CARDIO PULMONARY CARDIO PULMONARY RESUSCITATION RESUSCITATION

Basic Life SupportBasic Life Support

ANY ATTEMPT AT RESUSCITATION ANY ATTEMPT AT RESUSCITATION IS BETTER THAN NO ATTEMPT AT IS BETTER THAN NO ATTEMPT AT

ALLALL(Australian Resuscitation Council)(Australian Resuscitation Council)

(Revised March 2011)(Revised March 2011)

Chain of SurvivalChain of Survival 11stst link Early recognition and call link Early recognition and call

for helpfor help 22ndnd link Early CPR link Early CPR 33rdrd link Early defibrillation link Early defibrillation 44thth link Early advanced cardiac link Early advanced cardiac

life support life support

What is a cardiac arrest?What is a cardiac arrest?

A condition where there is cessation of A condition where there is cessation of heart action evidenced as:-heart action evidenced as:-

No signs of lifeNo signs of life unresponsive / unconsciousunresponsive / unconscious no normal breathing no normal breathing no purposeful movementno purposeful movement

Common Causes:Common Causes: Cardiac conditions such as AMI (heart attack)Cardiac conditions such as AMI (heart attack) Respiratory arrestRespiratory arrest

What is a What is a respiratoryrespiratory arrest? arrest?

A condition where spontaneous A condition where spontaneous respiratory effort is ineffective or has respiratory effort is ineffective or has ceased and cardiac output is still presentceased and cardiac output is still present

If recognised and treated promptly may If recognised and treated promptly may prevent deterioration into a cardiac arrestprevent deterioration into a cardiac arrest

Common CausesCommon Causes: : asthmaasthma allergic reaction allergic reaction foreign body airway obstructionforeign body airway obstruction

The aims of CPRThe aims of CPR

Buys time until reversible causes can Buys time until reversible causes can be found and treated eg blood lossbe found and treated eg blood loss

Maintain the supply of blood to vital Maintain the supply of blood to vital organs ( to preserve heart and brain organs ( to preserve heart and brain function)function)

May increase the chance of May increase the chance of successful defibrillationsuccessful defibrillation

Slows the deterioration of ventricular Slows the deterioration of ventricular fibrillation into asystolefibrillation into asystole

DRSABCDDRSABCD

DD - Danger - Danger R R - Response - Response SS - Send for help - Send for help AA - Airway - Airway BB - Breathing - Breathing CC - Circulation/compressions - Circulation/compressions DD - Defibrillation - Defibrillation

DANGERDANGER

Assess scene for Assess scene for DangerDanger to both to both patient/yourselfpatient/yourself

Ensure use of personal protective Ensure use of personal protective equipment at all times (eg gloves/masks equipment at all times (eg gloves/masks etc)etc)

Check for water, electricity, body fluids, Check for water, electricity, body fluids, vomit, blood and check for scene safetyvomit, blood and check for scene safety

Move patient to a safer place if needed, Move patient to a safer place if needed, but try to avoid moving them if possible in but try to avoid moving them if possible in case of other injuriescase of other injuries

Remember to be mindful of your backRemember to be mindful of your back

RESPONSE RESPONSE

Do not shake and shout - touch to the Do not shake and shout - touch to the shouldershoulder

Speak loudly “are you all right?”Speak loudly “are you all right?” Has the victim fainted or are they Has the victim fainted or are they

unconscious? (unconscious? (If he responds, leave as you find him, and find out what is wrong, reassess regularly)

A casualty who is unresponsive should be A casualty who is unresponsive should be considered unconsciousconsidered unconscious

SEND for helpSEND for help

SendSend for help for help Ensure the closest Automatic Ensure the closest Automatic

External Defibrillator (AED) has been External Defibrillator (AED) has been retrieved retrieved

