CPR

Slide 1 :20/07/2008 drdgm 1 Basic life support (BLS) for healthcare providers Winter 2005-2006/7 issue of Currents in Emergency Cardiac Care (vol16, no 4) 2005 American Heart Association Guidelines Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (Circulation. 2005;112: IV-1–IV-211)


Cardiac Arrest ? :20/07/2008 drdgm 2 Cardiac Arrest ? Sudden stopping of the pumping action of the heart Unconscious Major pulse absent SCA and VF- electrocution /MI Asphyxia drowning / drug overdose in majority of children Myocardial infarction Stroke Electrocution Drowning Choking Trauma Drug overdosage Poisoning In hospital SCA Out of hospital SCA Witnessed arrrest Unwitnessed arrest


Purpose of BLS :20/07/2008 drdgm 3 Purpose of BLS Holding operation To maintain respiration and circulation till expert help arrives Failure of circulation for 3 to 4 minutes leads to irreversible brain damage Emphasis on rapid and high quality bls


Golden minutes :20/07/2008 drdgm 4 Golden minutes


Immediate AED :20/07/2008 drdgm 5 Immediate AED


Chain of survival :20/07/2008 drdgm 6 Chain of survival


Basic life support (BLS)elements :20/07/2008 drdgm 7 Basic life support (BLS)elements Initial assessment, then airway maintenance, expired air ventilation (rescue breathing), and chest compression. Basic life support implies that no equipment is employed; where a simple airway or facemask for mouth to mouth ventilation is used, this is defined as "basic life support with airway adjunct". Defibrillation with Automated external defibrillator


Adult Basic Life support :20/07/2008 drdgm 8 USE AED ASAP DEFIB Adult Basic Life support


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CPR :20/07/2008 drdgm 10 CPR Restoration Of Spontaneous Circulation (ROSC) Perform Chest Compression (CC) Rescue Breathing (RB)


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Slide 12 :20/07/2008 drdgm 12 Performance Pitfalls emergency circumstances pressure-charged confusing disorderly unanticipated nature


History/Theory of CPR :20/07/2008 drdgm 13 History/Theory of CPR First mouth to mouth Ventilation ? Prophet Elisha First Medical success-1744 –Tossach Closed chest cardiac massage-1960 Kouwenhoven, Jude, and Knickerbocker


Slide 14 :20/07/2008 drdgm 14 JAMA,2005:293;299-304


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Hand Placement :20/07/2008 drdgm 16 Hand Placement


Hand Placement… :20/07/2008 drdgm 17 Hand Placement…


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CPR :20/07/2008 drdgm 19 CPR Minimize the number and length of interruptions in chest compressions. Try to limit interruptions to 10 seconds or less unless necessary for specific interventions such as advanced airway placement or defibrillation. The compressor should allow for full chest recoil following each compression. To reduce the chances of fatigue affecting the quality of compressions, the rescuers should change compressors frequently, about every 2 minutes when the rhythm is checked.


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Airway and Breathing :20/07/2008 drdgm 24 Airway and Breathing General Please do not Hyperventilate Opening the airway priority for an unresponsive trauma victim Breaths in all age groups should be delivered over 1 second and should produce visible chest rise. When the victim has an advanced airway (eg, endotracheal tube, LMA, Combitube) in place, CPR is no longer performed as "cycles" of compressions with pauses for breaths. The compressor gives continuous compressions. The rescuer giving breaths should give 1 breath every 6 to 8 seconds (about 8 to 10 breaths/minute)


Rescue breathing :20/07/2008 drdgm 25 Rescue breathing Ensure head tilt and chin lift Pinch the victim’s nose closed with the index finger and thumb of your hand on his forehead Open his mouth a little, but maintain chin lift Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out


Jaw thrust… :20/07/2008 drdgm 26 Jaw thrust…


Adult(RB..) :20/07/2008 drdgm 27 Adult(RB..) When giving 2 breaths at the beginning of the CPR sequence or during cycles of compressions and breaths, if the chest does not rise after the first breath, the rescuer should try again to open the airway before giving the second breath. Rescue Breathing Without Chest Compressions: Give 1 breath every 5 to 6 seconds (about 10 to 12 breaths/minute).


