CPR - assafh.org to Medicine/CPR/CPR 2011.pdf · Dan Drory, MDA Paramedic and ... Head Tilt - Chin Lift ( in trauma Jaw – thrust) Avoid Hyperextension ... Resume CPR immediately

CPR Cardio Pulmonary

Resuscitation

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Dan Drory, MDA Paramedic and Instructor, 2011

The Israel Experience –

Educational Tourism Services Ltd

Consciousness: הכרה (hakarah) Unconscious: מחוסר הכרה (mechoosar hakarah) CPR: החייאה (hachya’ah) Breaths: נשימות (neshimot) Pulse: דופק (dofek) Compressions: עסויים (eesooeem) Adult: מבוגר (mevoogar) Child: ילד (yeled) Baby: תינוק (teenok) Vomit: קיא (key) Choking- חנק (chenek)

Vocabulary

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Anatomy – the science that research the structure of the body.

Physiology – the science that studies the functions of the body.

Pathophysiology – the science that studies the malfunctions of the body.

Basic Terminology

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•Respiration

•Consuming food

•Secreting wastes

•Reproducing

•Reaction to stimulation

•Movement

•Aging and Death

•Cell Tissue Organ System Body

Life – Definition

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Brain

Heart Lungs

If one of these three fail eventually all will fail

Triangle of Life

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4-6 minutes after a stop of blood flow to the brain, brain cells begin to die. Forever.

Forever.

All we hope for is that they weren’t very important

Time Line

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Chain of Survival

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Spontaneous Cardiac Arrest is the leading cause of death in most parts of the world.

Five vital links that can save a life are: • Immediate recognition and activation of EMS

• Early CPR that emphasizes chest compressions.

• Rapid Defibrillation if indicated

• Effective Advanced Life Support

• Integrated post-cardiac care

Chain of Survival

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When these links are implemented in an effective way, survival rates can approach 50%.

If we do it right…

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Adult CPR: Older than 8 years

Child CPR: 1 to 8 years

Infant CPR: 28 years to 1 day

Paired CPR

CPR with Equipment

CPR for every body!

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“Safe CAB is shocking!”

• Safety • AVPU and breathing assessment • Compressions with early AED

operation • Airway • Breathing

CPR- for every one

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Look around at your environment!

Make sure you, your team and your patient are safe – in that order!

“No fire, no wire, no gas, no glass, no drugs, no thugs.”

Are there other people around that can help you?

Safety



A- Alert

V- Voice\Response to Vocal Stimulus

P- Pain\ Response to Painful Stimulus

U- Unresponsive

AVPU

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Is the patient breathing normally?

Option #1: yes

Option #2: no

Simple.

Quickly Evaluate Breathing

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Agonal Breathing is what happens when the brain still thinks that there is a pulse when there isn’t. Another one is Gasping.

Imagine a fish that has been pooled out of the water. There will be movement of breath organs ( mouth, guilds ), but what is it good for if there is no pulse?

Usually, it looks as if the patient is taking deep but slow breaths.

Gasps do not count as breathing!!!

Agonal “Breathing”?

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In Israel, the emergency number for the medical services is 101

Call for help

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Describe shortly why you need an EMS team. “Hi, I’m with an adult that is Unresponsive and he is not breathing right…”. They will know what that means.

Give your phone number.

Give the address of the place the patient is at.

Don’t hang up until the dispatcher does! Allow him/her to collect all necessary information.

Uhhh… I dialed. Now what???

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If possible check for, check for pulse

Then you will be able to pass that information to the dispatcher .

Ask for a Defibrillator.

In a public place, try asking the security for it, they know what and where that is ( usually )

Ask for help! The compressions are fatiguing!

One hand holds the phone, what can the other do?

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•Check for pulse 5-10 seconds

o Check at the carotid artery

o If there is no pulse or you are not sure if there is, perform 30 compressions

Circulation

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Place 3 of your fingers on the patients crycoid cartilage when they face away from you.

Apply gentle pressure

Slide inward the neck with your fingers.

Do you feel it?

Practice on your classmates ( 5 min )

Checking pulse



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ב א

PUSH DEEP, PUSH FAST, PUSH HARD!

Allow full chest recoil!

Minimize interruption of chest compressions!

Adult CPR



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Goal: 100 compressions at least per minute

Go 5cm (2.5”) deep (1/3 chest depth)

Allow full chest recoil

Avoid Interruptions of compressions

Perform CPR on hard surface

Position your self so your arms will be at a 90 degree angle to the patient’s chest

Keep elbows locked, knees on floor, both hands on patient

Placement of compressions is in the middle of the chest ( not the torso )

Change compressors every 2 minutes or when asked as quickly as possible.

