate Breathing with Pulse

If there is a palpable pulse > 60 per minute but there is inadequate breathing: Give rescue breaths at a rate of about 12-20 breaths per minute 1 breath every 3-5 seconds until spontaneous breathing resumes.
05/24/2011
32
Bradycardia with Poor Perfusion

If the pulse is less than 60 beats per minute and there are signs of poor perfusion ( i.e., pallor, mottling, cyanosis) begin compressions.
05/24/2011
33
AED/Defibrillators in Children and Infants

If a manual defibrillator is unavailable then an AED that has a pediatric dose attenuator (pediatric pads) is preferred for infants. An AED with a pediatric dose attenuator is also preferred for children under 8 years of age. If neither is available an AED without a dose attenuator may be used. AEDs that do not have pediatric dose attenuators have been used in infants with no clear adverse effects.
In infants, manual defibrillators are preferred. If a manual defibrillator is not available then one with a pediatric dose attenuator (pediatric pads) is preferred.
05/24/2011
BLS for Adults vs. Children

In this lesson we discussed Basic Life Support (BLS) for children and Infants. In the previous lesson Adult BLS was presented. It may be helpful to compare the differences of these groups. The next slide displays a table taken from the AHA 2010 Guidelines summarizing these differences.
05/24/2011
35
Summary of Key BLS Components for Adults, Children, and Infants*

Recommendations Component Adults Children Unresponsive (for all ages) Recognition No breathing or no normal breathing (i.e., only gasping) No breathing or only gasping Infants *Excluding the newly born, in
whom the etiology of an arrest is nearly always asphyxiate.
No pulse palpated within 10 seconds for all ages (HCP only) CPR Sequence Compression rate Compression depth At least 2 inches (5cm) C-A-B At least 100/min At least AP diameter About 2 inches (5cm) At least AP diameter About 1 inches (4cm)
Chest wall recoil Compression interruptions Airway Compression-toventilation ratios (until advanced airway placed) Ventilations: when rescuer untrained or trained and not proficient Ventilations with advanced airway (HCP)
Allow complete recoil between compressions HCPs rotate compressions every 2 minutes Minimize interruptions in chest compressions Attempt to limit interruptions to < 10 seconds Head tilt-chin lift (HCP suspected trauma: jaw thrust) 30:2 Single rescuer 15:2 2 HCP rescuers
30:2 1 or 2 rescuers
Compressions only
1 breath every 6-8 seconds (8-10 breaths/min) Asynchronous with chest compressions About 1 second per breath Visible chest rise Attach and use AED as soon as possible. Minimize interruptions in chest compressions before and after shock; resume CPR beginning with compressions immediately after each shock.
Source: Highlights of the 2010 AHA Guidelines for CPR & ECC
Defibrillation
In this lesson you learned about.

Lesson 3: Child and Infant CPR
The differences between CPR for infants and children versus adults Inadequate breathing issues Poor perfusion You also learned about using an Automated External Defibrillator (AED) in conjunction with CPR for children and infants.
05/24/2011
37
Lesson 4: Foreign Body Obstruction (Choking)
This final lesson will present information about foreign body obstructions in victims airways, including: Relief for responsive and unresponsive victims Recognizing and responding appropriately to mild and severe obstructions You will also learn about Hands-only CPR.
05/24/2011
38
Foreign Body Airway Obstruction (Choking)

Greater than 90% of childhood deaths from foreign body aspiration occur in children under 5 years old. Foreign body obstruction can be either mild or severe. When it is mild, the adult and children can cough and make some sounds. When it is severe, the adult or child cannot cough or make any sound.
05/24/2011
39
Relief of Foreign Body Obstruction

If the foreign body obstruction is mild, do not interfere. Allow the victim to clear airway by coughing while you observe for signs of severe foreign body obstruction. If the foreign body obstruction is severe you must act to relieve the obstruction. For adults and children, perform abdominal thrusts until the object is expelled or the victim becomes unresponsive. For infant, deliver repeated cycles of 5 back blows followed by 5 chest compressions until the object is expelled or the victim becomes unresponsive.
05/24/2011
40
Relief of Foreign Body Obstruction (Unresponsive)

If the victim becomes unresponsive:
Start CPR with chest compressions do not perform a pulse check.

