CARDIOPULMONARY RESUSCITATION

CHAIN OF SURVIVAL
Chain of survival as a universal chain that already implemented are consist of : Immediate recognition of cardiac arrest and activate of emergency response system. Early CPR that emphazise chest compressions (new guidelines AHA 20120). Rapid defibrilation if indicated. Effective advanced life support. Integrated post-cardiac arrest care.

CHANGES IN BASIC LIFE SUPPORT (BLS) GUIDELINES

The Change From "A-B-C" to "C-A-B
Critical element is chest compressions
Delay in A-B Avoidance of A & B

C Compressions

C--Chest compressions
PUSH HARD AND PUSH FAST At least 100 COMPRESSIONS / MINUTE* Allow the chest to recoil -- equal compression and relaxation times <10 seconds for pulse checks or rescue breaths 2 Rescuers Present: may alternate and switch roles as needed.

One rescuer should perform 30 compressions and the second rescuer provide 2 rescue breaths.
Change roles every 2 minutes (or 5 sets of 30:2) or as needed to prevent fatigue. Counting out loud. Compression Depth*
Adults: at least 2 Child/Infant 1/3 depth of chest 1.5" (4 cm) infant 2 (5 cm) child

C Compressions
Place victim flat on their back, face up, on a hard firm surface. Quickly remove any clothing covering the chest. Place hands in the center of the chest between the nipple line on the lower half of the sternum or Place heel of one hand on center of chest between the nipples. Place the second hand on top of the first hand in a manner that is comfortable for you. You may overlay or interlock your fingers. Position yourself over the victim and use your entire body to push up and down on the persons chest. Keep you elbows locked and think of moving at the waist.

A Stands for Airway

Open the airway with the head tilt chin lift and deliver 2 breaths
Look for chest rise

B- Breathing
After 30 compressions give 2 breaths Breathing: Mouth to Mouth - is considered the easiest and most readily available option. - Open the victims airway (head-tilt/chin-lift) - Cover the victims mouth completely with your mouth. - Pinch the victims nose and giving a regular breath for about 1 second into the victim. - Observe the chest rise. - Let the victim exhale and give the second breath just as you did with the first breath. - Check the rise and fall of the chest. - No rise and fall: readjust the head, open airway and breath again. - If the breaths do not make the chest rise and fall for a second time - move on to circulation and compressions.

CHANGES IN BASIC LIFE SUPPORT (BLS) GUIDELINES

Activation of Emergency Response System Should be made after assessment of the patients responsiveness and breathing but should not be delayed.

CHANGES IN BASIC LIFE SUPPORT (BLS) GUIDELINES

II) Removal of "look - listen - feel" Instead, - immediate activation of the emergency response system - starting chest compressions for any unresponsive adult victim with no breathing or no normal breathing (ie, only gasps).

CHANGES IN BASIC LIFE SUPPORT (BLS) GUIDELINES

IV) Cricoid pressure - AKA Sellick manoeuvre , is a technique applied during endotracheal intubation, used to either prevent regurgitation, or to assist with visualisation of the glottis by a practitioner attempting intubation. The technique involves the application of pressure to the cricoid cartilage of the neck. - Impedes ventilation.

CHANGES IN BASIC LIFE SUPPORT (BLS) GUIDELINES

New "circular" ACLS algorithm (Table 1

CHANGES IN BASIC LIFE SUPPORT (BLS) GUIDELINES

Hands Only CPR - For untrained lay rescuers on adult victims who collapse in front of them.

CHANGES IN BASIC LIFE SUPPORT (BLS) GUIDELINES

Identification of Agonal Gasps Irregular, gasping breaths often seen during cardiac arrest. In most cases, rescuers will see victims take these gasping breaths no more than 10 to 12 times per minute; that's one every five to six seconds. Agonal respirations do not provide adequate oxygen to the body and should be considered the same as no breathing at all (respiratory arrest).