Brocken or dislocated ribs should not bother you.

Adult Chest Compressions Key



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Check Airway: • Open the mouth

• Clean secretions and visible objects ( no more than 10 seconds if you stopped compressions )

Head Tilt - Chin Lift ( in trauma Jaw – thrust )

Avoid Hyperextension

Conscious Unconscious

Airway ( after first 30 compressions )



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So let’s discuss…

You are right!

You don’t have to do the next step…

If you choose not to, resume compressions

Check and Clean secretions and visible objects ( no more than 10 seconds if you stopped compressions ) every two minutes

( 200 compressions / 5 sets of 30:2 )

Wait a minute! That’s discussing!



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Seal the nose Seal the mouth Inhale normally Give 1 breath ( Exhale ) Stop with chest rise You saw chest rise? Cool! Give another! No chest rise? Improve Head Tilt and try again!

Only two tries! Could not get it right? Try to improve it after another 30 compressions

Mouth to Mouth Rescue Breathing



Continue with 30 compressions followed by 2 breaths ( 30:2 ) four more times.

If a defibrillator is available, operate it immediately.

If you walk around with one, even before the first 30 compressions!

After 5 sets of 30:2, check for pulse.

No pulse? Keep on going!

Ambulance arrival time in populated arias in

Israel is in average - 7 minutes.

Plan to use help!

Keep on going!

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The sequence of CPR is based on a possibility of a return of spontaneous circulation. After you do 5 sets : about 2 minutes

( 30 compressions + 2 breaths ) X 5 You should check for pulse as you did the first

time. If a pulse have returned, go to the

A and B ( Give 1 breath every 5 seconds if not breathing, or maintain airway if he is. Monitor pulse )

Ok, and how do I know when to stop?

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If the person has a pulse and is breathing – lift legs and keep the Airway open.

We need to secure their airway… Keep monitoring the pulse.

If the person has a pulse but is not breathing, give one breath every 5 seconds.

Keep monitoring the pulse.

Patient with a Pulse



Semi-Automated External Defibrillator

A device that is capable of analyzing the most common rhythm in a Cardiac Arrest (Ventricular Fibrillation) and terminate it.

After it Analyzes the rhythm and finds the VF, it charges it self and awaits your command to release the shock.

Right. What's an AED?

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It’s safe to use.

It’s user friendly.

It even gives you instructions,

in case you forget…

You just need to listen to it.

A reminder, this should be done as soon as an AED is available

The AED

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When you open it, you will find patches ( Electrodes ).

They need to be connected to the patient in the next manner:

Some patients will need to get a shave before attaching the electrodes.

When attaching the electrodes, press on them firmly!

That’s what it looks like



Another way to connect them is: one patch in the middle of the chest, and another between the scapulas. That method is usually used in children and infants. There are no age/weight restrictions. Chances of survival when an AED is not being used during VF drop 7-10% every minute! An excellent CPR has a high potential of prolonging the life expectancy of the heart and the brain, but only an AED can terminate the VF! More so, without a proper perfusion that is build with the CPR, the

AED’s potential is poor. Those to are tightly connected, and evenly important!

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Connect only to a patient that is unresponsive and breaths abnormaly

DO NOT use on wet surfice

DO NOT use in surroundings of a sparkle inflammable gases or fluids.

When the AED is Analyzing, DO NOT touch the patient

DO NOT touch the patient from the beginning of Analyze until the end of shock delivery.

Resume CPR immediately after.

Check for pulse after 2 minutes.

AED Safety

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Lifepack 500 built-in protocol:

Connect Electrodes Start CPR! Right arrow Analyzing Rhythm, stay clear of the patient

Shock not Advised, Check for pulse, If there is no pulse, start CPR.

OR Shock Advised, Charging, Signal when ready and await for your consent.

You should say loudly: “Stand Clear!” and push the red button after you made sure that they did. Resume CPR immediately after the shock is delivered! The AED will start a count down from two minutes and will

notify you when you should press “Analyze” again. During those two minutes you do the 30:2 like a crazy monkey.



Death

Vomit

• Use Suction or turn the head to the side if C spine is uncompromised.

• After cleaning, start again from C

No chest rise

• Re-tilt head, and try again ( Once ). If it still doesn’t go in – there might be a foreign object in the A.W. Chest Compressions will push that out.

Air escapes

• Maintain good seal and re-tilt the head

Abdomen rises

• Re-tilt head and maintain good seal

Laryngospasm

Complications during CPR

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In paired CPR, the idea is to decrease the amount of time between each step. In such, partners work together to cover all steps of CPR simultaneously.