After 30 chest compressions open the airway. If you see a foreign body, remove it but do not perform blind finger sweeps because they may push the objects further into the pharynx.
Attempt to give 2 breaths and continue with cycles of chest compressions and ventilations until the object is expelled. Look for the object after each round of compressions and sweep if seen. After 2 minutes, if no one has done so, activate the emergency response system.
05/24/2011
41
Hands-only CPR
Because we are in a healthcare setting, this CBT has focused primarily on CPR for Healthcare Providers. Hands-only CPR is for layperson cardiac arrest rescue in the community or out of the hospital when unable to provide breaths (no mask/barrier) because:
Lay rescuers are more likely to provide CPR if they do not have to give ventilations. It is easier for emergency response personnel to instruct lay rescuers how to perform chest compressions when they are untrained. Survival rates from cardiac arrest are similar for Hands-only CPR and CPR using both compressions and ventilations. If the lay rescuer is trained, it is still recommended that the rescuer perform both compressions and ventilations.
42
05/24/2011
Lesson 4: Foreign Body Obstruction (Choking)
This lesson presented information about foreign body obstructions in victims airways, including: Relief for responsive and unresponsive victims Recognizing and responding appropriately to mild and severe obstructions You also learned about Hands-only CPR used by laypeople.
05/24/2011
43
You have completed this module. In it you learned about the changes to the AHAs new recommendations for providing CPR. These changes impact providing basic life support for: Adult victims Infant and child victims Victims with foreign body obstructions in their airways
05/24/2011
2011 Childrens Healthcare of Atlanta Inc.
44
References
2010 American Heart Association Guidelines for CPR and ECC, Supplement to Circulation November 2,2010, Volume 122, Issue 18, Supplement 3.
www.heart.org
05/24/2011
45

AHA Update 2010

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

AHA Update 2010

Uploaded by

Copyright:

Available Formats

Welcome to the American Heart Association 2010 Update for CPR.

2010 AHA Update for CPR

404-785-6767 Shannon Dunlap

Clinical staff all levels

shannon.dunlap@choa.org Mark Guerrein

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Lesson 1: CPR Overview

Changes to the Chain of Survival Changes to the CPR sequence

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Integrated post-cardiac care

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Breathing: Give mouth-to-mouth or bag/mask rescue breathing.

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Change in Sequence continued

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Lesson 1: CPR Overview

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Lesson 2: Adult Basic Life Support for Healthcare Providers

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Adults / Adolescents Basic Life Support (BLS) for Healthcare Providers

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Adult BLS for Healthcare Providers

Chest Compressions in Adults

Provide chest compressions at an adequate rate (at least 100/min)

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Adult BLS for Healthcare Providers

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

1 Victim is unresponsive. No breathing or no normal breathing (i.e., only gasping).

2 Activate the emergency response

Adult / Adolescent BLS for Healthcare Providers

Check pulse: DEFINITE pulse within 10 secs.?

3a Give 1 breath every 5 to 6 secs.

4 Begin cycles of 30 compressions

High Quality CPR

6 Shockable rhythm? YES 7

No 8 No shockable rhythm: Resume

Lesson 2: Adult Basic Life Support for Healthcare Providers

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Lesson 3: Child and Infant CPR

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Child and Infant CPR

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Child and Infant CPR

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Pediatric Chain of Survival

Chest Compressions in Infants and Children

Pediatric BLS for Healthcare Providers in Infants and Children

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Pediatric BLS for Healthcare Providers in Infants and Children

Pediatric BLS for Healthcare Providers

2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved.

Pediatric BLS for Healthcare Providers

Check pulse: DEFINITE pulse within 10 secs.?

3a Give 1 breath every 3 secs. Add

High Quality CPR

6 Shockable rhythm? YES 7