lecture-basic cpr

8/7/2019 lecture-Basic CPR

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http://en.wikipedia.org/wiki/File:Picture_of_old_resus_methods.jpg

http://en.wikipedia.org/wiki/File:Picture_of_old_resus_methods.jpg



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James

Jude Guy Knickerbocker Peter Safar

1962 training video

promoted artificial respiration combined withchest compressions as a key part of

resuscitation following cardiac arrest

http://en.wikipedia.org/w/index.php?title=James_Jude&action=edit&redlink=1


http://en.wikipedia.org/w/index.php?title=Guy_Knickerbocker&action=edit&redlink=1

http://en.wikipedia.org/wiki/Peter_Safar

http://en.wikipedia.org/wiki/Cardiac_arrest


http://en.wikipedia.org/wiki/Peter_Safar







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Technique of CPR was originally developed

First effort at testing the technique was

performed on a dog by Redding, Safar and

JW Perason

ABC of resuscitationin 1957



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One is cautioned to onlyperform CPR onunconscious animals to

avoid the risk of being bittenand that animals, depending on species, have a lowerbone density than humans,

causing bones to becomeweakened after CPR isperformed.



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CPR involves chest compressions at a rate of at least 100 per minute in an effort to createartificial circulation by manually pumping

blood through the heart Rescuer may provide breaths by either

exhaling into their mouth or utilizing a device that pushes air into the lungs. The processof externally providing ventilation is termed artificial respiration.

http://en.wikipedia.org/wiki/Artificial_respiration




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CPR alone is unlikely to restart the heart; its

main purpose is to restore partial flow of

oxygenated blood to the brain and heart

http://en.wikipedia.org/wiki/Brain

http://en.wikipedia.org/wiki/Heart

http://en.wikipedia.org/wiki/Heart

http://en.wikipedia.org/wiki/Brain



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CPR may however induce a shockable

rhythm. CPR is generally continued until the

person regains return of spontaneous

circulation (ROSC) or is declared dead.

http://en.wikipedia.org/wiki/Return_of_spontaneous_circulation


http://en.wikipedia.org/wiki/Death

http://en.wikipedia.org/wiki/Death





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CPR is indicated for any person who

is unresponsive with no breathing or only

gasps as breathing as it is most likely that

they are in cardiac arrest. If a person still has

a pulse, but is not breathing (respiratory

arrest), artificial respirations are more

appropriate.

http://en.wikipedia.org/wiki/Unresponsive


http://en.wikipedia.org/wiki/Pulse

http://en.wikipedia.org/wiki/Respiratory_arrest






http://en.wikipedia.org/wiki/Pulse


http://en.wikipedia.org/wiki/Unresponsive



CVAH-NET In 2010, the American Heart

Association and International Liaison

Committee on Resuscitation updated theirCPR guidelines. The importance of high

quality CPR (sufficient rate and depth

without excessively ventilating) wasemphasized. The order of interventions was

changed for all age groups

except newborns from airway, breathing,

chest compressions (ABC) to chest

compressions, airway, breathing (CAB).

http://en.wikipedia.org/wiki/American_Heart_Association


http://en.wikipedia.org/wiki/International_Liaison_Committee_on_Resuscitation


http://en.wikipedia.org/wiki/Newborns

http://en.wikipedia.org/wiki/ABC_(medicine)




http://en.wikipedia.org/wiki/Newborns







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One rescuer

Adult, child, infant- 30:2

At least 2 rescuers

Child & infant 15:2 preferred

Newborn 3:1 recommended (unless a

cardiac cause is known in which case a 15:2

ratio is reasonable.



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As of 2010 the Resuscitation Council

(UK) still recommends ABC for children.

In adults rescuers should use two hands for

the chest compressions, while in children

they should use one, and with infants two

fingers (index and middle fingers)

http://en.wikipedia.org/wiki/Resuscitation_Council_(UK)






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There is no substitute for learning cardiopulmonary

resuscitation (CPR), but emergencies don't wait for training. These instructions are for conventional adultCPR. If you've never been trained in CPR and thevictim collapsed in front of you, use hands-only CPR.

