CPR CourseEmergency medicine department

OBJECTIVES

• At the end of this course

participants should be able to demonstrate:

– How to assess the collapsed victim.– How to perform chest compression and use AED.– How to approach to the pulseless arrest patients.

Basic Life Support

BACKGROUND

• Approximately 700,000 cardiac arrests per year in Europe

• Survival to hospital discharge presently approximately 5-10%

• Bystander CPR vital intervention before arrival of emergency services

• Early resuscitation and prompt defibrillation (within 1-2 minutes) can result in >60% survival

CHAIN OF SURVIVAL

Approach safely

Check pulse

Open airway

2 rescue breaths

Check response

Call 115 - AED

30 chest compressions

Approach safely

AED

Check pulse

30 chest compressions

Open airway

2 rescue breaths

Check response

Call 115

APPROACH SAFELY!

Scene

Rescuer

Victim

Bystanders

Approach safely

Call 115

AED

Check pulse

30 chest compressions

Open airway

Check response

2 rescue breaths

CHECK RESPONSE

Approach safely

AED

Check pulse

30 chest compressions

Open airway

Check response

Call 115

2 rescue breaths

Shake shoulders gently

Ask “Are you all right?”

If he responds:• Leave as you find him.

• Find out what is wrong.

• Reassess regularly.

CHECK RESPONSE

If he dose not respond:• Check breathing quickly.

• No or agonal breathing means cardiac arrest.

CHECK RESPONSE

AGONAL BREATHING

• Occurs shortly after the heart stops

in up to 40% of cardiac arrests

• Described as barely, heavy, noisy or gasping breathing

• Recognise as a sign of cardiac arrest

SHOUT FOR HELP – CALL 115

Approach safely

AED

30 chest compressions

Check response

Call 115

Check pulse

Open airway

2 rescue breaths

AED

Approach safely

AED

30 chest compressions

2 rescue breath

Check response

Call 115

Check pulse

Open airway

CHECK PULSE

Approach safely

AED

30 chest compressions

Open airway

2 rescue breath

Check response

Call 115

Check pulse

10 seconds

• The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally.

CHECK PULSE

Approach safely

AED

Check pulse

30 chest compressions

Open airway

Check response

Call 115

2 rescue breaths

CHEST COMPRESSIONS

• Place the heel of one hand in the centre of the chest

• Place other hand on top • Interlock fingers• Compress the chest

– Rate 100 per min

– Depth 5 cm– Equal compression : relaxation

• When possible change CPR operator every 2 min

CHEST COMPRESSIONS

OPEN AIRWAY

Approach safely

AED

30 chest compressions

Open airway

2 rescue breaths

Check response

Call 115

Check pulse

RESCUE BREATHS

Approach safely

AED

Check pulse

30 chest compressions

Open airway

2 rescue breaths

Check response

Call 115

RESCUE BREATHS

• Pinch the nose• Take a normal breath• Place lips over mouth• Blow until the chest rises• Avoid excessive ventilation• Take about 1 second• Allow chest to fall• Repeat

JAW THRUST (IN TRAUMATIC PATIENT)

CONTINUE CPR

30 2

IF YOU HAVE NOT TENDENCY TO BREATHE

Chest compression only

• One rescuer: 30 compressions 2 breaths

• Two rescuer: 15 compressions 2 breaths

PEDIATRIC BLS

METHODS

Child 1-8 Years Infant < 1 Year

BREATHING

KEY CHANGES

• Recognition of cardiac arrest based on assessing

unresponsiveness and absence of normal breathing.

KEY CHANGES

• Recognition of cardiac arrest based on assessing

unresponsiveness and absence of normal breathing.

• Look, listen and feel removed from the algorithm.

KEY CHANGES

• Recognition of cardiac arrest based on assessing

unresponsiveness and absence of normal breathing.

• Look, listen and feel removed from the algorithm.

• Sequences change to CAB rather than ABC.

KEY CHANGES

• Recognition of cardiac arrest based on assessing

unresponsiveness and absence of normal breathing.

• Look, listen and feel removed from the algorithm.

• Sequences change to CAB rather than ABC.

• High quality CPR.

KEY CHANGES

• Recognition of cardiac arrest based on assessing

unresponsiveness and absence of normal breathing.

• Look, listen and feel removed from the algorithm.

• Sequences change to CAB rather than ABC.

• High quality CPR.

• Continued de-emphasis on pulse check for health care

providers.

ANY QUESTIONS?

DEFIBRILLATION

AED

Approach safely

Check response

Shout for help

Call 115

Attach AED

Follow voice prompts

Start CPR after shock

SWITCH ON AED

• Some AEDs will automatically switch themselves on when the lid is opened

ATTACH PADS TO CASUALTY’S BARE CHEST

ANALYSING RHYTHM DO NOT TOUCH VICTIM

SHOCK INDICATED

• Stand clear• Deliver shock

SHOCK DELIVEREDFOLLOW AED INSTRUCTIONS

30 2

NO SHOCK ADVISEDFOLLOW AED INSTRUCTIONS

30 2

IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN RECOVERY POSITION

Approach safely

Check response

Shout for help

Call 115 - AED

Check pulse

30 chest compressions

Open airway

2 rescue breaths

Approach safely

Check response

Shout for help

Call 115

AED

Attach AED

Follow voice prompts

Start CPR after shock

ANY QUESTIONS?

PULSELESS ARREST

IV Line Central IV Line Peripheral IV Line

• Lidocaine, Epinephrine, Naloxone, Vasopressin

• Dose given by the endotracheal route is 2 to

2.5 times the recommended IV dose.

• Providers should dilute the recommended dose

in 5 to10 mL of water or normal saline.

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Endotracheal route

Rhythm In Monitor

PEA Or Asystole VF Or VT

Asystole Or PEA:

• Continue Chest Compression & Ventilation

• Epinephrine 1 mg q 3-5 min

No Atropine

An Important Point

VF Or Pulseless VT:

Monophasic: 360 J DC Shock Asynch.

Biphasic: 120 to 200 J DC Shock Asynch.

Correct position for electrode/paddle placement

What Would You do Then?

Important Point

After DC shock

Do Not

Look At Monitor

&

Continue CPR

For 2 min.

VT Or VF

DC Shock

DC Shock

+Epinephrine

DC Shock+

Epinephrine+

Amiodarone

2 min

2 min

VF Or VT:• Epinephrine 1 mg q 3-5 min• Amiodarone 300 mg stat

Amiodarone Should Be Pushed In CPR

It May Be Repeated After 15 Minutes

Rhythm May Change

PEA Or

Asystole

VFOr

VTRhythm Changes

Do Not Forget

5H

HypoxiaHypovolemia

H+Hyper & Hypo kalemia

Hypothermia

5T

ThrombusTension Pneumothorax

TamponadeTraumaToxins

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PEDIATRIC ACLS

• First shock: 2 J/kg

• 2th and 3th shocks: 4 J/kg

• Epinephrine: 0.01 mg/kg

• Amiodarone: 5 mg/kg

ANY QUESTIONS?

Thanks