Cardiopulmonary Resuscitation and AED

Remember the BASICS!

Outline

• Introduction to CPR• History• Review of the Circulatory System• Causes of Cardiac Arrest• CPR• AED

Introduction to CPR

Time is Critical!

• > 300,000 people experience sudden cardiac death in prehospital settings each year.

• If resuscitation begins within a few minutes, many of these individuals have a chance for survival.

Time is Critical!

Begin resuscitation within minutes:

• Patient’s collapse witnessed

• EMS immediately activated

• CPR started immediately

• Defibrillation within minutes

Trained bystanders are not always available or willing to do CPR.

The role of the rescuer is critical in reaching the patient quickly and beginning

resuscitation.

Historical Perspective

• Early 1900s: Shafer Method

Historical Perspective

• 1960s – Peter Safar– Prone position inadequate– Expired air did provide sufficient O2.– Head tilt, chin lift kept patent airway

Historical Perspective

• 1955: Paul Zoll: 1st successful closed chest defibrillation, external pacing

Historical Perspective

• 1930s: In hospital resuscitation team• 1960s: MICU with physicians• 1970: Education in Seattle

– 100,000 laypersons CPR– 911 dispatch education– Paramedic training

• 1979: 1st AED developed– Sensing electrode in pharynx– Shocking electrode on tongue and abdomen

• 1974: Training of laypersons formally sanctioned

Review of the Circulatory System

What is the function of the circulatory system?

The Circulatory System

• Delivers O2 and nutrients

• Removes CO2 and wastes

Why is the function of the circulatory system critical to our survival?

If the heart stops pumping

• Lack of O2 and accumulation of wastes quickly lead to death

Major Arteries

Where are capillaries found and what is their purpose?

Capillaries

• Found throughout the body• Connect smallest arteries to smallest veins• O2, nutrients, and

wastes move through thin walls

• Microscopic

How does a vein differ from an artery?

Veins

• Carry blood back to heart

• Lower pressure

What is the function of blood?

Blood

• The fluid of the circulatory system

• Carries O2, nutrients, and wastes

Heart Physiology

• Left Ventricle contracts – sends wave of blood

• Pressure wave felt as pulse

• No contraction = No blood flow = cardiac arrest

Time is Critical!

• Brain damage begins in 4–6 min

• Brain damage irreversible in 8–10 min

Circulation must be restored within 4–

6 minutes.

CPR

• Provides minimal amount of circulation/oxygenation until cause of cardiac arrest corrected

• External chest compressions circulate blood

• Artificial ventilations provide O2 to lungs

Causes of Cardiac Arrest

Causes of Cardiac Arrest

• Heart disease• Respiratory arrest• Medical emergencies• Drowning and suffocation• Congenital heart defects• Trauma

The cause of cardiac arrest is

important

BUT

do not delay CPR to obtain history

CPR

• Combines external chest compressions with artificial ventilation

• Provides 30% (or less) of normal circulation

• Only effective for short period of time

CPR – 1 Rescuer

• Assess responsiveness

• Summon EMS• Position the

patient

CPR – 1 Rescuer

• Check for a pulse (≤ 10 seconds)

No pulse..activate EMS…Get AED

CPR – 1 Rescuer

• If there is no pulse, find your landmarks, lower half of the sternum, between the nipples

CPR – 1 Rescuer

• Begin chest compressions

CPR – 1 Rescuer

• Perform 30 chest compressions

• Push hard• Push fast• Allow the chest to

recoil after each compression

CPR – 1 Rescuer

• Administer two ventilations then return to compressions

CPR – 2 Rescuer

1 2

3 4

CPR - Children

• Use heel of one hand

• Keep airway open with other hand

• 30 compressions:2 ventilations if alone (2 rescuers use 15:2)

CPR - Infant

• Give chest thrusts and puffs of air

• 30 compressions:2 ventilations if alone

• 15 compressions: 2 ventilations with 2 rescuers

Sequence of Survival

The chances of survival from cardiac arrest depend upon the sequence (chain) of survival being intact.

All links are equally important and one weak link can break the chain.

Sequence of Survival Also known as Chain of Survival

• Recognition and Early Access

• Early CPR

• Defibrillation

• Early Advanced Care

Recognition and Early Access

• Depends on public education

• EMS must be immediately notified

• 9-1-1 dispatchers can provide CPR instructions

Early CPR

• Must begin within 4-6 minutes of collapse

• Public training is necessary

• Rescuers have a critical role

Copyright © 2004 Elsevier (USA). All Rights Reserved

DefibrillationDefibrillation

•Ventricular fibrillationa common cause

ofCardiac arrest•Can only be

corrected with defibrillation

Copyright © 2004 Elsevier (USA). All Rights Reserved

• Chance of success decreases with time

• AEDs save lives!

• Chance of success decreases with time

• AEDs save lives!

DefibrillationDefibrillation

Ventricular FibrillationV-Fib

• The most common cause of sudden cardiac death– Chaotic, disorganized heart activity– Heart muscle cannot pump blood

Ventricular FibrillationV-Fib

• Requires immediate defibrillation

• CPR lengthens window of survival

Early Advanced Care

• Medication• Advanced airway

management• Post-resuscitation

care

AED

AEDs

• Safe, accurate & lightweight

• Easy to operate

What is public access defibrillation?

PAD

• AEDs in public places

• Training the public in CPR/AED

Special Considerations

• Children• Clothing• Body hair• Water• Transdermal

medication patches

• Implanted defibrillators or pacemakers

• Metal surfaces• Jewelry and glasses

AED

Assess • Check your patient

Universal Steps

Power

↓

Patient

↓

Analyze

↓

Shock

Power

• Turn the power on

Patient

• Apply pads to patient

Analyze• Stay clear while

patient’s heart rhythm is analyzed

Clear

• Head to toe and toe to head: everyone is clear!

Shock

• Defibrillate

Patient

• Standard is set of 1 shock

• Immediately restart CPR for 2 minutes then check pulse

Summary

• Continual beating, or contracting, of the heart is necessary to keep blood circulating throughout the body.

• Brain damage begins in 4 to 6 minutes of cardiac arrest.

• There are many causes of sudden cardiac death, but the most common is ventricular fibrillation.

Summary

• Survival from cardiac arrest depends on the sequence (chain) of survival.

• Rescuers are critically important in maintaining the sequence (chain) of survival.

CPR Video

Remember Hard and Fast !!

Keep the Beat of Staying Alive !!!