Cardiopulmonary Resuscitation (CPR)

HLTAID001 Provide Cardiopulmonary Resuscitation

What is CPR?> Cardiopulmonary Resuscitation (CPR) is a first aid technique to

help people who suffer a “cardiac arrest” (their heart stops

beating).

> It involves doing chest compressions, rescue breaths and

using a defibrillator to keep the casualty alive until an

Ambulance arrives.

> A defibrillator is an electrical device which can be used to help

restart someone’s heart.

> CPR on its own is unlikely to restart someone’s heart, however it

will increase the chance of a defibrillator being successful.

What is CPR? Cardiopulmonary Resuscitation (CPR) should commence

immediately if a person is

Unresponsive; and

Not breathing normally.

Legal Aspects

Resuscitation should be provided by a first aider to the best of their ability. Legal aspects around CPR include» Duty of Care» Consent» Privacy

Duty of Care

In Australia, there is no legal requirement to provide First Aid unless:

˃ You are the driver of a motor vehicle involved in an accident

˃ You are an employee trained in, and designated as a first aider at the workplace, and are paid to do so

˃ The person is in your care, such as a child, with a child care worker, or an aged care worker.

˃ Any person who commences first aid has a duty to continue to care for the person until they recover or further help arrives.

Duty of Care

As part of our duty of care, we should continue CPR until:

˃ The patient recovers and normal breathing returns

˃ Professional medical assistance is ready to take over

˃ It is physically impossible to continue

˃ A Doctor pronounces that the patient is deceased

Consent

An injured or ill person has the right to refuse assistance, so you must always ask for permission

˃ Children and people in care: Ask for permission from the parent or guardian

˃ Where a person is unconscious, the law implies permission where the persons life or health is at risk.

˃ Where a child’s carer cannot be found and emergency actions are required to save a life, first aid may be commenced in the best interest of the child

Privacy

All patients have the right to ensure their information is not released without their permission.

You may only pass patient information to another person involved in their further treatment (ambulance, Doctor etc) or to maintain legal records.

Records

Records should be kept of all first aid treatments you perform. In a workplace you should record this in accordance with procedures.

Records must be kept confidentially and are regarded as a legal document

Your company policies will determine where and by whom these are filed

Records

Your records should be made in ink, without the use of correction fluids and include:

˃ Patients Name and Date of Birth

˃ Incident Details

˃ Treatment provided

˃ Advice and referral provided to the patient

˃ Whether the patient went to hospital

˃ The name of the first aider

Patient assessmentFirst Aid Priorities

If you find someone collapsed, you can use the mnemonic “DRSABCD” to help you remember what to do

We call this the primary survey

History

The story of the accident or illness can also help you as a first aider and medical personnel to determine the most likely injuries or illnesses.

History can be determined from the surroundings, bystanders, family or the patient.

Chain of Survival

CPR is a key part of the Chain of Survival. The chain of survival describes the links which give the best chance of survival to a patient in cardiac arrest

D: Danger

> Ensure there are no dangers to yourself, other bystanders or the casualty

> Ask yourself - why has the casualty collapsed? Are there any hazards? Am I at risk?

> Dangers could include: moving vehicles, electricity, water, other people and smoke/fire Only help if it is safe to do so Your own safety is number 1 priority

D: Danger

> Dangers include biological dangers such as the transmission of germs. To reduce these risks we always use standard precautions such as Gloves Face Shield Washing our hands If you have them, goggles are useful for

your own personal protection during CPR

R: Response

> Try and wake the casualty up - are they responsive? Kneel by his/her head, shout loudly in

both ears and tap them on the shoulders Do not shake the patient Try touch and talk (Can you hear me, open your

eyes, what is your name)

> If no response, the casualty is unconscious

At this point…Send for Help

> If a casualty does not wake up they are unconscious.

> This is an emergency situation

> Try and attract attention to yourself/the casualty by shouting for helpIf you need to leave the patient to get

help, do soDial 000 (112 on a mobile phone)

A: Airway

> The airway is the tube which takes air from the mouth/nose to the lungs

> When a casualty is unconscious, their tongue can fall backwards and block their airway.

> This can cause an obstruction and stop the casualty from breathing

A: Airway (2)

> To open someone’s airway, place one hand on their forehead and tilt their head backwards

> Then place two fingers on the bony part of their chin and lift it.

> This is known as the “head tilt, chin lift” maneuver.

A: Airway (infants)

> Children under 12 months old have an undeveloped airway so we do not tilt the head back. Keep an infants head in a neutral position – not forward or back.

B: Breathing

> Keep your hands on the person’s head/chin

> Place your cheek above their mouth and look at their chest

> Look, listen and feel for regular breathing for 10 seconds.

Irregular shallow gasps is not normal breathing. This is a phenomenon known as ‘agonal breathing’ and should be treated as not breathing.To be breathing properly, we need 2 breaths or more in 10 seconds

B: Breathing

Normal Breathing Rates Breaths per minute

Adults 16-20

Children 6-12 Years of Age 16-25

Children 1-5 Years of Age 25-30

Infants 1-12 months old 25-40

Compressions

> If your patient is unconscious and not breathing normally, commence CPR.

> First, you should give 30 chest compressions

> Place your hands in the lower half of the person’s chest, over the breastbone (sternum)

> Interlock your fingers

> Push down 30 times at a rate of 100 compressions / minute (almost 2 per second)

Chest compressions

Ensure your elbows are locked and your shoulders positioned above the chest

Push down 1/3rd depth.

Ensure you release fully after each compression

Rescue breaths

> After 30 chest compressions, give 2 rescue breaths.

