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CARDIO PULMONARY CARDIO PULMONARY RESUSCITATION RESUSCITATION
Basic Life SupportBasic Life Support
ANY ATTEMPT AT RESUSCITATION ANY ATTEMPT AT RESUSCITATION IS BETTER THAN NO ATTEMPT AT IS BETTER THAN NO ATTEMPT AT
ALLALL(Australian Resuscitation Council)(Australian Resuscitation Council)
(Revised March 2011)(Revised March 2011)
Chain of SurvivalChain of Survival 11stst link Early recognition and call link Early recognition and call
for helpfor help 22ndnd link Early CPR link Early CPR 33rdrd link Early defibrillation link Early defibrillation 44thth link Early advanced cardiac link Early advanced cardiac
life support life support
What is a cardiac arrest?What is a cardiac arrest?
A condition where there is cessation of A condition where there is cessation of heart action evidenced as:-heart action evidenced as:-
No signs of lifeNo signs of life unresponsive / unconsciousunresponsive / unconscious no normal breathing no normal breathing no purposeful movementno purposeful movement
Common Causes:Common Causes: Cardiac conditions such as AMI (heart attack)Cardiac conditions such as AMI (heart attack) Respiratory arrestRespiratory arrest
What is a What is a respiratoryrespiratory arrest? arrest?
A condition where spontaneous A condition where spontaneous respiratory effort is ineffective or has respiratory effort is ineffective or has ceased and cardiac output is still presentceased and cardiac output is still present
If recognised and treated promptly may If recognised and treated promptly may prevent deterioration into a cardiac arrestprevent deterioration into a cardiac arrest
Common CausesCommon Causes: : asthmaasthma allergic reaction allergic reaction foreign body airway obstructionforeign body airway obstruction
The aims of CPRThe aims of CPR
Buys time until reversible causes can Buys time until reversible causes can be found and treated eg blood lossbe found and treated eg blood loss
Maintain the supply of blood to vital Maintain the supply of blood to vital organs ( to preserve heart and brain organs ( to preserve heart and brain function)function)
May increase the chance of May increase the chance of successful defibrillationsuccessful defibrillation
Slows the deterioration of ventricular Slows the deterioration of ventricular fibrillation into asystolefibrillation into asystole
DRSABCDDRSABCD
DD - Danger - Danger R R - Response - Response SS - Send for help - Send for help AA - Airway - Airway BB - Breathing - Breathing CC - Circulation/compressions - Circulation/compressions DD - Defibrillation - Defibrillation
DANGERDANGER
Assess scene for Assess scene for DangerDanger to both to both patient/yourselfpatient/yourself
Ensure use of personal protective Ensure use of personal protective equipment at all times (eg gloves/masks equipment at all times (eg gloves/masks etc)etc)
Check for water, electricity, body fluids, Check for water, electricity, body fluids, vomit, blood and check for scene safetyvomit, blood and check for scene safety
Move patient to a safer place if needed, Move patient to a safer place if needed, but try to avoid moving them if possible in but try to avoid moving them if possible in case of other injuriescase of other injuries
Remember to be mindful of your backRemember to be mindful of your back
RESPONSE RESPONSE
Do not shake and shout - touch to the Do not shake and shout - touch to the shouldershoulder
Speak loudly “are you all right?”Speak loudly “are you all right?” Has the victim fainted or are they Has the victim fainted or are they
unconscious? (unconscious? (If he responds, leave as you find him, and find out what is wrong, reassess regularly)
A casualty who is unresponsive should be A casualty who is unresponsive should be considered unconsciousconsidered unconscious
SEND for helpSEND for help
SendSend for help for help Ensure the closest Automatic Ensure the closest Automatic
External Defibrillator (AED) has been External Defibrillator (AED) has been retrieved retrieved
Note the timeNote the time
AIRWAYAIRWAY
Place a hand on the Place a hand on the victims’ foreheadvictims’ forehead