Difficulty: Easy

Time Required: CPR should start as soon as possible

http://firstaid.about.com/od/cprbasics/ht/08_HandsOnlyCPR.htm






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1. Attempt to wake victim



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2. Begin chest compressions



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3. Begin rescue breathing



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4. Repeat chest compressions



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5. Repeat rescue breaths.



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6. Keep going.



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7. After 2 minutes of chest compressions and

rescue breaths, stop compressions and

recheck victim for breathing.



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8. Repeat the process, checking for breathingevery 2 minutes (5 cycles or so), until helparrives. If the victim wakes up, you can stop

CPR.



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9. Place victim on recovery position



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Chest compressions are extremelyimportant. If you are notcomfortable giving rescue breaths,

still perform chest compressions!It's called Hands Only CPR.

If the victim is breathing, briskly rub

your knuckles against the victim'ssternum. If the victim does not

wake, call 911.


http://firstaid.about.com/od/callingforhelp/ht/06_Good911.htm





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If the victim wakes up, but is confused or not

able to speak, call 911.



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There is no substitute for proper training.

However, emergencies wait for no one.Use these steps to provide CPR to babies

under 1 year old.

Time Required: As long as it takes



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1. Stay Safe



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2. Try to wake the infant



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If the infant does not wake up, have

someone call 911 immediately. If no one

else is available to call 911 and the baby is

not breathing, continue to step 3 and do CPRfor about 2 minutes before calling 911.



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4. Give the baby two breaths



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5. Keep doing CPR and call 911 after 2 minutes



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Once 911 has been called or you have

someone else calling, keep doing CPR. Don't

stop until help arrives or the baby wakes up.



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6. Place in recovery position



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When checking for breathing, if you're not

sure then assume the baby isn't breathing.

It's much worse to assume a baby is

breathing and not do anything than toassume he or she isn't and start CPR.



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Put a book under the baby's shoulders -- if

you have time -- to help keep his head tilted

back.



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When asking someone else to call 911,

make sure you tell them why they are calling.

If not, they may not tell the 911 dispatcher

exactly what's going on. If the dispatcherknows the baby isn't breathing or

responding, the dispatcher may be able to

give you instructions to help.

http://firstaid.about.com/od/cpr/qt/07_Bystander911.htm




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There is no substitute for proper

training. However, emergencies wait forno one. Use these steps to provide CPR to children 1 to 8 years old.




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1. Stay Safe



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2. Try to Wake the Child



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If the child does not wake up, have someone

call 911 immediately. If no one else is

available to call 911 and the child is not

breathing, continue to step 3 and do CPR forabout 2 minutes before calling 911.



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4. Give the child two breaths



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5. Keep doing CPR and call 911 after 2 minutes



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Once 911 has been called or you have

someone else calling, keep doing CPR. Don't

stop until help arrives or the child wakes up.



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6. Place in recovery position



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When checking for breathing, if you're not

sure then assume the child isn't breathing.

It's much worse to assume a kid is breathing

and not do anything than to assume he orshe isn't and start rescue breaths.



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When giving rescue breaths, using a CPR

mask helps with making a proper seal and

keeps vomit out of the rescuer's mouth.

Put a book under the child's shoulders -- if

you have time -- to help keep his or her head

tilted back.

http://firstaid.about.com/od/ppe/qt/06_cprmasks.htm






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make sure you tell them why they are calling.

If not, they may not tell the 911 dispatcher

exactly what's going on. If the dispatcherknows a child isn't breathing or responding,

the dispatcher may be able to give you

instructions to help. If you call 911, be calmand listen carefully.







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Choking requires a quick response to

remove the airway obstruction before it

leads to unconsciousness. These stepsare for conscious adults and children

aged 1 to 8.

Difficulty: Easy

Time Required: N/A



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1.Stay Safe!



