CPR

CPR Saves Lives Cardiopulmonary Resuscitation or CPR and defibrillation within 3-5 minutes can save over 50% of cardiac arrest victims CPR followed by AED saves thousands of lives each year In most cases CPR helps keep victim alive until EMS or AED arrives  

Circulatory System Basics

Circulatory System Circulatory system consists of heart, blood, and blood vessels. Transports blood to lungs Delivers carbon dioxide and picks up oxygen Transports oxygen and nutrients to all parts of body Helps regulate body temperature Helps maintain body’s fluid balance  

Anatomy of the Heart

Coronary Arteries

Major Arteries

Circulatory System Emergencies

Circulatory System Emergencies Any condition that affects respiration reduces ability to deliver oxygen Heart conditions Severe bleeding Shock Stroke

Cardiac Arrest Cardiac Arrest (sudden stopping of the heart) may occur as a result of heart attack Brain damage begins 4 - 6 minutes after cardiac arrest Brain damage becomes irreversible in 8 - 10 minutes Dysrhythmia, an abnormal heartbeat, may also reduce heart’s pumping effectiveness

Causes of Cardiac Arrest Heart attack Drowning Suffocation Stroke Allergic reaction Diabetic emergency Prolonged seizures Drug overdose Electric shock Certain injuries

Chain of Survival Early Access Early CPR Early Defibrillation Early Advanced Care

Cardiopulmonary Resuscitation (CPR) CPR helps keep patient alive by circulating some oxygenated blood to vital organs Ventilations move oxygen into lungs where it is picked up by blood Compressions on sternum increase pressure inside chest, moving some blood to brain/other tissues

CPR effective only for a short time CPR should be started as soon as possible In some instances, the heart may start again spontaneously with CPR

Basic Skills Rescue Breathing Chest Compressions

Rescue Breathing The risk of infection from CPR is extremely low but the US Occupational Safety and Health Administration requires that healthcare workers use standard precautions in the workplace, including CPR Standard Precautions include using barrier devices such as a face mask or bag-mask device when giving breaths.

Head Tilt-Chin Lift Place one hand on the victim’s forehead and push with your palm to tilt the head back. Place the fingers of the other hand under the bony part of the lower jaw near the chin. Lift the jaw to bring the chin forward.

Jaw Thrust Maneuver If a victim has a head or neck injury use the jaw thrust maneuver to open the airway. Place one hand on each side of the victim’s head Place your fingers under the angles of the victim’s lower jaw and lift with both hands

Mouth to Mouth Breathing Position yourself at the victim’s side Perform the head tilt / chin lift Pinch the victim’s nose and cover his mouth with yours Deliver air over 1 second to make the chest rise

Mouth to Mask Breathing Position yourself at the victim’s side. Place the mask on the victim’s face, using the bridge of the nose as a guide. Perform the head tilt / chin lift Deliver air over 1 second to make the chest rise

Bag-Mask Breathing Position yourself at the victim’s side. Place the mask on the victim’s face, using the bridge of the nose as a guide. Using the EC technique, hold the mask in place while you hold the airway open. Perform the head tilt / chin lift Squeeze the bag to give breaths (1 second each) watching for the chest rise

Rescue Breathing Respiratory Arrest- an adult, child, or infant has a pulse but is not breathing effectively Rescuers should give breaths without compressions. Adults Infants and Children Give 1 breath every 5-6 seconds (about 10-12 breaths per minute) Give 1 breath every 3-5 seconds (about 12-20 breaths per minute) Give each breath in 1 second Each breath should make the chest rise Check the pulse about every 2 minutes

Tracheostomies Opening created in the airway through which the individual breathes Rescue breaths must be given through the stoma

Advanced Airways Secured airways inserted by physicians or paramedics

Chest Compressions

Chest Compressions Basics Position yourself at the victim’s side Make sure the victim is lying face up on a firm surface If you suspect a head or neck injury, try to keep the head, neck, and torso in one line when turning

Hand Placement Put the heel of one hand on the center of the victim’s chest on the lower half of the sternum Put the heel of your other hand on top of the first hand Straighten your arms and position your shoulders directly over your hands

Rate and Depth Push hard and fast. Press straight down at least 2 inches Deliver compressions in a smooth fashion at a rate of at least 100/min.

One-Rescuer CPR

Assess the victim for response and look for normal or abnormal breathing. If there is no response and no breathing, or no normal breathing (i.e. only gasping), shout for help. Tap and shout, “Are you OK?”

2. If you are alone, activate the emergency response system and get an AED (or defibrillator) if available and return to the victim.

3. Check the victim’s pulse (take at least 5 seconds but no more than 10 seconds).

4. If you do not definitely feel a pulse within 10 seconds, perform 5 cycles of compressions and breaths (30:2 ratio), starting with compressions (C-A-B sequence)

CPR Sequence ASSESSES: Checks for response, no breathing or no normal breathing (5-10 seconds) ACTIVATES emergency response system Check for PULSE (carotid) 5-10 seconds GIVES HIGH QUALITY CPR: Correct HAND PLACEMENT ADEQUATE RATE: At least 100/min (30 compressions in 18 seconds or less) ADEQUATE DEPTH: 2 inches MINIMIZES INTERRUPTIONS: Gives 2 breaths in less that 10 seconds

Chest Compressions Alert Be careful with your hand position For adults/children, keep your fingers off patient’s chest Do not give compressions over bottom tip of breastbone When compressing, keep elbows straight and hands in contact with patient’s chest at all times Compress chest hard and fast, but let chest recoil completely between compressions. Minimize amount of time used giving ventilations between sets of compressions.

