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OS 213: Human Disease and Treatment 3 (Circulation and Respiration) LEC 35: ADULT BASIC LIFE SUPPORT FOR HEALTH WORKERS

Exam 1 (MegaExam)| Dr. Paul Reganit | October 9, 2012

OUTLINE

INTRODUCTION

Objectives To increase awareness and knowledge of CPR as a life-saving

procedure for victims of sudden cardiac arrest To demonstrate the different steps and techniques of CPR

Burdern of CVS Diseases in the Philippines Heart diseases are the #1 cause of death in the Philippines (DOH

data as of 2004) Followed by vascular system disease, malignant neoplasm,

accidents, then pneumonias There has been a change in causes of mortality (initially due to

infectious diseases) now more due to lifestyle-related causes such as stress – an epidemiologic shift

Shift is thought to be from effective immunizations The middle class bears the double burden of disease o upper 10% of society have already transitioned to non-

communicable o the poor still at greatest risk for communicable diseases

Sudden Cardiac Death (SCD): A Health Burden Approximately 50% of deaths from cardiovascular diseases single largest categoric cause of natural death in the US, and

probably also in the Philippines most common mode of death in patients with coronary artery

disease

Sudden Cardiac Arrest an abrupt cessation of cardiac mechanical function which may be

reversible by a prompt intervention but will lead to death in its absence

The heart suddenly goes into very irregular fast ineffective contractions, the heart stops beating, the victim loses consciousness, and if untreated, dies.

It is unpredictable and can happen to anyone, anywhere at anytime

Risk increases with age (especially individuals 60 years old and above)

common in people with pre-existing heart disease o but may still strike people with no history of cardiac disease or

cardiac symptoms Rescue Breathing/CPR: Do what the patient isn’t o If not breathing, breathe for her

If sudden cardiac death occurs outside the hospital setting o cardiopulmonary resuscitation (CPR) must begin within 4-6

minutes o Advanced cardiac life support measures (ACLS) must begin

within 8 minutes, to avoid brain death Only 4-6 % of sudden cardiac arrest victims survive because

majority of those witnessing the arrest do not know how to perform CPR.

Almost 80% of out-of-hospital cardiac arrests occur at home and are witnessed by a family member.

Therefore: effective CPR done immediately after cardiac arrest can double a victim’s chance of survival o prompt recognition of the problem and swift action

(management) vs Sudden Cardiac Death: sudden irreversible cessation of all

biologic functions

CPR AND THE CHAIN OF SURVIVAL THE NEW CHAIN OF SURVIVAL: (MEMORIZE)

1. Early access (immediate recognition and activation) 2. Early CPR 3. Early defibrillation 4. Early advanced care 5. Integrated post-cardiac arrest care

First Link: Access A well-informed lay person is THE key in the early access link Recognition of signs of heart attack and respiratory failure Call for help immediately if needed Activate the Emergency Medical System (EMS)

Early Warning Signs Of Heart Attack Prolonged compressing pain or unusual discomfort in the center

of the chest Pain may radiate to shoulder, arm, neck or jaw, usually on the left

side Pain may be accompanied by sweating, nausea, vomiting and

shortness of breath

Early Warning Signs Of Respiratory Failure Unable to speak, breathe or cough Clutches neck (universal distress signal) Bluish color of skin and lips

Second Link: Early CPR Life saving technique for cardiac and respiratory arrest Rescue breathing and chest compressions For lay persons and medical personnel alike

CARDIOPULMONARY RESUSCITATION (CPR) What is CPR?

CPR = cardiopulmonary resuscitation Emergency procedure used when someone’s heart stops beating. Simple procedure that can be learned by anyone, and consists of a

manual technique using repetitive pressing to the chest and breathing into the person's airways that keeps enough oxygen and blood flowing to the brain

CPR requires no special medical skills and training is available for the ordinary person nationwide.

Why Is Early CPR Important? CPR is the best treatment for cardiac arrest until the arrival of an

automated external defibrillator (AED) and advanced cardiovascular (ACLS) care

Prevents ventricular fibrillation from deteriorating into asystole May increase the chance of defibrillation Contributes to the preservation of heart and brain function Significantly improves survival Prompt CPR is important: beyond 7 minutes with no CPR, you are

doomed to fail

How Does CPR Work? All the living cells of out body need a steady supply of oxygen to

keep us alive o Important organs of concern during acute CPR: lungs

(pulmonary), brain (cerebral), heart (cardiac) o A clarification regarding the importance of adrenals: by giving

oxygen perfusion to the adrenals, you can reactivate circulation of the catecholamines (Norepinephrine and Epinephrine); but in CPR, your immediate target organ includes the lungs but not necessarily the adrenals

CPR works because you can breathe air into the victim’s lungs to provide oxygen into the blood.