For example, after AVPU, while one partner checks breathing, the other can start making the 101 call. This eliminates any delay in getting BLS/ALS to the scene.

Both partners need to communicate with each other in order to ensure nothing gets forgotten.

CPR for Two

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Consciousness: הכרה (hakarah) Unconscious: מחוסר הכרה (mechoosar hakarah) CPR: החייאה (hachya’ah) Breaths: נשימות (neshimot) Pulse: דופק (dofek) Compressions: עסויים (eesooeem) Adult: מבוגר (mevoogar) Child: ילד (yeled) Baby: תינוק (teenok) Vomit: קיא (key) Choking- חנק (chenek)

Vocabulary Pause

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Child CPR

Similar to an adult CPR when you are alone, but:

Asphyxial Arrest is more common then VF in children and infants.

If you are curtain that the cardiac arrest was caused by an asphyxia and you are alone, commence 2 minutes of CPR ( 30:2 ) and only then call for help.

In a witnessed arrest call for help immediately

• When in doubt, CALL FIRST!

• Use of 1 or 2 hands for compressions

• Breaths are every 4 seconds for a patient with pulse,

monitor pulse ( for no longer then 10 seconds )

and airway.



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Recognize the need in CPR

One care taker starts CPR

The other activates 101 and fetches the AED if available

Upon the return of the second, commence CPR with a ratio of 15:2.

Connect and activate the AED as

soon as available.

Child CPR – Team Resuscitation



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Position your self so your arms will be at a 90 degree angle to the patient’s chest

Keep elbows locked, knees on floor, one or both hands on patient

Placement of compressions is in the middle of the chest (not the torso)

Change compressors every 2 minutes or when asked as quickly as possible.


Child Chest Compressions Key



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Similar to a child CPR as well, but few changes:

in AVPU assessment:

Verbal: make a familiar sound to the baby

Pain: press your thumbs on the soles of the

feet.

Infant CPR



Assessment of breathing:

Infant CPR

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Pulse check: locate the brachial artery Check for pulse for 10 seconds only

If pulse is slower then 60 bpm ( 0 included ), Start CPR Alone: 30:2, in a team 15:2

Connect and activate the AED as soon as available.

Infant CPR



Asphyxial Arrest is more common than VF in children and infants.

If you are curtain that the cardiac arrest was caused by an asphyxia and you are alone, commence 2 minutes of CPR ( 30:2 ) and only then call for help.

In a witnessed arrest call for help immediately

• When in doubt, CALL FIRST! • Use 2 thumbs on a “finger below nipple line” for

compressions • After first set of compression extent the head ( head tilt–chin

lift ), beware of hyperextension! • Supply breaths are every 3 seconds for a patient with pulse

above 60 bpm, monitor pulse ( for no longer then 10 seconds, every 2 minutes ) and airway.

• Lost the pulse – Start CPR



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Recognize the need in CPR

One care taker starts CPR

The other activates 101 and fetches the AED if available

Upon the return of the second, commence CPR with a ratio of 15:2.

Connect and activate the AED as

soon as available.

Infant CPR – Team Resuscitation



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Infant Chest Compressions Key






Use 2 thumbs on a “finger below nipple line” for compressions Change compressors every 2 minutes or when asked as quickly as possible.


They should bother the parents. If they do, you did

good enough!



Finally, the conclusion… But first -

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Infant Child Adult

>28 d,<1y >1y,<8y >8y Age

Immediately Call for help

Unresponsive, Discolored,

Pulse below 60 in the brachial artery for no

more then 10 sec

Unresponsive, Abnormal or

non excitant breathing, No definite pulse in the carotid for no more

then 10 sec

Indication for CPR

finger below nipple line

Middle of the chest Placement of hands

One third of chest depth Depth of compressions

At least 100 per minute Rhythm



Two thumbs Two hands/One

hand

Two hands Compressions done by

30:2 Lone rescuer CPR ratio

15:2 15:2 30:2 Team CPR ratio

Head tilt – Chin lift ( beware of hyperextension ) Airway opening

Mouth to nose and mouth

Depends on the size

Mouth to mouth Form of “Mouth to Mouth”

1 each 3 sec 1 each 4 sec 1 each 5 sec Rhythm of “Rescue Breaths”

Documents

CPR - assafh.org to Medicine/CPR/CPR 2011.pdf · Dan Drory, MDA Paramedic and ... Head Tilt - Chin Lift ( in trauma Jaw – thrust) Avoid Hyperextension ... Resume CPR immediately