AED Automated External Defibrillator

AED Automated External Defibrillator – computerized devices that can identify cardiac rhythms that need a shock, and then can deliver the shock Used to treat victims of sudden cardiac arrest with ventricular fibrillation - the heart muscle may “quiver” and/or not contract together to pump blood An electric shock can stop the quivering heart fibers This allows the muscle fibers of the heart to “reset” so they can begin to contract at the same time

Using the AED

Power on the AED Open the carrying case or the top of the AED Turn the power on (some devices will “power on” automatically when you open the lid.

Power on the AED Open the carrying case or top of the AED Turn the power on (some devices will “power on” automatically when you open the lid or case The AED will guide you through the steps

Attach AED pads to victim’s bare chest. Use adult pads for victims 8 years and older Peel away the backing from the AED pads Attach the AED pad to the victim’s bare chest One in the upper right chest below the collarbone The other to the side of the left nipple Attach the pads to the machine Attach the AED cable to the device

“Clear” the victim and Analyze the rhythm Be sure no one is touching the victim Some AED’s will tell you to push a button to analyze, others will begin automatically Some AED’s may take about 5-15 seconds to analyze

If the AED advises a shock, it will tell you to clear the victim Loudly state a “clear the victim” message Look to be sure no one is touching the victim Press the shock button The shock will produce a sudden contraction of the victim’s muscles

Resume CPR If no shock is needed, and after delivering a shock, immediately resume CPR starting with compressions After 5 cycles or about 2 minutes, the AED will prompt you to repeat previous steps If “no shock advised” immediately restart CPR beginning with chest compressions

Special Situations Hairy chest – use a razor (in some cases) or quickly remove the AED pad to remove hair Water – remove the victim and dry quickly Implanted defibrillator / pacemaker – do not place the pad on the device Transdermal medication – remove the patch and wipe with a cloth

Operation of an AED Power on the AED Attach the pads to the victim’s bare chest and cable to the device “Clear” the victim and analyze the rhythm If the AED advises a shock, it will tell you to clear the victim If no shock is advised

2 Rescuer Sequence with an AED Check for response and check breathing Check for pulse Attempt defibrillation with AED Power on the AED Attach the pads to the victim’s bare chest “Clear” the victim and analyze the rhythm If the AED advises a shock, it will tell you to clear the victim If no shock is needed, immediately resume CPR, starting with compressions After 5 cycles or about 2 minutes of CPR, the AED will ask you to clear and analyze the victim

CPR Review

What is the rate for performing chest compressions for a victim of any age? 100 per minute

Describe a way you can allow the chest to recoil completely after each chest compression. Allow the chest to expand completely between each compression.

After you open the airway and pinch the nose of an unresponsive adult or child, what is the best way to give mouth-to-mouth breaths? Seal your mouth over the victims mouth and give 2 breaths, watching for the chest to rise

What is the best way for a rescuer to know that a rescue breath is effective? The chest will rise with each breath.

You must check adequate breathing before giving breaths to an unresponsive adult victim.  You do this by looking for chest rise and feeling for airflow through the victim's nose or mouth.  What other sign should you assess? Listen for airflow from the victim’s nose or mouth

When you do not suspect a cervical spine injury, what is the best way to open an unresponsive victim's airway? The head tilt / chin lift technique

What should be the next step when you find an unresponsive adult victim who has agonal gasps and you have sent someone to activate the emergency response system? Check the carotid pulse

How do you know when to start cycles of chest compressions with breaths for an adult? The victims is unresponsive, is not breathing, and does not have a pulse.

What are the steps common to the operation of all AED's in the correct order? Power on, attach pads, clear & analyze, clear & deliver shock if advised

After you power on an AED and attach the pads to the victim, what is the next step you should do? Clear the victim so the AED can analyze the heart rhythm

What might happen if you touch the victim while the AED is delivering a shock? The AED could shock you while it is shocking the victim.

You are using an AED on an adult victim, and the AED gives a "no shock indicated" (or "no shock advised") message.  Until advanced care personnel arrive, what should you do next? Leave the pads in place and continue CPR

What is the best way to relieve severe choking in a responsive adult? Perform abdominal thrusts

A choking adult becomes unresponsive while you are doing abdominal thrusts for severe choking.  You ease the victim to the floor and send someone to activate your emergency response system.  What should you do next? Begin CPR, when you open the airway, look for and remove the object if seen, before giving breaths

Which of the following statements best describes why you should minimize interruptions when giving chest compressions to any victim of cardiac arrest? If you minimize interruptions, you increase the victims chance of survival.

Breathing stops but the heart still continues for 2-3 minutes Breathing stops but the heart still continues for 2-3 minutes.  What is this called? Respiratory arrest.

You find a victim lying on his right side You find a victim lying on his right side.  He is not breathing but has a pulse.  What should you do? Give a rescue breath every 5 seconds.

What happens during a cardiac arrest? The heart and breathing stop without warning.

Before starting chest compressions, you need to check for a pulse Before starting chest compressions, you need to check for a pulse.  What pulse site should you use? Carotid

A person shows signs of circulation after CPR was started A person shows signs of circulation after CPR was started.  What should you do? Place the victim in the recovery position, lying on their side.

The purpose of the recovery position is to: Prevent aspiration.