When you press on the chest, you move the oxygen-carrying blood through the body.

I. Introduction II. CPR and the Chain of Survival III. Cardiopulmonary resuscitation (CPR) IV. Techniques and Steps in CPR V. Hands-Only CPR VI. Summary for 2010 Guidelines

OS 213 LEC 35: BASIC LIFE SUPPORT


When Will You Do CPR? As soon as possible! Brain cells begin to die after 4-6 minutes without oxygen

Who May Learn CPR? CPR is an easy and life saving procedure and can be learned by

anyone One does not need to be a doctor to learn how to do CPR

TECHNIQUES AND STEPS IN CPR Witnessed Cardiac Arrest

*sir: “Do it to someone you’ve seen alive and go into cardiac arrest (because you know the type of arrest)” **Block B trans: “What to do when you find an unconscious person on the ground” 1. Check area safety Survey the scene See if the scene is safe to do CPR Get an Idea of what happened

2. Check Unresponsiveness Tap or gently shake the victim Rescuer shouts: “Are you okay”?” Quick check for normal breathing If the victim is unconscious, rescuer calls for help

3. Call for Help: ambulance, emergency services, doctor Rescuer activates the emergency medical services Get AED/Defibrillator Non-responsive, no normal breathing = get a defibrillator!

Check For Consciousness *from Block B trans only, not mentioned in lecture 1. Pulse Check Palpate for carotid pulse within 10 seconds At the same time check for breathing For trained health care providers only!!!

2. Mouth To Mouth Breathing Begin if there is a DEFINITE PULSE, but NO BREATHING Give one breath every 5-6 seconds (about 12 breaths per minute) Recheck pulse every 2 minutes

Mouth to Mouth Breathing and Pulse Check: Deemphasized in the new guidelines For trained healthcare providers only As short and quick as possible Pulse check not more than 10 seconds If unsure, proceed directly to chest compressions

After Determining Unconsiousness

PROCEED TO C-A-B Compression: Do chest compressions first Airway: does the victim have an open airway (air passage that

allow the victim to breathe)? Breathing: is the victim breathing

START CPR (C-A-B)

COMPRESSION To assist circulation After determining unconsciousness and calling for help, proceed

immediately to do chest compressions Procedure: 1. Kneel facing the victim’s chest 2. Place the heel of your hand on the center of the victim’s chest.

Put your other hand on top of the first with our fingers interlaced. o Note: Avoid the xiphoid cartilage!

3. Place the heel of one hand on the sternum in the center of the chest between the nipples then place the heel of the second hand on top of the first so that the hands are overlapped and parallel.

4. Align shoulders over hands with elbows locked and arms straight. 5. Compress down and release pressure smoothly, keeping hand

contact with chest at all times.

Figure 1. Procedure for doing proper chest compression.

Caveats: (and important things to remember) Give chest compressions at a rate of AT LEAST 100/minute Compress bone at least 2 inches deep Compress 30 times initially (takes around 15-18 seconds) Count aloud “1,2 3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,

18,19,20,21,22,23,24,25,26,27,28,29, and ONE!” Minimize interruptions Allow the chest to return to its normal position Slogan: Push hard, push fast (AHA); Modified by sir to: “Push hard,

push fast to reach your goal you must!” (from block B) One may choose which hand to put on chest and which one to put

over it, but sir uses dominant hand on chest

AIRWAY Open the airway by using the Head Tilt/Chin Lift Method

(MEMORIZE) o Place one hand on the victim’s forehead o Place fingers of the other hand under the bony part of the

lower jaw near the chin o Tilt head and lift jaw – avoid closing the victim’s mouth o This maneuver prevents airway obstruction by the epiglottis

If you are highly suspecting cervical spine injury, do Jaw Thrust Method instead (sir: Just lift jaw towards you, don’t lift the head)

Figure 2. The Head-tilt or chin-lift maneuver

BREATHING Procedure:

1. Give 2 one-second breaths 2. Maintain airway 3. Pinch nose shut 4. Open your mouth wide, take a normal breath, and make a tight

seal around outside of victim’s mouth. 5. Give 2 full breaths (1 second per breath) 6. Observe chest rise and fall; listen and feel for escaping air 7. Repeat cycles of 30 compressions and 2 breaths (this will take

about 2 minutes= 5 cycles!)