Fingertips to the point Fingertips to the point of the chinof the chin
Gently tilt the head Gently tilt the head and lift the chin to and lift the chin to open the open the airwayairway
Check for absence of Check for absence of signs of life – signs of life – unconscious, not unconscious, not breathing normally breathing normally and unresponsiveand unresponsive
AirwayAirway Assess the airway, ensuring it Assess the airway, ensuring it
is is - open- open
- clear- clear
Jaw thrust can be usedJaw thrust can be used
Look in mouth for obstructionLook in mouth for obstruction teeth, tongue, teeth, tongue,
vomit, foreign objectvomit, foreign object Ensure airway is clearEnsure airway is clear
If airway obstructed with If airway obstructed with fluid (vomit or blood) roll fluid (vomit or blood) roll patient onto their side & patient onto their side & clear airway or use suction clear airway or use suction if availableif available
AirwayAirway
Airway management takes precedence over any Airway management takes precedence over any injuryinjury
If spinal injury is suspected maintain alignment If spinal injury is suspected maintain alignment & support head& support head
Minimise bending and twisting of the neckMinimise bending and twisting of the neck
Visible material may be removed by rolling onto Visible material may be removed by rolling onto side and drain by gravity (ARC 2010)side and drain by gravity (ARC 2010)
Leave well fitting dentures insituLeave well fitting dentures insitu
Airway - PaediatricsAirway - Paediatrics Infants:Infants:
head head neutralneutral position position lower jaw supported chinlower jaw supported chin no pressure on soft tissuesno pressure on soft tissues If airway not open tilt head back If airway not open tilt head back veryvery
slightlyslightly Children should be managed as per adults Children should be managed as per adults
(ARC 2010) (ARC 2010)
BREATHING BREATHING
Look, listen and Look, listen and feel for normal feel for normal breathingbreathing
Normal breathing – Normal breathing – roll into the roll into the recovery position & recovery position & continue to continue to observeobserve
BREATHINGBREATHING
Confirm help has been calledConfirm help has been called
If absent or impaired breathing If absent or impaired breathing after after opening airwayopening airway commence commence compressions, NOT rescue breathscompressions, NOT rescue breaths
CIRCULATIONCIRCULATION
Check for signs of lifeCheck for signs of life Unresponsive / unconsciousUnresponsive / unconscious No purposeful movement No purposeful movement Absence of normal breathingAbsence of normal breathing
If victim takes an occasional gasp suspect cardiac If victim takes an occasional gasp suspect cardiac arrest arrest
If no signs of life commence chest compressionsIf no signs of life commence chest compressions
COMPRESSIONSCOMPRESSIONS Kneel at the side of the Kneel at the side of the
casualtycasualty Lower half of the Lower half of the
sternum in all age sternum in all age groupsgroups
Press 1/3 depth of the Press 1/3 depth of the chest chest
Rate 100 compressions / Rate 100 compressions / minuteminute
Give 30 compressions Give 30 compressions then 2 rescue breaths then 2 rescue breaths
DO NOT apply pressure DO NOT apply pressure over the ribs or over the ribs or abdomen abdomen
Adult and childAdult and child
Heel of one hand or two-handed technique
to suit size of child
Infant compressionsInfant compressions
Two fingersTwo fingers
Two thumbsTwo thumbs
Get your technique rightGet your technique right Ensure good positionEnsure good position 50% compression, 50% relaxation50% compression, 50% relaxation Allow complete chest recoil after each Allow complete chest recoil after each
compressioncompression Place heel of one hand on lower half Place heel of one hand on lower half
sternum (centre chest) & place heel of 2sternum (centre chest) & place heel of 2ndnd hand on top first, fingers parallel to the hand on top first, fingers parallel to the ribs & raisedribs & raised
Push with heel of handPush with heel of hand Shoulders vertically over sternumShoulders vertically over sternum Keep arms straightKeep arms straight