CHANGES IN BASIC LIFE SUPPORT (BLS) GUIDELINES

ELECTRICAL THERAPIES INCLUDING USE OF AED AND DEFIBRILLATOR Defibrillation of children 1 to 8 years of age with an AED, the rescuer should use a pediatric dose-attenuator system if one is available. If the rescuer provides CPR to a child in cardiac arrest and does not have an AED with a pediatric dose-attenuator system, the rescuer should use a standard AED. For infants (<1 year of age): a manual defibrillator is preferred. If a manual defibrillator is not available,an AED with pediatric dose attenuation is desirable. If neither is available, an AED without a dose attenuator may be used. Automated external defibrillators with relatively high-energy doses have been used successfully in infants in cardiac arrest, with no clear adverse effects.

Automated External Defibrillator (AED) 4 Universal steps to follow:

1. Turn on (voice prompts will tell you what to do) 2. Attach pads to patients bare chest: looking at picture placement on pad (choose correct pads: adult or pediatric) Remove medication patches and wipe skin Do not apply pads over pacemakers/internal defibrillators (noted as a lump on top of the chest) place pad 1 inch away May need to remove chest hair if pads do not attach firmly on chest 3. Connect cord to AED 4. Stand back from the patient so the AED can analyze the rhythm AED will advise if a shock is needed: Make sure to clear the patient (no one is touching the patient) and press the shock button

AED Considerations
With the 2010 Guidelines we now use an AED on the Adult, Child, and Infant victim as soon as it is available. Pediatric pads cannot be use on adult victims. Adult pads can be use on all victims, if they are the only pads available (they should be placed front to back on infants). Once the AED shocks the victim, chest compressions are resumed immediately.

Universal Steps of CPR

Assess responsiveness (are you okay)- if no response and no effective respirations call for help , activate the emergency response system , and get an AED. Check for pulse if no pulse- begin chest compressions After one cycle of 30 chest compressions, open the airway and give 2 breaths Use the AED as soon as it is available no matter where you are in the sequence.

Ratio 30: 2

Special Considerations
As a lone rescuer a bag valve mask device is not recommended as a ventilation device Once an advanced airway is in place (eg. ET tube, LMA), CPR is continued at a rate of at least 100 compressions per minute and ventilations are continued at 1 breath every 6-8 seconds.

You must assure that the scene is safe prior to attending to a potential victim.

Infant CPR
Determine unresponsiveness (stimulate rub or smack the bottom of the feet) do not shake and shout If the infant is unresponsive, check for a brachial pulse If there is no pulse, or the rate is less than 60 with signs of poor perfusion, begin chest compressions. After 30 compressions open the airway and give 2 breaths. Apply the AED as soon as it is available

CPR In Children
Modifications of CPR in Children include:

Amount of air for breaths Depth of compressions (at least 1/3 the depth of the chest or approximately 2 inches) Chest compressions may be done with one hand AED 2 person CPR in children the ratio becomes 15:2 In an unwitnessed arrest of a child perform CPR for 2min. Or 5 cycles before calling 911

Infant Compressions and Breathing

Compressions are performed at a rate of at least 100 beats per minute The ratio is 30 : 2 in one rescuer CPR. The compressions should be performed with 2 fingers placed between the nipple line and the chest should be compressed at least 1/3 the depth of the chest or approximately 1 inches. When performing breathing in an infant give just enough air to achieve visible chest rise.

2 Rescuer CPR in Infants

When performing 2 rescuer CPR on an infant, the rescuer has the option of using the 2 thumbs-encircling hands technique. This technique allows one rescuer to be at the infants head for breaths and the other rescuer to be at the feet for compressions. In 2 person CPR in infants the ratio becomes 15:2 (10 cycles-2 person) In an unwitnessed arrest of an infant perform 2 minutes or 5 cycles of CPR before calling 911 & getting AED.

Recommendations COMPONENT Recognition No breathing or no normal breathing(gasping) ADULTS CHILDREN Unresponsive No breathing or only gasping INFANTS

No pulse palpated within 10 seconds

CPR sequence Compression rate C-A-B At least 100/min

Compression depth

At least 2 inches (5cm)

At least AP diameter About 2 inches (5cm)

At least AP diameter About 1 inches (4 cm)

Chest wall recoil

Allow complete recoil between compressions HCPs rotate compressions every 2 minutes

Compression interruptions

Minimize interruptions in chest compressions Attempt to limit interruptions to <10 seconds

Airway Compression-to-ventilation ratio 30:2 1 or 2 rescuers

Head tilt-chin lift (suspected trauma: jaw thrust) 30:2 single rescuer 15:2 2 rescuers

If rescuer is untrained

Compressions only

When Can I Stop CPR?

