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CARDIOPULMONARY RESUSCITATION

definition

Cardiopulmonary resuscitation describe a combined technique of mouth-to-mouth ventilation and closed cardiac chest compressions in a pulseless patient

History

CPR is a term that was first used in the early 1960s

Specific techniques have been revised every 5 to 6 years.

The most recent guidelines were released in October 2010

Chain of Survival3

Simplified Universal Adult BLS Algorithm

729 American Heart Association

CPR

Bsic life support Advanced cardiac life support

Elements of BLS

Noninvasive emergency lifesaving care

For any patient having cardiac arrest, the most important steps are

(1) immediate recognition of unresponsiveness, (2) checking for lack of breathing or lack of normal

breathing (3) activating an emergency response system and

retrieving an automated external defibrillator (AED), (4) checking for a pulse (no more than 10 seconds),

and (5) starting cycles of 30 chest compressions followed

by 2 breaths

Responsiveness

Prior to approaching a victim, the rescuer should make sure that the scene is safe; then the victim is assessed for responsiveness by tapping or questioning (“Are you OK?”).

A quick check for presence of breathing or lack of normal breathing should

occur simultaneously then the emergency response system should be activated, and an AED should be quickly retrieved.

Circulation

The health care provider should take no more than 10 seconds to check for a definitive pulse either at the carotid or femoral artery

IF the patient has No pulse, No signs of life, Or the rescuer is unsure,

THEN compressions should be started immediately

METHOD

The heel of the hand should be placed longitudinally on the lower half of the sternum, between the nipples

The sternum should be depressed at least 5 cm (2 inches) at a rate of at least 100 compressions per minute.

Complete chest recoil is necessary to allow for venous return and is important for effective CPR

The pattern should be 30 compressions to 2 breaths (30:2 equals 1 cycle of CPR), regardless of whether one or two rescuers are present.

How CPR Works717

“C-A-B” rather than “A-B-C”

New for 2010 Initiate chest

compressions before ventilations.

Why Change? Beginning CPR with

30 compressions rather than 2 ventilations leads to a shorter delay to first compression11-13

providing vital blood flow to the heart and brain.

How can CPR be effective without rescue breathing?

because the oxygen level in the blood remains adequate for the first several minutes after cardiac arrest.4

Animal models suggest gasping do allow for some oxygenation and carbon dioxide (CO2)elimination.9-10

AIR WAY opening

Opening of the airway can be achieved by

Simple head tilt–chin lift technique

Oral or nasal airway Tracheal intubation Laryngeal mask

Breathing

chest compression-alone CPR is not inferior to traditional compression-ventilation CPR, health care providers are still expected to provide assisted ventilation

A lone rescuer, if not an expert in airway management, should not use a bag-mask for ventilation, but should use mouth-to-mouth or mouth-to-mask

Assessing ABCs (8 of 18)

NOTE

Care should be taken to avoid rapid or forceful breaths

Delivered tidal volumes are given over 1 second and should produce visible chest rise.

Delivered tidal volumes are given over 1 second and should produce visible chest rise

A lower than normal minute ventilation (cardiac output is much less than normal) should be the goal (CO2 and brain vasoconstriction and delay neurologic recovery.)

Mouth to Mouth Barrier Devices

Assessing ABCs (12 of 18)

Defibrillation

A defibrillator should be attached to the patient as soon as possible.

Proper electrode pad placement on the chest wall should be to the right of the upper sternal border below the clavicle and to the left of the nipple with the center in the midaxillary line

Alternative locations include anteriorposterior, anterior-left infrascapular, and anterior-right infrascapular. Right anterior axillary to left anterior axillary is not recommended(718)

ENERGY USED FOR DEFIBRILLATION amount of energy (joules) delivered is dependent

on type of defibrillator used Two major defibrillator types

monophasic : deliver a unidirectional energy charge Biphasic : deliver bidirectional energy charge more

successful in terminating ventricular tachycardia (VT) and ventricular fibrillation(VF) In addition, biphasic waveform shocks require less energy than traditional monophasic waveform shocks (120 to 200 J versus 360 J, respectively) and may therefore cause less myocardial damage.

Choking The tongue is the most common

obstruction in the unconscious victim (head tilt- chin lift)

Vomit Foreign body

Balloons Foods

Swelling (allergic reactions/ irritants)

Spasm (water is inhaled suddenly)

Conscious Choking (Adult Foreign Body Airway Obstruction)

Give 5 abdominal thrusts (Heimlich maneuver) Place fist just above

the umbilicus (normal size)

Give 5 upward and inward thrusts Pregnant or obese? 5 chest

thrusts Fists on sternum If unsuccessful, support chest with one

hand and give back blows with the other

If Victim Becomes Unconscious After Giving Thrusts

Call 115 Try to support victim with

your knees while lowering victim to the floor

Assess Begin CPR After chest compressions,

check for object before giving breaths breaths

Choking: Conscious Infants Position with

head downward 5 back blows

(check for expelled object)

5 chest thrusts (check for expelled object)

Repeat

Tracheal intubation

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