CompressionsCompressions
http://images.google.com/imgres?imgurl=www.thebcaa.com/images/Fig3X9.gif&imgrefurl=http://www.thebcaa.com/cprinfo.htm&h=239&w=331&prev=/images%3Fq%3Dcardiac%2Bcompressions%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8%26sa%3DG
CompressionsCompressions 30:230:2 – 30 compressions to 2 breaths– 30 compressions to 2 breaths
Universal ratio for all infants, children and adults with one Universal ratio for all infants, children and adults with one or two rescuers or two rescuers
Ratio 30:2 will achieve 5 cycles in two minutesRatio 30:2 will achieve 5 cycles in two minutes
CPR should not be interrupted to check for signs of life (ARC CPR should not be interrupted to check for signs of life (ARC 2006)2006)
CPR becomes ineffective when person doing compressions CPR becomes ineffective when person doing compressions becomes tired, change at least every two minutes to becomes tired, change at least every two minutes to reduce fatigue (ARC 2006)reduce fatigue (ARC 2006)
Team leader monitors effectiveness of compressions & Team leader monitors effectiveness of compressions & ventilations directing change of ventilations directing change of rescuers as necessaryrescuers as necessary
Circulation - Duration of CPRCirculation - Duration of CPR
Continue CPR untilContinue CPR until Signs of life returnSigns of life return
Advanced Life Support personnel direct Advanced Life Support personnel direct advanced resuscitationadvanced resuscitation
An authorised person pronounces life extinct An authorised person pronounces life extinct
It is impossible to continueIt is impossible to continue
Breathing techniqueBreathing technique
Observe for chest rise with each Observe for chest rise with each inflationinflation
If the chest does not rise ensure If the chest does not rise ensure correct head tilt, adequate air seal correct head tilt, adequate air seal and ventilationand ventilation
Various devices available, pocket Various devices available, pocket mask, bag-valve-mask device mask, bag-valve-mask device
Mouth to pocket maskMouth to pocket mask
Bag/Valve/MaskBag/Valve/Mask
DEFIBRILLATION DEFIBRILLATION The purpose of BLS is to maintain The purpose of BLS is to maintain
myocardial and cerebral perfusion until myocardial and cerebral perfusion until defibrillationdefibrillation
Time is critical, the chance of successful Time is critical, the chance of successful defibrillation decreases with timedefibrillation decreases with time
Immediate CPR & early defibrillation Immediate CPR & early defibrillation provides the best chance of survival in provides the best chance of survival in victims with VF or pulseless VTvictims with VF or pulseless VT
Back to the chain of survivalBack to the chain of survival
AUTOMATED EXTERNAL AUTOMATED EXTERNAL DEFIBRILLATOR (AED)DEFIBRILLATOR (AED)
Portable, battery operated Portable, battery operated For use by trained first For use by trained first
aiders aiders Will analyse the rhythmWill analyse the rhythm AED’s accurately diagnose AED’s accurately diagnose
cardiac rhythms and separate cardiac rhythms and separate them into 2 groupsthem into 2 groups those responsive to those responsive to
defibrillationdefibrillation those unresponsive to those unresponsive to
defibrillationdefibrillation Will only ‘shock’ a Will only ‘shock’ a
shockable rhythmshockable rhythm
DEFIBRILLATION PADSDEFIBRILLATION PADS Soft thin foam padsSoft thin foam pads Layer of gel which picks up the Layer of gel which picks up the
electrical signalselectrical signals Must adhere firmly to chest wall – no Must adhere firmly to chest wall – no
creasescreases Direction for placement clearly on Direction for placement clearly on
pack and pads pack and pads
USE OF AEDUSE OF AED Assign tasks if number of people Assign tasks if number of people
presentpresent Continue CPR while preparing AEDContinue CPR while preparing AED Turn on AED Turn on AED Attach electrodesAttach electrodes Follow the promptsFollow the prompts Ensure no one touches the casualty Ensure no one touches the casualty
