CPR and FBAO Final Lecture

8/12/2019 CPR and FBAO Final Lecture

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CARDIOPULMONARY RESUSCITATION (CPR)

and

FOREIGN-BODY AIRWAY OBSTRUCTION

Kierstine O Garcia, RN

FO1 BFP

EMS STAFF

CHAIN OF SURVIVAL

CARDIOPULMONARY RESUSCITATION

FOREIGN-BODY AIRWAY OBSTRUCTION


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CPR

CARDIOPULMONARY RESUSCITATION

1. Chain of SurvivalCardiopulmonary resuscitation (CPR) can save the lives of victims in cardiac arrest. Two

thirds of heart attack victims (due to heart disease) die outside the hospital, most within two

hours of the onset of symptoms. Though CPR itself is not enough to save the life of a victim of

heart attack, it is a vital link in the chain of survival.

The chain of survival has hour links, and the patients chances for surviving are the greatest

when all the links come together.1. Early access

2. Early CPR 3. Early defibrillation 4. Early advanced life support

The need for these interventions should not be limited to victims of heart disease .Many

victims of drowning, trauma, electrocution, suffocation, airway obstruction, allergic reaction,

etc., may be saved by prompt intervention.

2. Heart Attack Risk Factors

Risk factors that cannot be changed (non-modifiable)

Heredity Age Gender

Risk factor that can be changed (modifiable)

Smoking Hypertension Exercise High cholesterol

Contributing factors

Obesity Diabetes Stress


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3. Breathing

Adequate breathing is characterized by:

Chest and abdomen rise and fall with each breath

Air can be heard and felt exiting the mouth and or nose

Inadequate breathing is characterized by:

Inadequate rise and fall of the chest

Noisy breathing:bubbles,rales,stridor,whistling,etc.,

Absent breathing is characterized by:

No chest or abdominal movement

Air cannot be heard or felt exiting the mouth or nose

4. Cyanosis

A bluish discoloration of the skin and the mucous membranes caused by a lack of oxygen in

the blood and tissues.

This condition can be the result of the patient breathing in an environment poor in oxygen,

suffering from illness or respiratory injury, or airway obstruction.

Cyanosis can be more easily noticed on the lips, ears and nostrils or nailbeds. In patients with

dark pigmentation, it is necessary to inspect the nostrils, palm, and nailbeds, and the mouth andtongue.

5. Clinical and Biological Death

Clinical Death: Occurs when a patient is in respiratory arrest (not breathing)or in cardiacarrest(heart not beating).The patient has a period of 4 to 6 minutes to be resuscitated without

brain damage. Clinical death can be reversed.

Biological Death: The moment the brain cells begin to die. Biological death cannot be reversed.

6. Signs of Certain Death

Lividity: pooling of blood from the lower areas of the body

Purple to bluish color


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Rigormortis:Stiffening of body and limbs, occurs usually 4-10 hours after death.

Decomposition: the breakdown of substance into simpler chemical forms.

Other: Mortal wounds such as decapitation, severe crashing injuries

Technique for Opening the Airway

Head-Tilt Chin-Lift

Jaw Thrust

When opening the airway, use the correct method:

Medical case: (any part of the body is affected none in particular)

Head-Tilt Chin-LiftTrauma case: (specified like head or neck injury)

Jaw Thrust


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Head-Tilt Chin -Li ft

This is the method of choice for opening the airway.

Do not use this method if you suspect head, neck or spinal injury.

1. Position the patient lying face up (supine position).2. Kneel by the patients shoulder toward the head.3. Place hand on the forehead and place the fingertips of your other hand under the bony

part of the patients jaw.

4. Lift on the chin, support the jaw, and at the same time, tilt the head back as far aspossible.

For infants and children: Place in the sniffing positiondo not over-extend.

Important Precautions:

Always keep the patients mouth slightly openuse your thumb to hold down thepatients lower lip.

Never dig into the soft tissue under the patients chin.Once the airway is open, check breathing.Look, listen and feel. If patient is not breathing,

artificial ventilation should be started. If unable to ventilate, assume the airway is obstructed.

Jaw Thrust

The jaw thrust is the only maneuver recommended on an unconscious patient with suspected

head, neck, or spinal injury.

1. Position the patient lying face up.2. Kneel above the patients head. Place your elbows next to the patients head on the surface

where the patient is lying. Place both hands on either side of the patients head.

3. Grasp the angle of the patients jaw on both sides. For an infant or child use two or threefingers.

4. Use a lifting motion to move the jaw forward (up) with both hands.5. Keep the patients mouth slightly open by using your thumbs if needed.

Ar tif icial Venti lation (Rescue Breathing)

Once the patient has an open airway, you can provide artificial ventilation for a patientbreathing inadequately or not at all.