Note the timeNote the time

AIRWAYAIRWAY

Place a hand on the Place a hand on the victims’ foreheadvictims’ forehead

Fingertips to the point Fingertips to the point of the chinof the chin

Gently tilt the head Gently tilt the head and lift the chin to and lift the chin to open the open the airwayairway

Check for absence of Check for absence of signs of life – signs of life – unconscious, not unconscious, not breathing normally breathing normally and unresponsiveand unresponsive

AirwayAirway Assess the airway, ensuring it Assess the airway, ensuring it

is is - open- open

- clear- clear

Jaw thrust can be usedJaw thrust can be used

Look in mouth for obstructionLook in mouth for obstruction teeth, tongue, teeth, tongue,

vomit, foreign objectvomit, foreign object Ensure airway is clearEnsure airway is clear

If airway obstructed with If airway obstructed with fluid (vomit or blood) roll fluid (vomit or blood) roll patient onto their side & patient onto their side & clear airway or use suction clear airway or use suction if availableif available

AirwayAirway

Airway management takes precedence over any Airway management takes precedence over any injuryinjury

If spinal injury is suspected maintain alignment If spinal injury is suspected maintain alignment & support head& support head

Minimise bending and twisting of the neckMinimise bending and twisting of the neck

Visible material may be removed by rolling onto Visible material may be removed by rolling onto side and drain by gravity (ARC 2010)side and drain by gravity (ARC 2010)

Leave well fitting dentures insituLeave well fitting dentures insitu

Airway - PaediatricsAirway - Paediatrics Infants:Infants:

head head neutralneutral position position lower jaw supported chinlower jaw supported chin no pressure on soft tissuesno pressure on soft tissues If airway not open tilt head back If airway not open tilt head back veryvery

slightlyslightly Children should be managed as per adults Children should be managed as per adults

(ARC 2010) (ARC 2010)

BREATHING BREATHING

Look, listen and Look, listen and feel for normal feel for normal breathingbreathing

Normal breathing – Normal breathing – roll into the roll into the recovery position & recovery position & continue to continue to observeobserve

BREATHINGBREATHING

Confirm help has been calledConfirm help has been called

If absent or impaired breathing If absent or impaired breathing after after opening airwayopening airway commence commence compressions, NOT rescue breathscompressions, NOT rescue breaths

CIRCULATIONCIRCULATION

Check for signs of lifeCheck for signs of life Unresponsive / unconsciousUnresponsive / unconscious No purposeful movement No purposeful movement Absence of normal breathingAbsence of normal breathing

If victim takes an occasional gasp suspect cardiac If victim takes an occasional gasp suspect cardiac arrest arrest

If no signs of life commence chest compressionsIf no signs of life commence chest compressions

COMPRESSIONSCOMPRESSIONS Kneel at the side of the Kneel at the side of the

casualtycasualty Lower half of the Lower half of the

sternum in all age sternum in all age groupsgroups

Press 1/3 depth of the Press 1/3 depth of the chest chest

Rate 100 compressions / Rate 100 compressions / minuteminute

Give 30 compressions Give 30 compressions then 2 rescue breaths then 2 rescue breaths

DO NOT apply pressure DO NOT apply pressure over the ribs or over the ribs or abdomen abdomen

Adult and childAdult and child

Heel of one hand or two-handed technique

to suit size of child

Infant compressionsInfant compressions

Two fingersTwo fingers

Two thumbsTwo thumbs

Get your technique rightGet your technique right Ensure good positionEnsure good position 50% compression, 50% relaxation50% compression, 50% relaxation Allow complete chest recoil after each Allow complete chest recoil after each

compressioncompression Place heel of one hand on lower half Place heel of one hand on lower half

sternum (centre chest) & place heel of 2sternum (centre chest) & place heel of 2ndnd hand on top first, fingers parallel to the hand on top first, fingers parallel to the ribs & raisedribs & raised

Push with heel of handPush with heel of hand Shoulders vertically over sternumShoulders vertically over sternum Keep arms straightKeep arms straight

