1. FO1 Marko D Mission EMT-B Bureau of Fire Protection

2. Emphasis on, and recommendations to improve, delivery of effective chest compression   A single compression-to-ventilation ratio for all single rescuers for all victims   Recommendation that each rescue breath be given over 1 second and should produce visible chest rise

3. A new recommendation that single shocks, followed by immediate CPR, be used to attempt defibrillation for VF cardiac arrest. Rhythm checks should be performed every two minutes.   Simplified Hand Placement

4. Give effective chest compressions all rescuers should “push hard and push fast”   Allow the chest to recoil completely after each compression, and use approximately equal compression and relaxation times.   Limit interruptions in chest compressions

5. The AHA recommends a compression-to ventilation ratio of 30:2

6. Breathing and Circulation Air that enters the lungs contains: Air that enters the lungs contains: – 21% O2 – trace of CO2 Air exhaled from the lungs contains: Air exhaled from the lungs contains: – 16% O2 – 4% CO2 Clinical death (0 - 4 min. - brain damage not likely, 4 - 6 min. - damage probable). Clinical death (0 - 4 min. - brain damage not likely, 4 - 6 min. - damage probable). Biological death (6 - 10 min. - brain damage probable; over 10 min. - brain damage is certain). Biological death (6 - 10 min. - brain damage probable; over 10 min. - brain damage is certain). Body System HUMAN BODY

7. The Heart

8. The Circulatory System

9. The Circulatory System Delivers oxygen and nutrients to the tissues. Removes waste products from the tissues

10. Pulse Left ventricle contracts, sending a wave of blood through the arteries. This can be felt anywhere an artery passes near the skin surface over a bone. Carotid Radial Femoral

11. When the patient has lost a pulse, they are in cardiac arrest. Brain damage begins in 4 - 6 minutes and becomes irreversible in 8 - 10 minutes. Pulse

12. Reasons the Heart will Stop Sudden Death and Heart Disease Respiratory Arrest, Especially in children Medical Emergencies Drowning, Suffocation, Trauma, Bleeding

13. Regardless of the reason, the First Responder’s emergency medical care of cardiac arrest is CPR. Regardless of the reason, the First Responder’s emergency medical care of cardiac arrest is CPR.

14. Cardiopulmonary Resuscitation “The combination of artificial ventilation and external chest compressions is called cardiopulmonary resuscitation (CPR).”

15. CPR Cannot sustain life indefinitely Must be started as early as possible. CPR increases the amount of time that defibrillation will be effective.

16. Chain of Survival

17. Check the Scene Safety Check the Scene Safety Check for Responsiveness ResponseMonitor No Response Activate Medical Assistance Check for Signs of Life Is Breathing Monitor/ Recovery Position No Sign of Life Give 2 Breaths Chest does not rise, Retilt the head and ventilate Still chest does not rise Perform unconscious choking Check for pulse No Pulse/Not Sure Give cycles of 30ECC and 2RB If definite Pulse, Begin RB: 1 breath every 5 seconds for 1 minute

18. Establish unresponsiveness.

19. Open airway.

20. Look, listen, feel.

21. Ventilate.

22. Check pulse.

23. Locate compression site.

24. Begin compressions.

25. One-Rescuer CPR for Two Minutes

26. Recheck pulse.

27. Two-rescuer CPR

28. RESCUE BREATHING ADULTCHILDINFANT Opening of airway (Head-Tilt- Chin Lift Maneuver) Maximum tilt of the headNeutral plus positionNeutral position Location for checking of signs of circulation Carotid pulse (Side of the neck) Carotid pulse Brachial pulse (inner aspect of upper arm) Method Mouth-to-mouth or Mouth-to-nose Mouth-to-mouth & nose Breaths Normal breath (1 second per breath) Gentle, slow breath (1 to 1.5 seconds per breath) Rate 10 to 12 breaths per minute (1 breath every 4 to 5 seconds) 12 breaths in 1 minute 20 breaths per minute (1 breath every 3 seconds) 20 breaths in 1 minute Counting for standardization purposes: Mnemonic ADULT-1 breathe every 5 seconds ; CHILD / INFANT -1 breath every 3 seconds. Breath 1, 1002, 1003, 100 1, breath 1, 1002, 1003, 100 2, breath 1, 1002, 1003, 100 3, breath… 100 10 or up to 100 12, breath Breath 1, 100 1, breath 1, 100 2, breath 1, 100 3, breath…1, 10 20, breath TABLE OF COMPARISON ON RESCUE BREATHING FOR ADULT, CHILD, and INFANT

29. TABLE OF COMPARISON ON CARDIOPULMONARY RESUSCITATION FOR ADULT, CHILD, AND INFANT CPR ADULTCHILDINFANT Compression Area Center of Chest, between nipples Just below the nipple line Depth Approximately 1 ½ to 2 inches. 1/3 to ½ the depth of the chest How to Compress 2 hands. Heel of 1 hand, other hand on top 2 hands 1 hand 2 fingers (middle & ring fingertips).

30. ADULTCHILD INFANT Rate Approximately 100/min Compression-ventilation ratio. 30:2 (1 or 2 rescuers) 30:2 (1 rescuer) 15:2 (2 rescuer) Counting for standardization purposes. 1, 2, 3, 4, 5, 6, 7, 8,9, 10, 11, 12, 13, 14, 15, 16,17,18,19,20,21,22,23,24,25,26, 27,28,29, and 1 then breathe, breathe; 1, 2, 3, 4, 5, 6, 7, 8,9, 10, 11, 12, 13, 14, 15, 16,17,18,19,20,21,22,23,24,25,26,27,28, 29, and 1 then breathe, breathe; TABLE OF COMPARISON ON CARDIOPULMONARY RESUSCITATION FOR ADULT, CHILD, AND INFANT

31. Infant and Child CPR “Infants (up to one year old) and children (one to eight years old) need slightly different care.”

32. Determine unresponsiveness.

33. Open airway.

34. Determine breathlessness.

35. Ventilate.

36. Determine pulselessness.

37. Locate correct hand position.

38. Compress 1/2 to one inch.

39. 30:2

40. Child Compression

41. When to Spontaneous signs of circulation are restored Turned over to medical services or properly trained and authorized personnel. Operator is already exhausted and cannot continue CPR. Physician assumes responsibility. ( Declares death, take over) STOP CPR

42. Bureau of Fire Protection “To Save lives and Protect Properties” Thank you!