How is it possible to maintain a patient alive with exhaled air?Natural air containsapproximately 21% oxygen and the body only utilises about 5%.Therefore,exhaled air contains

16%oxygen.This exhaled air can resuscitate a person who is not breathing, until a high-

concentration oxygen source is available.


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Techniques for Ar tif icial Venti lation

Mouth to mouth and nose

Mouth to mouth

Mouth to mouth


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Mouth to stoma

Cardiopulmonary Resuscitation Management

1. Survey the scene, introduce and ask permission2. Check for responsiveness

a. Tapping of shoulders (2x)b. Calling of names

3. Shout for help or activate EMS if patient is unresponsive4. If available get Automated External Defibrillator5. Perform 30 chest compression for about 15-18 seconds

a. Proper position should be at the midsternum area of the chestb. Always observe the proper depth of the compression not to deepc. Allow the chest to return to its normal positiond. Position shoulders over hand with elbows lock and arm straighte. Keep hand in contact with the chest all the times

6. Opening the airway (head-tilt, Chin-lift maneuver)a. Proper position is observeb. Hand on the foreheadc. Fingers on the chin

7.

After every 30 chest compressions give two 1 second breath (1,1001,1,1002)8. While giving ventilation observe:

a. Nose maintained pinchb. Full slow breaths (1sec)x 2c. Cover the whole mouth

9. Repeat cycles of chest compressions and 2 ventilations for 5 seconds (approximately 2minutes)


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10.Check the carotid pulse for 10 seconds every 2 minutes (equivalent to 5 cycles of CPR)11.If pulse is positive and breathing is negative give artificial respirations:

a. Give one full breath every 5 seconds for 24 cycles (blow, 1,1002,1003,1001 up to 24cycles)

12.While giving artificial ventilation:a. Nose maintained pinchb. Full slow breaths (1sec)x 2c. Cover the whole mouth

13.Recheck the carotid pulse for 10 seconds14.Place the patient in recovery position if pulse and breathing are both present.

CPR for Infant

1.

Survey the scene, introduce and ask permission2. Check for the infants responsivenessa. Gently tap the bottom of the infants feetb. Shout hey baby are you OK?

If there is no response

3. Ask someone to call EMS4. Perform 30 chest compressions at about 15-18 seconds

a. Position two fingers on the compression area (one finger width below theimaginary nipple line)

b. Depth of compression at 1/3 to c. Allow the chest to return to its normal positiond. Maintain open airway with one hand while compressing the chest with two

fingers of the other hand.

e. Keep fingers at contact with the chest at all times.5. Open the airway (head-tilt, chin-lift maneuver)

a. Proper head-tilt should be observe (neutral or slightly extended position)b. Hand should be at the infants foreheadc. Fingers should be place at the infants chin

6. Give two puffs after each 30 compressions7. While giving ventilation:

a. Slow breath 1 second x 2b. Mouth seal over the infants mouth and nose

8. Repeat cycles of chest compressions and 2 ventilations for 5 cycles (approximatelyfor 2 minutes)

9. Check the brachial for 10 seconds every 2 minutes (equivalent to 5 cycles of CPR)10.If pulse is positive and breathing is negative give artificial respiration:

Give 1 breath every 3 seconds for 40 cycles (blow, 1, 1001 up to 40 cycles)


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11.While giving ventilation:a. Slow breath 1 second x 2b. Mouth seal over the infants mouth and nose

12.Recheck the brachial pulse for 10 seconds13.Place the infant in recovery position if the pulse and breathing is present.

Recognizing Foreign Body Airway Obstruction (FBAO)

Foreign-Body Airway Obstruction

Foreign-body airway obstruction should be considered in any victimespeciallya younger victimwho suddenly stops breathing, becomes cyanotic, or loses

consciousness for no apparent reason.

Two types of FBAO:

Partial:

An object caught in the throat that does not totally block breathing. A patient withpartial obstruction may have adequate or poor air exchange. With adequate air

exchange, the patient may cough forcefully, though there may be wheezing

between coughs. Do not interfere with patients attempt to clear the airway. With

poor air exchange ,the patient will exhibit a weak, ineffective cough, high pitched

noise while inhaling, increased respiratory difficulty and possible cyanosis. Treat

this situation as a complete airway obstruction.

Complete

The patient is unable to speak, breath, or cough. May clutch the neck with thumb and

finger. Air movement will be absent.

Heimlich maneuver

The Heimlich maneuver (sub diaphragmatic abdominal thrusts) isrecommended for relieving foreign-body airway obstruction. By elevating the

diaphragm, the Heimlich maneuver can force air from the lungs to create an

artificial cough intended to expel a foreign body obstructing the airway. Each

individual thrust should be administered with the intent of relieving the

obstruction. It may be necessary to repeat the thrust several times to clear the

airway. Five thrusts per sequence is recommended.