> Tilt the casualty’s head backwards, life their chin and then pinch their nose

> Make a seal over their mouth and breath in for approximately one second

Adult CPR

> Continue the cycle of 30 chest compressions to 2 rescue breaths until help arrives

> If there is more than one first aider, swap over doing CPR every 2 minutes

> If a defibrillator arrives it should be used immediately. Turn on the defibrillator and follow its prompts

Child / infant CPR> The rules that apply for an adult do not change for an infant or child in CPR.

> First, you should give 30 chest compressions

> Place your hand or hands in the lower half of the child’s chest, over the breastbone (sternum)

> Interlock your fingers if using 2 hands Push down 30 times at a rate of 100

compressions / minute (almost 2 per second)

Depth remains 1/3rd front to back

Chest compressions(infant)

Using 2 fingers on the lower half of the infants sternum, compress 1/3rd the depth of the chest.

Compress at a rate of almost 2 compressions per second (100 min)

Rescue breaths(Infant)

> After 30 chest compressions, give 2 rescue breaths.

> Leaving the casualties head in a neutral position

> Make a seal over their mouth and nose and gently puff into the infant.

Defibrillation

When a person suffers a cardiac arrest, the electrical system in the heart does not act properly. The only way to reverse erratic electrical systems in the heart is with a defibrillator

Defibrillation

A defibrillator should be used as soon as it is available, even if this means CPR must be stopped.

Automated External Defibrillators (AED) analyse the heart rhythm of the patient and determine if shocks are advised

In many cardiac arrests, multiple shocks may be required.

To use an AED, open the unit and follow the prompts. The pads will have pictures to show where they need to be placed

Recovery

If a patient shows signs of life, they must be placed in the recovery position.

Continue to monitor the patient as they may quickly relapse into cardiac arrest.

If they return to cardiac arrest, recommence CPR

The recovery position - steps

1.Kneel by the casualty’s waist

2.Place the hand nearest you at right angles

3.Grasp the hand furthest to you, place the back of

their hand against their cheek closest to you

4.Lift the leg furthest away from you at the knee and

place their foot on the floor

5.Using their knee as a lever, pull the person onto

their side

6.Ensure their head is still tilted back and they are

on their side

Watch this video

The video next is a real life resuscitation captured on TV for the series Bondi Rescue.

It shows lifeguards successful resuscitating a swimmer and using a defibrillator.

The protocols in the video are slightly different to what we’ve covered, however the general idea is the same!

Watch this video

Hands Only CPR

The Australian Resuscitation Council (ARC) states:The Australian Resuscitation Council continues to hold the view that any attempt at resuscitation is better than no attempt, and if rescuers are unwilling or unable to do rescue breathing they should do chest compressions only. If chest compressions only are given, they should be continuous at a rate of approximately 100/min.

http://www.resus.org.au/policy/guidelines/guideline_faqs.pdf

The Australian Resuscitation Council

The Australian Resuscitation Council (ARC)The Australian Resuscitation Council is a voluntary co-ordinating body which represents all major groups involved in the teaching and practice of resuscitation. The Australian Resuscitation Council is sponsored by the Royal Australasian College of Surgeons and the Australian and New Zealand College of Anaesthetists.The Australian Resuscitation Council produces Guidelines to meet its objectives in fostering uniformity and simplicity in resuscitation techniques and terminology. Guidelines are produced after consideration of all available scientific and published material and are only issued after acceptance by all member organisations. This does not imply, however, that methods other then those recommended are ineffective. http://www.resus.org.au/

The Australian Resuscitation Council

First aid principles are determined by » the ARC» State and territory legislation» Workplace Policy and ProcedureIt is recommended that CPR and Defibrillation is refreshed annually

The Australian Resuscitation Council

The Australian Resuscitation Council (ARC)The Australian Resuscitation Council is a voluntary co-ordinating body which represents all major groups involved in the teaching and practice of resuscitation. The Australian Resuscitation Council is sponsored by the Royal Australasian College of Surgeons and the Australian and New Zealand College of Anaesthetists.The Australian Resuscitation Council produces Guidelines to meet its objectives in fostering uniformity and simplicity in resuscitation techniques and terminology. Guidelines are produced after consideration of all available scientific and published material and are only issued after acceptance by all member organisations. This does not imply, however, that methods other then those recommended are ineffective.It is the policy of the Australian Resuscitation Council to respect the autonomy of member organisations. http://www.resus.org.au/

Handover» Do not stop CPR when the ambulance arrives.

Continue until the paramedic is ready to take over.

» Paramedics may ask you to continue so they can prepare equipment or drug therapies

A good handover will provide an appropriate story to paramedics. It should be brief and relevant.Include:» Time of collapse, signs or symptoms prior to collapse, what the

patient was doing at the time, any drugs they have taken, what first aid you have provided.

Post Incident

Following serious first aid incidents, it is important to debrief.Rescuers who have had to assist with CPR or where the patient did not survive may experience stress as a result. It is important that all rescuers have a chance to discuss their feelings.Support mechanisms available include:» Friends and Family» Workplace Counsellors» Professional Counselling services» Lifeline 131114

Operational Debrief

Debriefings with relevant personnel following a serious first aid event should include reviewing the emergency response.This allows for a review of existing procedures.You should also ensure that your supervisors and managers are aware of the incident and are involved in the debrief

Summary

> Danger

> Response

> Send for Help

> Airway

> BreathingCompressionsDefibrillate

http://www.resus.org.au/public/arc_basic_life_support.pdf