Victim revives Trained help arrives Too exhausted to continue Unsafe scene Physician directed (do not resuscitate orders) Cardiac arrest of longer than 30 minutes (controversial)

Injuries Related to CPR

Rib fractures Laceration related to the tip of the sternum
Liver, lung, spleen

Complications of CPR
Vomiting
Aspiration Place victim on left side Wipe vomit from mouth with fingers wrapped in a cloth Reposition and resume CPR

Stomach Distension
Air in the stomach
Creates pressure against the lungs Prevention of Stomach Distension
Dont blow too hard Slow rescue breathing Re-tilt the head to make sure the airway is open Use mouth to nose method

Choking
The tongue is the most common obstruction in the unconscious victim (head tilt- chin lift) Vomit Foreign body
Balloons Foods

Swelling (allergic reactions/ irritants) Spasm (water is inhaled suddenly)

How To Recognize Choking

Can you hear breathing or coughing sounds?
High pitched breathing sounds?

Is the cough strong or weak? Cant speak, breathe or cough Universal distress signal (clutches neck) Turning blue

Recognizing Choking
A partial airway obstruction with poor air exchange should be treated as if it were a complete airway blockage. If victim is coughing strongly, do not intervene

Choking
Cases of Choking can be mild or severe.
If the victim is coughing , and air is moving, let them continue to cough. If the victim is unable to speak, moving no air, and has no cough, they have severe airway obstruction.

Begin Abdominal Thrusts!

Conscious Choking
(Adult Foreign Body Airway Obstruction)
Give 5 abdominal thrusts (Heimlich maneuver)

Place fist just above the umbilicus (normal size)

Give 5 upward and inward thrusts Pregnant or obese? 5 chest thrusts
Fists on sternum If unsuccessful, support chest with one hand and give back blows with the other

Continue until successful or victim becomes unconscious

If You Are Choking And You Are Alone

Use fist Use corner of furniture Be creative

If Victim Becomes Unconscious

After Giving Thrusts

Call 911
Try to support victim with your knees while lowering victim to the floor Assess Begin CPR After chest compressions, check for object before giving breaths breaths

You Enter An Empty Room And Find An Unconscious Victim On The Floor
What do you do? Assess the victim
Give CPR if needed After giving compressions:
look for object in throat then give breaths

Choking: Conscious Infants

Position with head downward 5 back blows (check for
expelled object)

5 chest thrusts (check for

expelled object)

Repeat

Choking: Unconscious Infants

If infant becomes unconscious: Assess When the first breaths dont go in, check for object in throat then try 2 more breaths. If neither set of breaths goes in, suspect choking Begin 30 compressions Check for object in throat (no blind finger sweep) Give 2 breaths

Choking continued
Perform abdominal thrusts until the victim either expels the item or becomes unresponsive. Once the choking individual becomes unresponsive begin CPR- starting with chest compressions. After compressions, and before giving breaths, open the airway and check to see if anything is in the mouth. If you see something, take it out, and then give 2 breaths. We no longer perform blind finger sweeps.

Infant Choking
To clear an infants airway we perform a series of 5 back slaps followed by 5 chest thrusts.
Hold the infant prone, resting on your forearm with the head slightly lower than the chest. Support the infants head with your hand, and deliver 5 forceful back slaps with the heel of your hand between the infants shoulder blades. Rotate the infant over and deliver 5 quick downward chest thrusts (deliver these in the same location as you would do compressions).

Infant Choking Continued

Continue performing alternating sets of back slaps and chest thrusts until the infant expels the object or becomes unresponsive. Once the infant becomes unresponsive begin the steps of CPR starting with chest compressions. Before giving breaths, open the airway and look for an object. If you see something remove it , do not perform a blind finger sweep.