Cardiopulmonary Resuscitation

American Heart Association

2011 Guidelines

CPR for Health Providers

CPR for Health Care Providers

Adult

Child

Infant

Terminology

BLS / BCLS

ALS / ACLS

Respiratory Arrest

Arrest, Cardiac Arrest, Code, Code Blue

Ventilations

American Heart Association

Research

Training

Public Education

Chain of Survival

Early AccessEarly CPREarly DefibrillationEarly ACLS

The Myth

A little CPR & everything turns out O.K.

Definitions

Clinical Death = no pulse & not breathing

Biological Death = Permanent brain death (irreversible)

Begins 4 - 6 minutes after arrest

CABD’s of CPRC = CirculationA = AirwayB = BreathingD = Defibrillation

Causes of Cardiac Arrest

Heart attack -

(or cardiovascular disease)TraumaDrowningDrugsElectrocution

Cardiovascular Disease

Heart Attack - myocardial infarction (MI)

Stroke - cerebral vascular accident or CVA (now called “brain attack”)

Aneurysm

Can Lead To:

Signs of ...

Heart attack = chest pain

Typical - pressure, “tightness”

Vs

Atypical - indigestion, jaw pain

and..

DENIAL is common

Activating EMS is the right thing to do if you have chest pain

Sudden Death

Ventricular Fibrillation

Ventricular Fibrillation

The most effective intervention is early defibrillation

Defibrillators

ManualSemiautomaticAutomatic

Public access is AHA goal

Public Access Defibrillation -PADCasinosAirportsCity buildingsSenior centersGated communities

Stroke or “Brain Attack”

hemiparesis & hemiparalysisheadache, blurred visionaphasia (speaking problems)one sided facial droop

#1 Risk factor = hypertension

Signs and Symptoms:

CVD risk factors

Factors that influence the probability of cardiovascular disease.

CVD risk factors that cannot be changed

HeredityGenderAge

Race also plays a role

CVD risk factors that you can change.

SmokingHigh blood pressureHigh cholesterol**Lack of exercise

note

Cholesterol is found in eggs, meat, & dairy products.

other factors ...

DiabetesObesityExcessive stress

note

Having multiple risk factors poses a much greater risk than having only 1 risk factor.

Pediatric safety

Injury due to “accident” #1 cause of pediatric death

And most are PREVENTABLE

seat beltsfire safetypools firearmsetc...

Pediatrics

Airway problems are common cause of death in infants & children.

Respiratory arrest leading to cardiac arrest.

Basic principles of CPR

Obviously dead

Reasons to stop CPR

Positioning

Initial actions

CABDs

Obviously Dead (policy 814)

Decapitation Incineration Decomposition Evisceration of

heart, lung, or brain

Obviously Dead (policy 814)

Post mortem lividity & rigor mortis

(check apical pulse for 60 seconds)

Special situations MVI with limited resources entrapment (> 15 minutes extrication time) ?

Reasons to Stop CPR

Patient Revives.Patient is turned over to rescuers of

equal or greater training.Doctor tells you to stop.You are so exhausted you can not

continue.

American Heart Association

Infant 0-1 year old

Child 1year - onset of puberty

Adult Puberty on

Establish unresponsiveness

Shake & Shout

THIS IS THE FIRST THING YOU DO WHEN ASSESSING A UNRESPONSIVE PERSON

Activate EMSAdults

Initiate immediately and get AEDChildren and infants

Witnessed – initiate immediately and get AED

Unwitnessed – 5 cycles of CPR, then initiate and get AED

Position the patient

Supine

On a hard surface

CABD’s of CPRC = CirculationA = AirwayB = BreathingD = Defibrillation

AIRWAY

Conscious Vs Unconscious

anatomical obstructionsolid obstructionliquid obstruction

AIRWAY

Open the airway.Head tilt, chin lift : preferred method If suspected neck injury: Modified jaw

thrust.

BREATHING

Mouth to mouthMouth to nose & mouthMouth to stomaMouth to mask

BREATHING

Rescue Breathing

Adult = 1 every 5-6 secondsChild = 1 every 3-5 secondsInfant = 1 every 3-5 seconds

Adequate Ventilation

No resistanceNo escape of air from around maskChest Rise - stop when chest

begins to rise

Complications of rescue breathing

GASTRIC DISTENTION

is caused by air entering the stomach

Over-ventilating

Improper head tilt (no tilt)

Cricoid PressureSellicks Manuever

Prevent gastric inflation/passive regurgitation

Assistance during Endotracheal Intubation

CIRCULATION

Chest compressions

Proper speedProper depthProper position

Speed of Compressions

Adult 100 times / minChild 100 times / minInfant 100 times / min

Depth of Compressions

Adult 1 1/2 - 2”Child 1 - 1 1/2”Infant 1/2 - 1”

OR 1/3 to 1/2 the patient’s body depth.

Hand Position

At the nipple line

Off the zyphoid process

2 fingers = infant1 hand = child2 hands = adult

Ratios

Compressions to ventilations Adult = 30:2 (1 and 2 rescuer)

Child & infant = 30:2 (1 rescuer)

15:2 (2 rescuer)

The pause is important to allow for slow ventilations

Complications of Compressions

fractured ribsfractured sternumlacerated lungslacerated liver, blood vessels, etc.,,

if you break ribs..

Check your hand position and keep going!

Pulse Checks

Pause to recheck the pulse after 5 cycles.

Then every few minutes after that.

Pulse check with CPR in progress.

Interrupting CPR

5-10 seconds for pulse checks, etc...

10 seconds absolute maximum break & then only when absolutely necessary

During AED rhythm analysis and delivery of shocks

Special Situations

Cold water drowning (no - it doesn’t have to be very cold)

Hypothermia

Good Samaritan Laws

should reduce your fear of being sued.

Manikin usage

treat with respect.

The End

Questions?

Fee DisclaimerThe AHA strongly promotes knowledge

and proficiency in CPR and has developed instructional materials for this purpose. Use of these materials does not represent course sponsorship by the AHA, and any fees charged for such a course do not represent income to the association.