CARDIO-PULMONARY RESUSCITATION (CPR) 4/14/2017 CARDIO-PULMONARY RESUSCITATION (CPR) Module 10 Press Here for Video JO/CPR/04

CARDIAC PULMONARY RESUSCITATION Introduction Cardiac disease is the second main cause of death in Singapore. Hence, public education and training are crucial in reducing “sudden death”

CARDIAC PULMONARY RESUSCITATION CHAIN OF SURVIVAL The concept of ‘Chain of Survival’ is the best approach to the treatment of victim with cardiac arrest

CARDIAC PULMONARY RESUSCITATION (Chain of Survival) Early Access prompt a person to call 995 before victim collapse Early CPR most effective when started immediately after victim collapse, chances of successful resuscitation depend on prompt bystander CPR and competent rapid response team Early Defibrillation is most likely to improve survival rates of cardiac arrest patients Early Advance cardiac life support to bring equipment to support ventilation, eg drug, defibrillator machine

CARDIAC PULMONARY RESUSCITATION Heart Attack Foreign Body Airway Obstruction Drowning Stroke Drug Overdose Suffocation Smoke Inhalation Electrocution Severe Allergic Reaction

ONE MAN CPR D - Danger R - Check responsiveness (Tapping the shoulder) Look out for unsafe environment R - Check responsiveness (Tapping the shoulder) Are you OK? Call ambulance 995 A - Check airway by head tilt chin lift (remove foreign body if visible) B - Check breathing -- (look, listen and feel for breathing ) up to 10 Seconds (no Breathing) Attempt 2 ventilation Air Blow (400 to 600mls)allow the lung deflation between each breath C - Check Circulation Check carotid pulse –6 to10 Seconds No pulse start CPR

Determine pulselessness Proper hand position Run the middle finger along bottom edge of rib cage to notch at centre (tip of sternum) Place you index finger next to your middle finger on notch. Place the heel of one hand on the lower half of the sternum next to the index finger Release the 2 finger and place the hand on top of the hand on the sternum so that the hand are parallel. Straight both elbows and lock them into position

Tracing Landmark & Position

CARDIAC PULMONARY RESUSCITATION Use your body weight to compress the victim’s chest about ( 4 to 5 cm) Count: 1 & 2 & 3 & 4 & 5 & 1 & 2 & 3 & 4 & 10 & 1 & 2 & 3 & 4 & 15 & 1 & 2 & 3 & 4 & 20& 1 & 2 & 3 & 4 & 25 & 1 & 2 & 3 & 4 & 30 Chest compression rate to achieve 100 per mins Ratio – 30 compressions : 2 breaths Perform – 5 cycles Check pulse Absent – continue compression Present – Stop compression Check breathing Present – Recovery position Absent – Rescue breathing

Rescue Breathing Time for rescue breathing : 1 breath every 5 second Count: 2 a thousand 3 a thousand 4 a thousand 5 a thousand Cycle: 12 for one min

Summary for one man CPR Check for pulse (carotid) - 6 to 10 seconds Check for breathing - 10 seconds Time for each breath - 1 second per breath Dept of compression - 4 to 5 cm Air volume - 400 to 600 mls Compression rate - 100 per mins Ratio - 30 : 2 Cycle - 5 cycles Rescue breathing - 12 cycles Time for rescue breathing - 1 breath every 5 seconds

INFANT CPR D - Danger-Look out for unsafe environment R - Check responsiveness - (call tap or gently shake the infants shoulder or tickle the sole of the foot to elicit response.) Are you OK? Call ambulance 995 A - Check airway-by head tilt chin lift (remove foreign body if visible) B - Check breathing -- (look,listen and feel for breathing ) up to 10 Seconds (no Breathing) Attempt 2 ventilation Air Blow (30 mls)allow the lung deflation between each breath C - Check Circulation-Check Brachial pulse 6 to10 Seconds No pulse start CPR

Infant CPR Proper hand position Draw imaginary line between nipples Place your middle and ring fingers next to the index finger Move the 3 fingers to the centre of the sternum Position the fingers upright Lift up the index finger but maintain the middle and ring fingers on the sternum Lean forward and place your cheek near the infants mouth and nose Use your middle and ring fingers to compress the sternum about 2 cm

INFANT CPR Count: Chest compression rate to achieve 100 per mins 1 & 2 & 3 & 4 & 5 & 1 & 2 & 3 & 4 & 10 & 1 & 2 & 3 & 4 & 15 & 1 & 2 & 3 & 4 & 20& 1 & 2 & 3 & 4 & 25 & 1 & 2 & 3 & 4 & 30 Chest compression rate to achieve 100 per mins Ratio – 30 compressions : 2 breaths Perform – 5 cycles Check pulse Absent – continue compression Present – Stop compression Check breathing Present – Recovery position(lateral side) Absent – Rescue breathing