CompressionsCompressions

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CompressionsCompressions 30:230:2 – 30 compressions to 2 breaths– 30 compressions to 2 breaths

Universal ratio for all infants, children and adults with one Universal ratio for all infants, children and adults with one or two rescuers or two rescuers

Ratio 30:2 will achieve 5 cycles in two minutesRatio 30:2 will achieve 5 cycles in two minutes

CPR should not be interrupted to check for signs of life (ARC CPR should not be interrupted to check for signs of life (ARC 2006)2006)

CPR becomes ineffective when person doing compressions CPR becomes ineffective when person doing compressions becomes tired, change at least every two minutes to becomes tired, change at least every two minutes to reduce fatigue (ARC 2006)reduce fatigue (ARC 2006)

Team leader monitors effectiveness of compressions & Team leader monitors effectiveness of compressions & ventilations directing change of ventilations directing change of rescuers as necessaryrescuers as necessary

Circulation - Duration of CPRCirculation - Duration of CPR

Continue CPR untilContinue CPR until Signs of life returnSigns of life return

Advanced Life Support personnel direct Advanced Life Support personnel direct advanced resuscitationadvanced resuscitation

An authorised person pronounces life extinct An authorised person pronounces life extinct

It is impossible to continueIt is impossible to continue

Breathing techniqueBreathing technique

Observe for chest rise with each Observe for chest rise with each inflationinflation

If the chest does not rise ensure If the chest does not rise ensure correct head tilt, adequate air seal correct head tilt, adequate air seal and ventilationand ventilation

Various devices available, pocket Various devices available, pocket mask, bag-valve-mask device mask, bag-valve-mask device

Mouth to pocket maskMouth to pocket mask

Bag/Valve/MaskBag/Valve/Mask

DEFIBRILLATION DEFIBRILLATION The purpose of BLS is to maintain The purpose of BLS is to maintain

myocardial and cerebral perfusion until myocardial and cerebral perfusion until defibrillationdefibrillation

Time is critical, the chance of successful Time is critical, the chance of successful defibrillation decreases with timedefibrillation decreases with time

Immediate CPR & early defibrillation Immediate CPR & early defibrillation provides the best chance of survival in provides the best chance of survival in victims with VF or pulseless VTvictims with VF or pulseless VT

Back to the chain of survivalBack to the chain of survival

AUTOMATED EXTERNAL AUTOMATED EXTERNAL DEFIBRILLATOR (AED)DEFIBRILLATOR (AED)

Portable, battery operated Portable, battery operated For use by trained first For use by trained first

aiders aiders Will analyse the rhythmWill analyse the rhythm AED’s accurately diagnose AED’s accurately diagnose

cardiac rhythms and separate cardiac rhythms and separate them into 2 groupsthem into 2 groups those responsive to those responsive to

defibrillationdefibrillation those unresponsive to those unresponsive to

defibrillationdefibrillation Will only ‘shock’ a Will only ‘shock’ a

shockable rhythmshockable rhythm

DEFIBRILLATION PADSDEFIBRILLATION PADS Soft thin foam padsSoft thin foam pads Layer of gel which picks up the Layer of gel which picks up the

electrical signalselectrical signals Must adhere firmly to chest wall – no Must adhere firmly to chest wall – no

creasescreases Direction for placement clearly on Direction for placement clearly on

pack and pads pack and pads

USE OF AEDUSE OF AED Assign tasks if number of people Assign tasks if number of people

presentpresent Continue CPR while preparing AEDContinue CPR while preparing AED Turn on AED Turn on AED Attach electrodesAttach electrodes Follow the promptsFollow the prompts Ensure no one touches the casualty Ensure no one touches the casualty

while the AED analyses the rhythmwhile the AED analyses the rhythm

Applying the padsApplying the pads

Avoid placing pads directly over Avoid placing pads directly over medication patches, jewellery, ECG medication patches, jewellery, ECG electrodes, implanted devices or electrodes, implanted devices or invasive linesinvasive lines

