Cardiopulmonary Resuscitation

Basic Life SupportA set of emergency procedures involving the

immediate recognition of signs of sudden cardiac arrest (SCA), heart attack, stroke, and foreign-body airway obstruction (FBAO); and the application of external chest compressions, rescue breathing, abdominal thrusts, as well as the defibrillation with the use of an AED to maintain life or until advanced life support is available.

Cardiopulmonary ResuscitationSeries of steps to help you save one’s life by

manually providing blood flow to the heart, brain and lungs until further medical attention can be obtained

Provided through quality chest compressions that is uninterrupted as possible and only for the shortest time needed

NOTE: CPR itself does not completely save a life it does prolong it for a short period of time

CHAIN OF SURVIVALA series of critical interventions which need to

be performed on a patient for him or her to have a chance of surviving respiratory or cardiac arrest.

Chain of Survival2010 Guidelines Pediatric Chain of

Survival

CPR Broken downCARDIO = heart

Muscle that contracts/expands more than 60-100 beats per minute

Pumps oxygen-rich blood from the lungs out to the rest of the body

CPR Broken downPULMONARY = lungs

Breathe about 15-25 times per minuteBrings oxygen into our lungs and gets rid of

carbon dioxideBreathe in 21% oxygen and breathe out 16-

18% oxygen

CPR Broken downRESUSCITATE = Revive

Mimics the function of the heart and lungs Prevents brain damage

CPR slows down deterioration of patient’s chance of survival from 7-10% per minute to 3-4%

Immediate RecognitionUnresponsiveness and absence of breathing

or normal breathing should prompt the rescuer to call for emergency assistance

Pulse checking is often unreliable even for trained healthcare professionals. Pulse checking should not take more than 10 seconds .

When there are more than one rescuer, one should start CPR immediately while the other calls for help

If alone one should call for help first before providing CPR except for infants and children

What is CPR?CARDIOPULMONARY RESUSCITATION =

Reviving the heart and lungs Rescue breathing + chest compression

Effective if commenced within 6 mins after the blood stops flowing

When effective can provide only about 30% of the “normal” heart output

RESCUE BREATHING (RB)Exhale air from your lungs into the victim’s

mouthBreathe into a victim’s mouth and have their

nose closed, and see the chest rise

CHEST COMPRESSIONManually compress the heart by pressing the

chestBy compressing and allowing the heart to

expand, the blood flows through it

WHEN TO START CPRAll victims of cardiac arrest should receive CPR

unless:• Patient has a valid DNAR (Do Not Attempt

Resuscitation)• Patient has signs of irreversible death (Rigor

Mortis, Decapitation, Dependent Lividity)• No physiological benefit can be expected because

functions have deteriorated (terminally ill)• Gestation of < 23 weeks or birth weight of <400g,

anencephaly• Attempts to perform CPR would place the rescuer

at risk of physical injury

RULES IN GIVING EMERGENCY CARE

WHAT TO DO:• Do obtain consent when possible• Do remember to identify yourself to the victim• Do provide comfort and emotional support• Be calm and direct as possible• Keep onlookers away from the injured person• Do loosen tight clothing

1- SCENE SURVEYOBTAIN AS MUCH INFORMATION AS

POSSIBLE: • Is the scene safe?• What happened?• How many people are injured?• Are there any bystanders who can help?• Identify yourself as a trained CPR provider• Get consent to give care

2 – CHECK LEVEL OF RESPONSIVENESS

Tap shoulders and shout “ are you ok?” to get a response.

Someone who does not respond and lack normal breathing can be assumed unresponsive.

3 – CALL FOR HELP• What happened?• Exact location?• Number of persons injured?• Extent of injury/illness and first aid

given?• Person who activated medical

assistance must identify him/herself and drop the phone last.

C - CIRCULATION• Check for carotid pulse for not more than 10

secs.• Negative pulse = start compression• Perform 30 compressions

C – CHEST COMPRESSION• Loosen tight clothing• Place palm of one hand between the nipple line

and over the breast bone (sternum), 2 fingers above the xyphoid process

• Place the other hand over the first and interlock fingers

• Your should be on your knees squarely at the patient’s side

• Lean slightly over the patient keeping your elbows locked and back straight.

Compress at the depth of at least 2 inches and release pressure allowing the chest to recoil

PUSH HARD, PUSH FAST at the rate of 100 compressions/minute

RATIO: 30 compressions : 2 rescue breaths

A - AIRWAY• Ensure open airway by performing the

HEAD TILT, CHIN-LIFT• Hyperextend the neck to ensure adequate passage of air\• Check and look for any obstructions. If you can’t see it, do not attempt to remove it

WHAT NOW?REPEAT STEPS C, A, B.