Pulse Check Recheck pulse every 2 minutes (Equivalent to 5 cycles CPR) Very brief pulse check – should take less than 10 seconds (at

the same time check for normal breathing) In case there is any doubt about the presence or absence of

pulse continue chest compressions This is for trained healthcare providers only

Continue CPR until Help arrives (emergency services, ambulance, doctor, AED) Person is revived

If the Victim is Breathing, place him/her in the Recovery Position Maintain open airway and position the victim

The unresponsive victim with spontaneous respirations should be placed in the recovery position if no cervical trauma is suspected

Placement in this position consists of rolling the victim onto his other side to help protect the airway



Figure 3. The recovery position.

SUMMARY OF STEPS IN CPR • Survey the scene. • Check responsiveness – Hey, are you ok? • Call for help! Activate EMS • [Quick check pulse within 10 secs] • C (Compression): 30x; 100/min; 2 inches deep; push hard and fast • A (Airway): head tilt chin lift • B (Breathing): 2 breaths (1 second/breath) • Cycle – 30:2 compression-ventilation • [Quick check pulse every 2 mins] • Continue until: EMS arrives, patient is revived/has signs of life

Indications Not trained Do not know mouth to mouth ventilation Not sure about mouth to mouth ventilation Hesitant to do mouth to mouth ventilation Do not want to do mouth to mouth ventilation You can do HANDS ONLY CPR: It only takes two steps to save a

life: 1. Call for help 2. Do chest compressions

Hands only CPR should only be used for adult victims who have suddenly collapsed or become unresponsive

Recommendations All victims of cardiac arrest should receive high-quality chest

compressions When an adult suddenly collapses, all bystanders should activate

their community EMS and provide high quality chest compression, minimizing interruptions (Class I)

If not trained in CPR, provide hands only CPR (Class IIa) until o AED arrives o EMS providers take over care of the victim

If trained in CPR, provide either conventional CPR using 30:2 compression-to-ventilation ratio or hands only CPR

SUMMARY OF 2010 BLS GUIDELINES

Figure 4. Simplified Adult BLS Algorithm (Summary)

Key Changes CABV instead of ABC Compress first NO more Look, Listen and Feel Harder at least 2 inches compression Faster at least 100 per minute compression Deemphasize pulse checks o For trained healthcare providers not more than 10 secs

Check for normal breathing together with check for unresponsiveness

Hands only CPR for the untrained lay rescuer

Important Points There are no mistakes when you perform CPR o The only harm is to delay responding o Start chest compressions now viewed as the most effective

procedures o All victims in cardiac arrest need chest compressions

Don’t stop pushing o Keep pushing as long as you can. Push until AED is in place and

ready to analyze the heart. When it is time to do mouth to mouth, do it quick and get right back on the chest

80-90% of cardiac emergencies occur at home Training is now simpler and more accessible (reduced steps and

simplified) Being trained to do CPR can save a loved one Effective CPR done immediately after cardiac arrest can double a

victim’s chance of survival END OF TRANSCRIPTION

Leonard: “The basic problem in human relationships is that of freedom. We call people bad because we do not do what we want them to do. We judge them for being themselves, for fulfilling their wishes. We withdraw love from them when they do what they feel is best for them, but it is not what we want them to do. We do the same thing with God. We feel entitled to God’s favor, as if He has to do what we want Him to do. How do you feel when someone asks you for a favor but does not give you a free choice? This childish entitlement gets many people dissatisfied with God the same way that they are dissatisfied with others in their lives.” – Henry Cloud No judgment, no controlling, only grace. =) Jasper: Last trans of the sem. Ambilis at ang daming transes haha. Hello nalang sa mga palagi kong ginigreet kayo parin naman ang iggreet ko tinatamad lang ako magisa isa. Haha. :p Patti:

HANDS-ONLY CPR



Appendix I. Summary of Key BLS Components for Adults and Children (CHECK FORMAT OF TABLE CAPS/TEXT PLEASE)

Maneuvers Adults Children

RECOGNITION UNRESPONSIVE

No breathing, not breathing normally (eg. only gasping)

No breathing or only gasping

CPR Sequence CAB CAB

Compression Rate

At least 100/min

Compression Depth

At least 2 inches (5 cm)

At least 1/3 AP depth

Chest wall Recoil

Allow complete recoil between compressions HCP compressors rotate 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 suspects trauma: jaw thrust)

Compression-Ventilation ratio

30 : 2 (one or 2 rescuers)

30:2(single rescuer); 15:2(2 rescuer)

Ventilations: when rescuer untrained or trained and not proficient

Compressions only

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 breath Visible chest rise

DEFIBRILLATION ( AED )

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

Appendix II. BLS Flowchart

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