What to do with the AEDWhat to do with the AED Plug in AED pads Plug in AED pads

connector to defibrillatorconnector to defibrillator

Wait for AED to analyse Wait for AED to analyse the victims cardiac rhythmthe victims cardiac rhythm

Follow voice promptsFollow voice prompts

If no shock indicated If no shock indicated continue to follow the continue to follow the voice prompts and voice prompts and maintain Basic Life Supportmaintain Basic Life Support

USE OF AED (cont)USE OF AED (cont) If a shock is indicated – the machine will deliver If a shock is indicated – the machine will deliver

the shockthe shock Before you push the shock buttonBefore you push the shock button

Perform a Perform a visual sweepvisual sweep of the area of the area Ensure no one is in contact with the patient or Ensure no one is in contact with the patient or

the patients bed the patients bed Ensure oxygen is removed from immediate Ensure oxygen is removed from immediate

areaarea Remove patient from excessive moistureRemove patient from excessive moisture Call out Call out “STAND CLEAR”“STAND CLEAR” and recheck the area and recheck the area

before you push the orange shock buttonbefore you push the orange shock button

What next ?What next ?

Commence CPR immediately after Commence CPR immediately after delivering the shockdelivering the shock

Use a ratio of 30 compressions to 2 Use a ratio of 30 compressions to 2 breathsbreaths

Follow the voice prompts & continue Follow the voice prompts & continue CPR until signs of life returnCPR until signs of life return

CAUTION IN USE OF AEDCAUTION IN USE OF AED

Don’t apply pads over pacemakersDon’t apply pads over pacemakers Don’t apply pads over skin Don’t apply pads over skin

patches/medicationspatches/medications Be cautious around waterBe cautious around water NEVER attach to anyone not in NEVER attach to anyone not in

cardiac arrestcardiac arrest

ARRIVAL OF AMBULANCEARRIVAL OF AMBULANCE DO NOT stop CPR DO NOT stop CPR Ambulance officers - timeAmbulance officers - time

- equipment - equipment

- factual details- factual details

- assessment - assessment Place victim in recovery position if signs of Place victim in recovery position if signs of

life returnlife return

CESSATION OF CPRCESSATION OF CPR

Return of signs of lifeReturn of signs of life The scene becomes unsafeThe scene becomes unsafe Qualified help arrives and takes overQualified help arrives and takes over You are physically unable to continueYou are physically unable to continue An authorised person pronounces life An authorised person pronounces life

extinct extinct

CULTURAL AWARENESSCULTURAL AWARENESS

Be aware of cultural and linguistic Be aware of cultural and linguistic diversity diversity

Debriefing in an appropriate setting can be Debriefing in an appropriate setting can be very helpful following an intense situation very helpful following an intense situation such as a cardiac arrestsuch as a cardiac arrest

CAUTIONCAUTION

Motorcyclists – Motorcyclists – take care when removing take care when removing helmet helmet

Pregnant women Position on her back with shoulders flatPosition on her back with shoulders flat Use padding / wedge to give pelvic tilt Use padding / wedge to give pelvic tilt The pelvic tilt obtains lateral displacement of The pelvic tilt obtains lateral displacement of

the uterusthe uterus Enhance venous return and reduce pressure on Enhance venous return and reduce pressure on

vena cavavena cava

Pt in supine positionNOTE: compressed

inferior vena cava andaorta

Pt positioned with pelvic tiltNOTE: compression relieved

on the inferior vena cava and

aorta

XX

REMEMBERREMEMBER

ANY ATTEMPT AT RESUSCITATION IS ANY ATTEMPT AT RESUSCITATION IS BETTER THAN NO ATTEMPT AT ALLBETTER THAN NO ATTEMPT AT ALL

Australian Resuscitation Council, Australian Resuscitation Council, (2010)(2010)