Reassess the patient every 5 cycles

WHEN TO STOP CPRSpontaneous signs of life are restored (effective

or normal breathing and circulation)Turnover to medical services or properly trained

personnel (such as EMTs, physicians)Operator is exhaustedPhysicians assumes responsibilityScene becomes unsafe

WHEN SIGNS OF LIFE APPEAR

A patient who has circulation but does not breath adequately should be given RESCUE BREATHING

1 breath every 5 seconds 24 times (cycles)Reassess pulse after 24 cycles.

A patient who has circulation and is adequately breather should be positioned to the RECOVERY POSITION

WHEN SIGNS OF LIFE APPEAR

RECOVERY POSITION: * Lift left arm next to head, bend right leg up

and pull them towards you. * this positions guards the patient from vomit

and secretions

AUTOMATED EXTERNAL DEFIBRILLATOR

• A device that provides electrical shocks to the body to restart the heart.

• This provides the rescue the advantage to provide more advanced care therefore increasing the patient’s chance of survival

The Universal AED STEP 1: POWER ON the

AED. STEP 2: Attach electrode

pads. STEP 3: Analyze the

rhythm. STEP 4: Clear the victim

and press the

SHOCK button.

Component Adults Children InfantsRecognition Unresponsive (for all ages)

No breathing, not breathing normally (e.g., only gasping)

No breathing or only gasping

No pulse palpated within 10 seconds (HCP Only) CPR Sequence CAB CAB CABCompression Rate At least 100/minCompression Depth At least 2’ (5 cm) At least 1/3 AP depth,

about 2’ (5 cm)At least 1/3 AP depth, about 1½’ (4 cm)

Chest Wall Recoil Allow complete recoil between compressions. HCPs rotate compressors every 2 minutes.

Compression Interruptions

Minimize interruptions in chest compressions. Attempt to limit interruptions to less than 10 seconds.

Airway Head tilt-chin lift (HCP suspected trauma: jaw thrust)Compression to ventilation ratio (until advanced airway placed)

30:2 (1 or 2 rescuers) 30:2 for single rescuer15:2 for 2 HCP rescuers

Ventilations: When rescuer untrained or not proficient

Compressions only

Ventilations with advanced airway (HCP)

1 breath every 6-8 seconds (8-10 breaths/min)Asynchronous with chest compressions

About 1 second per breathVisible chest rise

Defibrillation Attach and use AED as soon as available. Minimize interruptions in chest compressions before and after shock, resume

CPR beginning with compressions immediately after each shock.

FOREIGN BODY AIRWAY OBSTRUCTION (FBAO)

OBSTRUCTED AIRWAY• An event most likely

witnessed• Universal Choking Sign:

hands around the neck• SIGNS OF COMPLETELY

OBSTRUCTED AIRWAY:• Making high pitched

wheezing noises• Inability to speak or move

any air

HEIMLICH MANUEVER• Discovered by Dr. Henry

Heimlich• Also known as the

abdominal thrust• Not for infants < 1 y.o.

HEIMLICH MANUEVER• Procedure:• Ask the patient “Are you choking?”• If they are unable to speak, stand behind them,

place a closed fist (thumb first) above the belly button and place the other hand over the fist

• Deliver thrusts inward and then upward• Do this until object is expelled or patient starts to

become unresponsive• If they lose consciousness, assist them gently to the

floor and protect their head.

HEIMLICH MANUEVER

Obstructed Airway:Unresponsive Patient

Place patient on their backSTEP 1: Start CPR with 30 chest

compressions. STEP 2: Open mouth and inspect for

obstruction. If the object is visible, remove it with your finger.Do not attempt to remove the obstruction if you can’t see it!

Obstructed Airway:Unresponsive Patient

STEP 3: Attempt first ventilation. If chest doesn’t rise, reposition and give second ventilation.

Repeat the Steps 1-3 in an attempt to relieve obstruction.

If the obstruction persists, continue this modified CPR sequence until help arrives.

Pediatric FBAOChild FBAO

Kneel to be level with the child’s height.Just as in Adult FBAO

Infant FBAOFive chest thrusts, as in CPRFive back slaps between the shoulder blades

1 - Scene Survey Scene Safety Identify and Consent

2 - Check Level Of Consciousness

Tap Shout and Chest Rub3 - Call for help (AED if

available)C - Circulation

Pulse check (not more than 10 secs) – negative=compression

A - Airway Head-tilt, chin-lift, Check

for obstructionB - Breathing

adult = 2 blows: 5secs: 24 cycles

Infant = 2 blows: 3 secs: 40 cycles

RESCUE BREATHING

ADULT

Blow, 1,1002,1003, 1001….. 24

INFANT

Blow, 1,1001… 40

THANK YOU!!!

PARAÑAQUE DRRMO

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