Rescue Breathing Time for rescue breathing : 1 breath every 3 second Count: 2 a thousand 3 a thousand Cycle: 20 for one min

Summary Infant CPR Check for pulse (brachial) - 6 to 10 seconds Check for breathing - Up to 10 seconds Time for each breath - 1 second per breath Depth of compression - 2 cm Air volume - 30 mls Compression rate - 100 per mins Ratio - 30 : 2 Cycle - 5 cycles Rescue breathing - 20 cycles Time for rescue breathing - 1 breath every 3 seconds Count - 2 a thousand, 3 a thousand

Infant : conscious to unconscious choking Assess for sign of complete airway obstruction ( choking) Support the infants head and body between your hands and forearms using the sandwich manoeuvre Hold the infants face down and rest your forearm on your thigh Keep the head lower than the trunk Deliver 5 back blows forcefully between the shoulder blades with the heel of your other hand Support the infants head and body between your hands and forearms after delivering the 5 back blows Turns the infant over on his/her back resting on your thigh Deliver 5 chest thrusts over the lower half of the sternum by counting 1,2,3,4,5

Infant : conscious to unconscious choking Reassessment Check if foreign body is expelled after every set of 5 back blows and 5 chest thrusts and remove if it is visible. If the airway remains obstructed and the infant is conscious, repeat the sequence of 5 back blows and 5 chest thrusts until the foreign body is expelled or the infant becomes unconscious.

Infant unconscious choking When infant becomes unconscious . Position infant on a firm , flat surface Call the ambulance 995

Infant unconscious choking A - Check airway - by head tilt chin lift (remove foreign body if visible) B - Check breathing (look,listen and feel for breathing up to 10 Seconds No Breathing – Attempt ventilation(1st attempt) If airway is blocked, reposition the infant’s head and re-attempt to ventilate ( 2nd attempt) If airway is still blocked, relieved obstruction by performing 30 chest compression ( The landmark and technique for chest compression is the same as for infant CPR) REPEAT THE STEP UNTIL ABLE TO GIVE 2 SUCCESSFUL VENTILATIONS C - Check circulation: Absent – continue compression Present – Stop compression Check breathing Present – Recovery position(lateral side) Absent – Rescue breathing

Adult Obstruction Conscious Victim Ask “Are you choking" I can help) Determine if victim can Speak Breath Cough Stand behind the victim Put your arms around the casualty's abdomen and locate for the navel 2 finger above navel perform inward upward thrust Make a fist with one hand Place thumb side of the fist against the abdomen above 2 fingers spacing Release the 2 fingers spacing but maintaining the fist against the abdomen Give 5 successive inward-upward thrust Check if foreign body is expelled after every set of 5 abdominal thrust Every thrusts until the foreign body is dislodged or the casualty becomes unconscious

Position (Pregnancy & Obese) Stand behind the person, position one foot between the casualty's legs Locate landmarks: Place arms under the casualty’s armpits to encircle the chest Make a fist with one hand Place thumb side of fist on the middle of the person’s breaths bone Grasp the fist with the other hand and give successive quick backward thrust Check if foreign body is expelled after every set of 5 chest thrusts Repeat thrust until the foreign body is dislodged or the person becomes unconscious

ADULT UNCONSCIOUS CHOKING Unconscious Victim Position the victim –lie on flat surface Establish unresponsiveness Activate EMS - Call 995 Check for : Airway Breathing If the breathing is absent, attempt to ventilate ( 1st attempt) If airway is blocked, re-position the casualty’s head and re-attempt to ventilate ( 2nd attempt) If airway is blocked , relieve obstruction by Performing 30 compression (position & landmark as CPR) Repeat Step until able to give 2 successful ventilators Check for : Circulation –pulse Absent – Start CPR Present – Stop compression Check breathing Present – Recovery position Absent – Rescue breathing Reassessment - Recovery position

Step 2 – Recovery Position Step 1 – Recovery Position 4/14/2017 Step 2 – Recovery Position Step 1 – Recovery Position Step 3 – Recovery Position Step 4 – Recovery Position JO/CPR/04

And the patient gets a chance at life Remember CPR can SAVE LIVES. Do it WELL. Do it RIGHT. And the patient gets a chance at life

The end Cardio-Pulmonary Resuscitation Module 10 For training purpose only Not for sale