Slide 28 :20/07/2008 drdgm 28 Child(RB..) When giving 2 breaths at the beginning of the CPR sequence or during cycles of compressions and breaths, if the chest does not rise after the first breath, the rescuer should try again to open the airway before giving the second breath. Healthcare providers may need to try "a couple of times" to open the airway and deliver effective breaths breaths that produce visible chest rise Rescue Breathing Without Chest Compressions: Give 1 breath every 3 to 5 seconds (about 12 to 20 breaths/minute)


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Infant(RB..) :20/07/2008 drdgm 30 Infant(RB..) Healthcare providers 30:2 compression-to-ventilation ratio for 1-rescuer CPR 15:2 compression-to-ventilation ratio for 2-rescuer CPR Chest compressions if the heart rate is less than 60 per minute with signs of poor perfusion. Give compressions just below the nipple line, over the lower half of the breastbone. 2-rescuer infant CPR the healthcare provider who gives compressions should use the 2 thumb–encircling hands technique, including a thoracic squeeze. If the healthcare provider is alone or cannot physically encircle the infant's chest, the rescuer should use 2 fingers to compress the breastbone.


Un / Witnessed Collapse :20/07/2008 drdgm 31 Un / Witnessed Collapse Unresponsive victims of likely asphyxial arrest (drowning) of all ages (unwitnessed) CPR First 5 cycles (2 minutes) Phone fast and get AED Return for steps of cpr and use AED For Sudden collapse in victims of all ages Phone First –ERS(witnessed) Get AED( if available) Return for CPR and use AED


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Adult BLS -SAFE Approach :20/07/2008 drdgm 34 Adult BLS -SAFE Approach


Slide 35 :20/07/2008 drdgm 35 SAFETY First SHAKE on shoulders and SHOUT Hey ?Are You all right? Sequence of Action and (Re)/Assessment, Response, What is the response of the victim to your action?


Airway Assessment :20/07/2008 drdgm 36 Airway Assessment Keeping the airway open, look, listen, and feel for normal breathing- ten seconds Look for chest movement Listen at the victim's mouth for breath sounds Feel for air on your cheek


Give 2 Rescue Breaths :20/07/2008 drdgm 37 Give 2 Rescue Breaths Give 2 rescue breaths, each over 1 second, with enough volume to produce visible chest rise to all forms of ventilation during CPR, including mouth-to-mouth and bag-mask ventilation and ventilation through an advanced airway, with and without supplementary oxygen (Class IIa)


Response of victim :20/07/2008 drdgm 38 Response of victim No response Shout for help turn the victim on to his back and then open the airway With your fingertips under the point of the victim's chin, lift the chin to open the airway.


If no visible chest rise on RB….? :20/07/2008 drdgm 39 If no visible chest rise on RB….? Check the victim's mouth and remove any visible obstruction. Recheck that there is adequate head tilt and chin lift. Do not attempt more than two breaths each time before returning tochest compressions If you see a foreign body, remove it.


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AED Use :20/07/2008 drdgm 43 AED Use When using an AED, rescuers should deliver 1 shock (if advised) followed by immediate CPR, beginning with chest compressions. Immediately after shock delivery, healthcare providers should not check a pulse because that will delay the resumption of chest compressions; a pulse is unlikely to be present in the first seconds after shock delivery. Rescuers should follow the AED voice prompts. Check with the device manufacturer regarding re-programming of the AED to be consistent with the 2005 AHA Guidelines. After re-programming by the manufacturer, the AED should prompt rescuers to allow the AED to analyze the victim's rhythm every 2 minutes. The evidence is insufficient to recommend for or against the use of AEDs in infants under 1 year of age.


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Slide 45 :20/07/2008 drdgm 45 No response No breathing No pulse


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Integration of CPR and AED :20/07/2008 drdgm 47 Integration of CPR and AED


How long the CPR ? :20/07/2008 drdgm 48 How long the CPR ? Before and after shock delivery Qualified help arrives and takes over The victim starts breathing normally Till rescuer becomes exhausted Till defib


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Future of CPR -- in You :20/07/2008 drdgm 50 Future of CPR -- in You most important determinant of survival from sudden cardiac arrest Presence of a trained rescuer who is Ready, able, willing and equipped to act