while the AED analyses the rhythmwhile the AED analyses the rhythm
Applying the padsApplying the pads
Avoid placing pads directly over Avoid placing pads directly over medication patches, jewellery, ECG medication patches, jewellery, ECG electrodes, implanted devices or electrodes, implanted devices or invasive linesinvasive lines
What to do with the AEDWhat to do with the AED Plug in AED pads Plug in AED pads
connector to defibrillatorconnector to defibrillator
Wait for AED to analyse Wait for AED to analyse the victims cardiac rhythmthe victims cardiac rhythm
Follow voice promptsFollow voice prompts
If no shock indicated If no shock indicated continue to follow the continue to follow the voice prompts and voice prompts and maintain Basic Life Supportmaintain Basic Life Support
USE OF AED (cont)USE OF AED (cont) If a shock is indicated – the machine will deliver If a shock is indicated – the machine will deliver
the shockthe shock Before you push the shock buttonBefore you push the shock button
Perform a Perform a visual sweepvisual sweep of the area of the area Ensure no one is in contact with the patient or Ensure no one is in contact with the patient or
the patients bed the patients bed Ensure oxygen is removed from immediate Ensure oxygen is removed from immediate
areaarea Remove patient from excessive moistureRemove patient from excessive moisture Call out Call out “STAND CLEAR”“STAND CLEAR” and recheck the area and recheck the area
before you push the orange shock buttonbefore you push the orange shock button
What next ?What next ?
Commence CPR immediately after Commence CPR immediately after delivering the shockdelivering the shock
Use a ratio of 30 compressions to 2 Use a ratio of 30 compressions to 2 breathsbreaths
Follow the voice prompts & continue Follow the voice prompts & continue CPR until signs of life returnCPR until signs of life return
CAUTION IN USE OF AEDCAUTION IN USE OF AED
Don’t apply pads over pacemakersDon’t apply pads over pacemakers Don’t apply pads over skin Don’t apply pads over skin
patches/medicationspatches/medications Be cautious around waterBe cautious around water NEVER attach to anyone not in NEVER attach to anyone not in
cardiac arrestcardiac arrest
ARRIVAL OF AMBULANCEARRIVAL OF AMBULANCE DO NOT stop CPR DO NOT stop CPR Ambulance officers - timeAmbulance officers - time
- equipment - equipment
- factual details- factual details
- assessment - assessment Place victim in recovery position if signs of Place victim in recovery position if signs of
life returnlife return
CESSATION OF CPRCESSATION OF CPR
Return of signs of lifeReturn of signs of life The scene becomes unsafeThe scene becomes unsafe Qualified help arrives and takes overQualified help arrives and takes over You are physically unable to continueYou are physically unable to continue An authorised person pronounces life An authorised person pronounces life
extinct extinct
CULTURAL AWARENESSCULTURAL AWARENESS
Be aware of cultural and linguistic Be aware of cultural and linguistic diversity diversity
Debriefing in an appropriate setting can be Debriefing in an appropriate setting can be very helpful following an intense situation very helpful following an intense situation such as a cardiac arrestsuch as a cardiac arrest
CAUTIONCAUTION
Motorcyclists – Motorcyclists – take care when removing take care when removing helmet helmet
Pregnant women Position on her back with shoulders flatPosition on her back with shoulders flat Use padding / wedge to give pelvic tilt Use padding / wedge to give pelvic tilt The pelvic tilt obtains lateral displacement of The pelvic tilt obtains lateral displacement of
the uterusthe uterus Enhance venous return and reduce pressure on Enhance venous return and reduce pressure on
vena cavavena cava
Pt in supine positionNOTE: compressed
inferior vena cava andaorta
Pt positioned with pelvic tiltNOTE: compression relieved
on the inferior vena cava and
aorta
XX
REMEMBERREMEMBER
ANY ATTEMPT AT RESUSCITATION IS ANY ATTEMPT AT RESUSCITATION IS BETTER THAN NO ATTEMPT AT ALLBETTER THAN NO ATTEMPT AT ALL
Australian Resuscitation Council, Australian Resuscitation Council, (2010)(2010)