Upload
mireya-buckler
View
214
Download
0
Tags:
Embed Size (px)
Citation preview
American Heart Association
Approximately 330,000 prehospital and Emergency Department deaths/year in US are from cardiac arrest
Survival is 6.4% or less
Changes in AHA guidelines are based on research
Major Changes for Everyone
Emphasis on effective chest compressions
Universal compression:ventilation ratio for lone rescuer
1 Second breaths during CPR
1 Shock, then immediate CPR
Effective Chest Compressions
Change:Push hard and push fast
Why:Need adequate rate and depth in order to produce blood flow and
perfuse vital organs
Change:Equal compression/relaxation times
Why:Need full recoil of chest in order to have better blood flow
Change - not emphasized
Effective Chest Compressions, continued
Change:Limit Interruptions to chest compressions
Why:Blood flow stops when CPR is interrupted, more compressions in
a row provides better blood flow
Change –never limited
Universal Compression:Ventilation Ratio
Change:
30:2 for lone rescuer, infants through adults (not newborns)
Why:
Simplify information, longer series of uninterrupted compressions
Changed from - 15:2
1 Second Breaths
Change:
Give the recommended number of breaths, with each breath given over 1 second
Why:
Lungs require less oxygen during CPR due to decreased blood flow and it is important to reduce interruptions to compressions
Changed from - breaths over 1-2 seconds, the more the better
1 Second Breaths, continued
Change:
Avoid delivering too many breaths or breaths that are too large or too forceful
Why:
Too much volume in the chest cavity decreases blood return to the heart. Too forceful a breath can cause gastric distention
and all it implies.
Changed from - belief that more oxygen was better
1 Shock, Immediate CPR
Change:
Deliver 1 shock, followed by the compression phase of CPR, continue 5 cycles
Why:
There is almost a 40 second delay in analyzing the rhythm, delaying blood flow to vital organs
V-fib is almost always eliminated in first shock so stacked shocks aren’t usually necessary.
After shocking, it takes a few moments for a normal heart rhythm to return and more time for optimal blood flow, CPR can
help increase the blood flow sooner
Changed from - stacked shocks
Major Changes for EMS
Definition of “Child” Tailor sequence for most likely cause Opening the Airway, Trauma Victim Check for “adequate” breathing Try a couple of times to get chest rise Excessive ventilation should not be performed
Major Changes for EMS, continued
Emphasis on CPR children with HR <60bpm Compressions at adequate rate and depth Hand placement change for pediatrics Compression:Ventilation ratio changes With advanced airway no pause for breaths When 2 or more providers, rotate compressor role every 2
minutes
Definition of “Child”
Change:
1 year to onset of puberty
Why:
Difficult to pick one anatomical or physiological
characteristic that changes “child” to “adult”
Changed from - 1-8 years
Tailor Sequence to Cause
Change
Adult – phone first, get AED, provide CPR
Infant/Child – CPR for 2 min, phone 911, AED when available
Any age- Hypoxic event, CPR for 2 min, phone 911, AED when available
Why:
Sudden collapse requires AED, Hypoxic event requires immediate CPR before activating 911
Change –not emphasized
Opening the Airway, Trauma Victim
Change:
Head tilt – chin lift unless c-spine injury is suspected
Jaw thrust - if c-spine injury suspected, unless maneuver doesn’t work, then head tilt –chin lift
Why:
Airway is a priority
Changed from - Jaw thrust only
Check for “Adequate” breathing
Change:Adults -Check for “adequate” vs “normal” breathing, give 2 breathsInfant/Child – check for presence/absence of breathing, give 2 breaths if not breathing
Why:No need to wait for apnea in adultsDifficult to assess “adequate” but not “normal” breathing in pediatrics
Changed from - check for adequate breathing for all victims
Chest Rise
Change:Try a “couple of times” to get adequate chest rise
Why:Asphyxia most common cause of cardiac arrest, need to try a “couple of times” to provide effective breaths
Changed from - maneuver head to get optimal airway opening
Excessive Ventilation
Change:
Give breath over 1 second, with just enough force to get chest rise
Why:
Less ventilation than normal needed during CPR
During CPR blood flow to lungs is 25% of normal, requiring less oxygen
Hyperventilation decreases blood return to heart and can cause gastric distention
Changed from - 1-2 seconds, large breaths
CPR for peds HR<60bpm
Change:
Despite adequate ventilatory support, HR remains<60bpm, if so, begin CPR
Why:
Bradycardia is a common terminal rhythm in children
Change –not emphasized
Adequate Rate and Depth
Change:Push Hard, Push Fast, allow recoilLimit interruptions to 10 seconds
Why:More effective chest compressionsIncreased cardiac outputBetter blood flow
Changed from -no emphasis on recoil
Hand Placement
Change:Children – heel of 1 or two hands
Why:Depending on child’s size, better compressions were found to be
done with 2 hands
Change:Infants: - 2 thumb-encircling hands technique
Why:Produces higher coronary artery perfusion pressureBetter depth and force of compressionGenerates higher systolic and diastolic pressures
Changed from -1 hand in children and 2 fingers in infants
Compression:Ventilation Ratio
Change:1 rescuer – 30:22 rescuer – 15:2
Why:Simplify trainingReduce interruptions
Changed from - 5:1
Advanced Airway
Change:
Once an advanced airway ( ET Tube, LMA, Combitube) is in place, continuous compressions at a rate of 100/minute
Why:
No need to pause for breath, provides uninterrupted chest compressions
Changed from - asynchronous compressions
Rotate Compressor Role
Change:
Rotate compressor role every 2-3 cycles
Why:
At the new rate compressors will tire more easily and may provide inadequate compressions
Change: not emphasized
Foreign Body Obstruction
Change:Intervention only applied to those with severe obstruction – (poor
air exchange, increased breathing difficulty, silent cough, cyanosis, inability to speak or breathe)
Why: not everyone requires intervention
Change:CPR instead of abdominal thrusts
Why:Previous system more complicated, CPR just as effective as abdominal thrusts
Changed from - intervention if even mild symptoms, abdominal thrusts and back blows
Foreign Body Obstruction, continued
Change:In an unresponsive person, every attempt to deliver breaths should start with looking in the mouth and removing object if seen. Blind finger sweeps should not be performed
Why:Blind finger sweeps can result in damage to mouth or throat or to
rescuer’s finger, and there is no evidence of effectiveness
Changed from - blind finger sweeps in adults
What hasn’t changed?
