2. 2010 AHA Guidelines Update 2010 AHA Guidelines Update 4-1 Jason Ferguson, BPA, NREMT-Paramedic EMS Program Head, CVCC

3. Disclaimer The purpose of this presentation is to provide participants a brief overview of potential changes based on the 2010 AHA Guidelines. It is not intended to take the place of additional training. Always follow local protocols. Some restrictions apply. Void where prohibited. May be offensive to some audiences. Harmful if swallowed. Slippery when wet. Batteries not included. Use as directed. Apply only to affected areas. The defense “Ferg said” will not protect you should you disregard your protocols. Please sit back, keep all arms in legs inside at all times and enjoy the ride. The purpose of this presentation is to provide participants a brief overview of potential changes based on the 2010 AHA Guidelines. It is not intended to take the place of additional training. Always follow local protocols. Some restrictions apply. Void where prohibited. May be offensive to some audiences. Harmful if swallowed. Slippery when wet. Batteries not included. Use as directed. Apply only to affected areas. The defense “Ferg said” will not protect you should you disregard your protocols. Please sit back, keep all arms in legs inside at all times and enjoy the ride.

4. BLS CPR 4-2

5. BLS CPR Still the same: –Compression rate of at least 100/min –Allow complete recoil –Minimizing interruptions in compressions –Avoid excessive ventilations –Compression:Ventilation ratios Adult Child Infant Newborn Still the same: –Compression rate of at least 100/min –Allow complete recoil –Minimizing interruptions in compressions –Avoid excessive ventilations –Compression:Ventilation ratios Adult Child Infant Newborn

6. BLS CPR Significant Changes: –ABC’s now the CAB’s Except in newborns Good compressions and early defib most important Opening the airway difficult for bystanders No more “Look, Listen and Feel” Significant Changes: –ABC’s now the CAB’s Except in newborns Good compressions and early defib most important Opening the airway difficult for bystanders No more “Look, Listen and Feel”

7. BLS CPR Compression depth –1 ½ inches in infants, 2 inches in children No more routine use of cric pressure –Does do what we want it to do, but may inhibit ventilation as well –We don’t do it correctly a lot of the time AED –Pediatric dose attenuator may be used for children and INFANTS Compression depth –1 ½ inches in infants, 2 inches in children No more routine use of cric pressure –Does do what we want it to do, but may inhibit ventilation as well –We don’t do it correctly a lot of the time AED –Pediatric dose attenuator may be used for children and INFANTS

8. ACLS

9. Continuous waveform capnography –Recommended for all intubated patients –Blood must circulate through lungs for CO2 to be exhaled and measured Confirmation of tube placement Monitors effectiveness of compression Detecting of ROSC Continuous waveform capnography –Recommended for all intubated patients –Blood must circulate through lungs for CO2 to be exhaled and measured Confirmation of tube placement Monitors effectiveness of compression Detecting of ROSC

10. ACLS Medication changes: –No more Atropine in: PEA/Asystole –Adenosine Now more recognized for treatment of monomorphic wide complex tachycardia –Chronotropic Agents (for Bradycardias) Epi drip Dopamine drip Medication changes: –No more Atropine in: PEA/Asystole –Adenosine Now more recognized for treatment of monomorphic wide complex tachycardia –Chronotropic Agents (for Bradycardias) Epi drip Dopamine drip

11. PALS/NRP

12. Manual defibrillator preferred Congenital heart disease more recognized Concentration on getting good medical and family hx Manual defibrillator preferred Congenital heart disease more recognized Concentration on getting good medical and family hx

13. PALS/NRP No need to routinely suction after delivery of newborn Delay cord clamping 1 min in babies not requiring resuscitation Use of room air in beginning vs. 100% O2 If no HR detected within 10 mins, consider termination of efforts No need to routinely suction after delivery of newborn Delay cord clamping 1 min in babies not requiring resuscitation Use of room air in beginning vs. 100% O2 If no HR detected within 10 mins, consider termination of efforts

14. POST CARDIAC ARREST CARE POST CARDIAC ARREST CARE

15. Post Cardiac Arrest Care Mainly for in-hospital planning –Calls for consistent, multidisciplinary plan –Cardiopulmonary and neurological support –Therapeutic hypothermia –Percutaneous Coronary Intervention (PCI) –Assess neurological signs and other markers at 3 days Mainly for in-hospital planning –Calls for consistent, multidisciplinary plan –Cardiopulmonary and neurological support –Therapeutic hypothermia –Percutaneous Coronary Intervention (PCI) –Assess neurological signs and other markers at 3 days

16. SPECIAL SITUATIONS SPECIAL SITUATIONS

17. Special Situations More specialized treatments for: –Asthma –Anaphylaxis –Pregnancy –Morbid Obesity –PE –Electrolyte Imbalance –Toxins –Trauma More specialized treatments for: –Asthma –Anaphylaxis –Pregnancy –Morbid Obesity –PE –Electrolyte Imbalance –Toxins –Trauma

18. Special Situations Cont’d: –Drowning –Electrical Shock/Lightning –PCI –Cardiac Tamponade –Cardiac Surgery Cont’d: –Drowning –Electrical Shock/Lightning –PCI –Cardiac Tamponade –Cardiac Surgery

19. SAY WHAT????????

20. Say What? New Concepts: –Oxygen may be bad –Calling Codes in field –Intubation an afterthought New Concepts: –Oxygen may be bad –Calling Codes in field –Intubation an afterthought