CPR Lecture Final

7/29/2019 CPR Lecture Final

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CARDIOPULMONARY RESUSCITATION



CHAIN OF SURVIVAL

• Chain of survival as a universal chain that alreadyimplemented 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

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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 chestbetween the nipple line on the lower half of the sternum or Place heel of one hand oncenter of chest between the nipples.

– Place the second hand on top of the firsthand in a manner that is comfortable foryou. You may overlay or interlock yourfingers.

– Position yourself over the victim and useyour entire body to push up and down on thepersons chest.

– Keep you elbows locked and think of movingat the waist.

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A – Stands for Airway

• Open the airway with the head tiltchin 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 readilyavailable option.

- Open the victims airway (head-tilt/chin-lift)

- Cover the victims mouth completely withyour mouth.

- Pinch the victims nose and giving a regularbreath for about 1 second into the victim.

- Observe the chest rise.

- Let the victim exhale and give the secondbreath just as you did with the first breath.

- Check the rise and fall of the chest.

- No rise and fall: readjust the head, openairway and breath again.

- If the breaths do not make the chest riseand fall for a second time - move on to

circulation and compressions.




(BLS) GUIDELINES

Activation of Emergency Response System

Should be made after assessment of the

patients’ responsiveness and breathing but

should not be delayed.




(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).




(BLS) GUIDELINES

IV) Cricoid pressure

- AKA Sellick manoeuvre , is a techniqueapplied during endotracheal intubation, used

to either prevent regurgitation, or to assistwith visualisation of the glottis by apractitioner attempting intubation. Thetechnique involves the application of pressureto the cricoid cartilage of the neck.

- Impedes ventilation.




(BLS) GUIDELINES

New "circular" ACLS algorithm (Table 1




(BLS) GUIDELINES

Hands Only CPR

- For untrained lay rescuers on adult victims who

collapse in front of them.




(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 adequateoxygen to the body and should be considered the

same as no breathing at all (respiratory arrest).




(BLS) GUIDELINES ELECTRICAL THERAPIES INCLUDING USE OF AED AND DEFIBRILLATOR

Defibrillation of children 1 to 8 years of age with an AED, the rescuershould use a pediatric dose-attenuator system if one is available.

If the rescuer provides CPR to a child in cardiac arrest and does nothave 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 doseattenuation is desirable.

If neither is available, an AED without a dose attenuator may be used.

Automated external defibrillators with relatively high-energy doseshave been used successfully in infants in cardiac arrest, with no clearadverse 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 patient’s bare chest: looking atpicture placement on pad (choose correct pads:adult or pediatric)

– Remove medication patches and wipe skin

– Do not apply pads over pacemakers/internaldefibrillators (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 cananalyze the rhythm

– AED will advise if a shock is needed: Make

sure to clear the patient (no one is touchingthe patient) and press the shock button



AED Considerations

• With the 2010 Guidelines we now use an AED on theAdult, 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 onlypads available (they should be placed front to back oninfants).

• Once the AED shocks the victim, chest compressionsare resumed immediately.



Universal Steps of CPR

• Assess responsiveness (are you okay)- if no responseand no effective respirations call for help , activate theemergency response system , and get an AED.

• Check for pulse – if no pulse- begin chest compressions

• After one cycle of 30 chest compressions, open theairway and give 2 breaths

• Use the AED as soon as it is available no matter whereyou are in the sequence.

»Ratio 30: 2



Special Considerations

• As a lone rescuer a bag valve mask device is notrecommended as a ventilation device

•

Once an advanced airway is in place (eg. ET tube,LMA), CPR is continued at a rate of at least 100compressions per minute and ventilations arecontinued at 1 breath every 6-8 seconds.

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



Infant CPR

• Determine unresponsiveness (stimulate rub orsmack the bottom of the feet) do not “shake andshout”

• If the infant is unresponsive, check for a brachialpulse

• If there is no pulse, or the rate is less than 60with signs of poor perfusion, begin chestcompressions.

• After 30 compressions open the airway and give 2breaths.

• 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 1½ 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 handstechnique”.

• This technique allows one rescuer tobe at the infants head for breaths and

the other rescuer to be at the feet forcompressions.

• In 2 person CPR in infants the ratiobecomes 15:2 (10 cycles-2 person)

• In an unwitnessed arrest of an infantperform 2 minutes or 5 cycles of CPR

before calling 911 & getting AED.

Recommendations



COMPONENT ADULTS CHILDREN INFANTS

Recognition Unresponsive

No breathing or no normal

breathing(gasping)

No breathing or only gasping

No pulse palpated within 10 seconds

CPR sequence C-A-B

Compression rate At least 100/min

Compression depth At least 2 inches (5cm) At least ½ AP diameter

About 2 inches (5cm)

At least ½ AP diameter

About 1 ½ 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 Head tilt-chin lift (suspected trauma: jaw thrust)

Compression-to-ventilation ratio 30:2

1 or 2 rescuers

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

– Don’t 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 tiltchin lift)

• Vomit

• Foreign body

– Balloons

– Foods

• Swelling (allergic reactions/ irritants)

• Spasm (water is inhaled suddenly)



How To Recognize Choking

• Can you hear breathing or coughingsounds?

– High pitched breathing sounds?

• Is the cough strong or weak?

• Can’t 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 airwayblockage.

• 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, andhas 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 thefloor

• Assess

• Begin CPR

• After chest compressions, checkfor object before giving breathsbreaths



You Enter An Empty Room

And Find An UnconsciousVictim 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 don’t go in, check forobject 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 thevictim 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 downwardchest thrusts (deliver these in the same location as you

would do compressions).



Infant Choking Continued•

Continue performingalternating sets of back slapsand chest thrusts until theinfant expels the object orbecomes unresponsive.

•

Once the infant becomesunresponsive begin the stepsof CPR starting with chestcompressions. Before givingbreaths, open the airway and

look for an object. If you seesomething remove it , do notperform a blind finger sweep.

CPR Lecture Final

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