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When you perform this maneuver, you should guard against damage to internal

organs, such as rupture or laceration of abdominal or thoracic viscera. To minimize this

possibility, your hands should never be placed on the xiphoid process of the sternum or on the

lower margins of the rib cage. They should be below this area but above the navel and in the

midline. Regurgitation may occur as a result of abdominal thrusts. Be prepared to position

the patient so aspiration does not occur.

HEIMLICH MANEUVER WITH VICTIM STANDING OR SITTING.

To perform the Heimlich maneuver with victim standing or sitting, stand behind the

victim, wrap your arms around the victims waist, and proceed as follows:

Step 1Make a fist with one hand.

Step 2Place the thumb side of the fist against the victims abdomen, in the midline slightlyabove the navel and well below the tip of the xiphoid process.

Step 3Grasp the fist with the other hand and press the fist into the victims abdomen with a

quick upward thrust.

Step 4Repeat the thrusts and continue until the object is expelled from the airway or

the patient becomes unconscious.

Each new thrust should be a separate and distinct movement


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HEIMLICH MANEUVER WITH VICTIM LYING DOWN.

To perform the Heimlich maneuver with victim lying down, proceed as follows:

Step 1Place the victim in the supine position (face up). Step 2Kneel astride the victims thighs and place heel of one hand against the victims

abdomen, in the midline slightly above the navel and well below the tip of the xiphoid.

Step 3Place the second hand directly on top of the first. Step 4Press into the abdomen with a quick upward thrust.

Responsive Adult/Chi ld

1. Introduce, ask for consent and determine complete or partial airway obstruction2. Get in position, stand behind the patient and place one leg between the patients leg3. Reach around and locate the navel4.

With the other hand, make a fist and place it against the abdomen, thumb side in, justabove the navel

5. Grasp your fist with the first hand and give up to five abdominal thrust/HeimlichManeuver in quick inward and upward direction

6. Observe, the patient will cough or speak if the object is removed or dislodged7. If still obstructed repeat the thrust until the airway is clear or the patient becomes

unconscious.


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Unresponsive Adult/Chil d

1. Place the patient into supine position2. Activate EMS3. Open the airway using the appropriate technique (head-tilt, chin-lift)4. Assess breathing for ten (10) seconds5. Attempt to provide one full slow breath6. If unable to provide adequate chest rise/air bounces back, reposition the head7. Give again one full slow breath8. If air still bounces back, give thirty (30) chest compressions9. Check airway, if obstruction is visible perform finger sweep. If obstruction is not visible

go back to step number 5

10.If object was removed and patient still unconscious:a. Give two (2) confirmatory blowsb. Check breathing for ten (10) secondsc. If breathing is adequate, put the patient into recovery position

11.If object was removed and patient becomes conscious, put him/her into recovery position(side lying).

FBAO in I nfant

1. Survey the scene, introduce and ask permission2. Pick up the infant and determine if partial or complete obstruction:

a. No strong cryb. Weak, ineffective coughc. Difficulty of breathing

3. Support the infants head as you place him down on your forearm. Use your thigh tosupport your forearm. Keep the infants head lower than the body.

4. Rapidly deliver 5 back blows just between the shoulder blades. If this fails to expel theobject proceed to the next step.

5. While supporting the infant between your forearms, turn him over onto his back. Perform5 chest thrust (at about 15-18 seconds).

a. Position two fingers on the compression area (one finger width below the imaginarynipple line)

b.

Depth of compression at 1/3 to c. Allow the chest to return to its normal positiond. Maintain open airway with one hand while compressing the chest with two fingers of

the other hand.

e. Keep fingers at contact with the chest at all times.6. Continue with this sequence of back slaps and chest thrust until the object is expelled or

the infant loses consciousness


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Unresponsive I nfant

1. Position the infant lying face up, the open the airway by placing the infants head inneutral or sniffings position

2. Activate EMS if you are not alone (ask someone to call for help)3. Check breathing for 10 seconds. Open the airway (head-tilt, chin-lift maneuver)

a. Proper head-tilt should be observe (neutral or slightly extended position)b. Hand should be at the infants foreheadc. Fingers should be place at the infants chin

4. If there are no signs of breathing attempt to ventilate.a. Slow breath 1 second x 2b. Mouth seal over the infants mouth and nose

5. If air bounce back reposition the head and ventilate again.6. If still bounces back proceed to the next procedure7. Perform 30 chest compressions8. Open the airway and look for the object. If the object is not visible repeat step 49. If the object is visible, do finger sweep. If object is removed proceed10.Provide two (2) confirmatory blows11.Check breathing for 10 seconds12.Place infants into recovery position if infants coughed or becomes responsive.

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CPR and FBAO Final Lecture