cpr skil blok27
TRANSCRIPT
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CPR SKILL
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SILVIA TRIRATNA
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Learning Objective
Upon completion of this training program, astudent will be able to Describe how to recognize and provide treatment for sudden cardiac
arrest.
Explain how to perform effective chest compressions for adults,children, and infants.
Describe how to perform effective rescue breaths using a CPR maskfor adults, children, and infants.
Describe how to perform effective rescue breaths using a bag-maskdevice.
Describe the steps of the primary assessment for an unresponsivepatient.
Describe the steps of performing CPR as a single provider for adults,children, and infantsIdentify basic skills in cardiopulmonary arrestresuscitation
Demonstrate the basic psychomotor skills in cardiopulmonary arrest
resuscitation 2
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SKILL Objective
Correctly demonstrate how to perform externalchest compressions for adults, children, andinfants.
Correctly demonstrate how to perform rescuebreaths using a CPR mask.
Correctly demonstrate how to perform rescuebreaths using a bag-mask device.
Correctly perform a primary assessment for anunresponsive patient.
Correctly demonstrate CPR as a single provider
for adults, children, and infants.3
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Pediatric Chain of Survival
Berg, M. D. et al. Circulation 2010;122:S862-S875
prevention Early CPR EMS Rapid PALS Intergrated
Post-cardiacArrest care
http://circ.ahajournals.org/content/vol122/18_suppl_3/images/large/zhc1431087590001.jpeghttp://circ.ahajournals.org/content/vol122/18_suppl_3/images/large/zhc1431087590001.jpeghttp://circ.ahajournals.org/content/vol122/18_suppl_3/images/large/zhc1431087590001.jpeghttp://circ.ahajournals.org/content/vol122/18_suppl_3/images/large/zhc1431087590001.jpeg -
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Not SICK
SICK
Stablepotential unstable.
UnStable Level 1 Resuscitative Level 2 Emergent
Level 3 Urgent
Level 4 Less urgent
Level 5 Non-urgent
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Diagnosis of cardiac arrest
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Loss
of time !!!
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Symptoms of cardiac arrest
Absence of pulse on centralarteries
a pathognomonic symptom
Respiration arrest
may be in 30 seconds after cardiacarrest
Enlargement of pupils
may be in 90 seconds after cardiacarrest
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Primary lesion of cardiac muscle leading to the
progressive decline of contractility, conductivitydisorders, mechanical factors
CARDIAC
EXTRA CARDIAC
all cases
accompanied with
hypoxia
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CPR A technique combining artificial
ventilation and chest compressionsdesigned to perfuse vital organs orrestore circulation in cardiacstandstill.
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CPR Indications should be performed immediately on
any person who has becomeunconscious and is found to bepulseless
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For the purpose of resuscitation,children are divided into 3 age
groups:
Infants: under one year of age
Small children: 1 to 8 years of age
Older children/adults: 9 years and over
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American Heart Association(AHA) guidelines 2010
standard for CPR comprises 3 steps:
chest compressions, airway, and
breathing
(CAB),
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performed by
healthcare
providers and
not byrescuers
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Preparation
1. Position a child on a hard surface.
2. Position a neonate or infant on a
hard surface or on the forearm of therescuer with the hand supporting thehead.
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Determine Responsiveness
Gently tap on shoulder and speakloudly.
If responsive, place in position ofcomfort
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20/76Copyright 2000 American Heart Association
Circulation 2000;102:253I--290I-
Brachial pulse check in infant
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Circulation 2000;102:253I--290I-
Carotid pulse check in child
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Circulation, Circulation,Circulation
Push hard
Push fast
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High quality CPR
Chest compressions ofappropriate rate anddepth.
"Push fast": push at a rate of at least 100compressions per minute.
"Push hard": push with sufficient force todepress the chest (at least 1/3 of the AP diameterof the chest or approximately 1 in. = 4 cm ininfants and approximately 2 in. = 5 cm inchildren)
allowing complete recoil of the chest after eachcompression
minimizing interruptions in compressions
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High quality CPR Effective PALS
the cornerstone of asystem of care that canoptimize outcomes
beyond return ofspontaneous circulation(ROSC).
Return to a prior qualityof life and functionalstate of health is theultimate goal of aresuscitation system of
care.
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INFANTCPR
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Infant CPR
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Place infant on firmsurface and maintainairway.
Place two fingers in themiddle of the sternum.
Use two fingers to
compress the chestabout 1" at a rate ofleast 100/min
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Slide 29
CPR InfantFinger/Thumb
position:lower 1/2 of the sternum
Compression depth:
1/3 of the depth of the chest
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Allow sternum toreturn briefly to itsnormal positionbetween compressions.
Coordinate rapidcompressions andventilations in a15:2 or 30 :2 ratio.
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CHILDCPR
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Circulation 2000;102:253I--290I-
One-hand chest compressiontechnique in child
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After eachcompression allow the
chest to recoil fully
because complete
chest reexpansionimproves blood flow
into the heart
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should be performed 5 times - 30compressions and 2 breaths
check the victim's artery for pulse(for no longer than 10 seconds) andother signs of consciousness.
If you not feel a pulse within 10
seconds, you should begin cycles ofchest compressions and ventilations.
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Minimize interruptions in compressions
Avoid excessive ventilation
Rotate compressor every 2 minutes If no advanced airway, 15:2
compressionventilation ratio.
If advanced airway, 8 -10 breaths perminute with continuous chestcompressions
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Drug Therapy
Epinephrine IO/IV Dose:
0.01 mg/kg (0.1 mL/kg of 1:10,000concentration). Repeat every 2- 3
minutes.
If no IO/IV access, may giveendotracheal dose: 0.1 mg/kg (0.1
mL/kg of 1:1,000 concentration).
Amiodarone IO/IV Dose:
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Advanced Airway
Endotracheal intubation orsupraglottic advanced airway
Waveform capnography orcapnometry to confirm and monitorET tube placement.
Once advanced airway in place give 1
breath every 3- 6 seconds (10 -20breaths per minute)
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AIRWAY
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Slide 57
Airway Opening ManoeuvresChin lift/head tilt
InfantsNeutral head position
with chin lift
Smaller children
Sniffing position
with chin lift
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Slide 58
Airway Opening ManoeuvresChin lift/head tilt
Older children/adultsBackward head tilt
with pistol grip
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Slide 61
Airway Opening ManoeuvresJaw thrust
Jaw thrust
Use when concerned re
cervical spine injuryMay also facilitate
bag and mask
ventilation
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Bag to Mask Ventilation
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Monitor the Effectiveness of
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Monitor the Effectiveness of
Ventilation
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Visible chest rise with each breath.
Oxygen saturation.
Heart rate. Blood pressure.
Distal air entry.
Patient response
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cpr
Any question ?
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Check for pulsE
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