EMS Providers:
BLSChecking for responsePulse checkRescue breathing without chest compressionsHand placement for adult chest compressions Compression rateCompression depth Ages used for infant BLS recommendations
DefibrillationInitial dose for infants and children
NYS ProtocolsAdult Obstructed Airway
ALWAYS: Request ALS, do not delay transport, keep patient warm
If pt is conscious and can breathe, cough or speak:Do not interfere. Encourage coughing.
If unable to dislodge obstruction with coughing:Admin high flow O2, transport in sitting position,
If pt is conscious with signs of severe airway obstruction:Perform obstructed airway maneuvers
If airway obstruction persists or pt becomes unconscious:Begin CPR, transport
If airway obstruction is cleared and pt resumes breathing:Admin High flow O2, transport
Changed from -continue obstructed airway maneuvers to CPR
NYS ProtocolsPediatric Obstructed Airway
ALWAYS: Request ALS, do not delay transport, keep patient warm, don’t agitate child, transport
If pt is conscious and can breathe, cough or speak:Do not interfere, position of comfort, encourage
coughing. If conscious but unable to breath, cough, speak or cry:
Perform obstructed airway maneuvers If pt is unconscious or becomes unconscious & is not breathing:
Establish BLS airway, remove visible foreign body, CPR, If airway obstruction is cleared and/or establishment of chest rise:
Assess respiratory status, O2, assist respirations prn
Changed from - continue obstructed airway maneuvers to CPR
NYS ProtocolsAdult Respiratory Arrest/Failure
ALWAYS: Request ALS, do not delay transport, keep patient warm
Inadequate ventilatory status:OPA (or NPA) High Flow O2 with BVM Rate 10-12/min, each over 1 secondTidal Volume adequate to make chest rise
Changed from - without O2 700-1000ml over 2 seconds, or with O2 400-600ml over 1-2 seconds
NYS ProtocolsPediatric Respiratory Arrest/Failure
ALWAYS: Request ALS, do not delay transport, keep patient warm
Inadequate ventilatory status:
OPA (or NPA) High Flow O2 with BVM
Rate 12-20/min, each over 1 second
Tidal Volume adequate to make chest rise
Changed from - without O2 450-500ml over 2 seconds, or with O2 400-600ml over 1-2 seconds
NYS ProtocolsAdult & Pediatric Cardiac Arrest
ALWAYS: DNR?, Request ALS, do not delay transport
If apneic and pulseless: If unwitnessed or EMS arrival ≥ 4 minutes since arrest:
CPR (5 cycles/2 min) prior to AED. Compressions 15:2 (2 person) If witnessed or EMS arrival < 4 minutes since arrest:
AED first, then CPR prn, Compressions 15:2 (2 person) If secured advanced airway:
Respiratory rate 8-10/minute, no pause in compressions If one rescuer CPR compressions at 30:2
Changed from - old compression ratio, AED first always
NYS ProtocolsAdult & Pediatric Cardiac Arrest, continued
AEDMonophasic- All shocks at 360jBiphasic – All shocks at 120-200jPediatric – under age 8 use pediatric pads
After all shocks CPR for 5 cycles/2min without checking pulse, rhythm check and/or defib.
Pulse check after 5 cycles/2min or if pt appears to no longer be in cardiac arrest
Max of 3 shocks on scene before transport
Changed from - stacked shocks and joule settings, longer scene time
NYS ProtocolsEmergency Childbirth, Resuscitation and Stabilization of the Newborn
ALWAYS: Request ALS, do not delay transport
If newborn RR is absent or depressed (<30bpm):
ventilate with high flow O2 at 40-60bpm
If newborn’s HR <60 or does not increase above 60 bpm
after 30 seconds of assisted ventilations:
Add chest compressions
at rate of 100/min and
ratio of 30:2 for 1 rescuer, 15:2 for 2 rescuers
Changed from - RR 30-60, HR – does not increase