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2.Establish that the victim is actually choking.Choking victims cannot speak, cough, orbreath.



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3.Stand behind the victim.



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4.Wrap your hands around the victim as

if to give a hug.



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5.Make a fist with your right hand and place

it just above the victim's belly button



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6.Grab your fist with your left and thrust

inwards and upwards forcefully.



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7.Repeat thrusts until the victim is able to breath

again - or until the victim becomes unconscious

http://firstaid.about.com/od/glossary/g/10_unconscious-defined.htm

http://firstaid.about.com/od/glossary/g/10_unconscious-defined.htm



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8.If the victim becomes unconscious, begin adultCPR if the victim is over 8 years old and child

CPR if the victim is between 1 and 8 years old.

http://firstaid.about.com/od/cpr/ht/06_cpr.htm


http://firstaid.about.com/od/cpr/ht/08_Child_CPR.htm








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Do not slap the victim on the back.

Dislodging the airway obstruction while

the victim is upright will result in a deeper

obstruction (gravity will pull it down).



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There's no substitute for proper training when itcomes to saving an infant from choking.However, emergencies don't wait for training.Follow these steps for a choking infant under 1year old.




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1.Stay Safe



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2.Quickly Assess the Infant



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3.Give 5 Blows to the Back



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4.Give 5 Chest Thrusts



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5.Look in the Baby's Mouth



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make sure you tell them why they are

calling. If not, they may not tell the 911

dispatcher exactly what's going on. If thedispatcher knows the baby isn't breathing

or responding, the dispatcher may be

able to give you instructions to help.





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No more looking, listening and feeling.



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Push a little harder

Push a little faster



2010 American Heart Association Guidelines forCPR and Emergency Cardiovascular Care

Comparison Chart of Key Changes

EMBARGOED FOR RELEASE

Oct. 18, 12:30 a.m. EST

2010Recommendation

2005Recommendation

Explanation



Basic Life Support

A change in the basic life

support (BLS) sequenceof steps for trained

rescuers from “A-B-C”

(Airway, Breathing, Chest

compressions) to “C-A-B”

(Chest compressions,

Airway, Breathing) foradults and pediatric

patients

Use of the “A-B-C”

basic life supportsequence.

In the majority of cardiac arrests, the

critical initial elements of CPR are chestcompressions and early

defibrillation.

• In the C-A-B sequence, chest

compressions will be initiated

sooner and ventilation only minimally

delayed until completion of the first cycleof chest compressions.

• The A-B-C sequence could be a reason

why fewer than a third of people in

cardiac arrest receive bystander CPR.

ABC starts with the most difficult

procedures: opening the airway and

delivering rescue breaths.

2010Recommendation

2005 Recommendation Explanation



“Look, Listen and Feel”

has been removed from

the BLS algorithm.Also applies to BLS for

healthcare providers.

“Look, Listen and Feel”

Included in BLS algorithm

Performance of “Look, Listen and

Feel,” is inconsistent and

time consuming.

A compression rate of at

least 100/min.

A compression rate of

“approximately”100/min.

The number of chest compressions

delivered per minuteduring CPR is an important

determinant of return of

spontaneous circulation (ROSC) and

survival with good

neurologic function. In most studies,

delivery of more compressionsduring resuscitation is associated

with better

survival, and delivery of fewer

compressions is associated with

lower survival.

2010Recommendation




If a bystander is not

trained in CPR, the

bystander should provide

Hands-Only™(compression-only)

CPR for the adult victim

who suddenly collapses,

with an emphasis to

“push hard and fast” on

the center of the chest,or follow the directions of

the EMS dispatcher. All

trained lay rescuers

should, at a minimum,

provide chest

compressions for victimsof cardiac arrest. In

addition, if the trained lay

rescuer is able to perform

rescue breaths,

compressions and

breaths should be

The 2005 AHA Guidelines

for

CPR and ECC did not

provide differentrecommendations for

trained versus untrained

rescuers

but did recommend that

dispatchers provide

compression-only CPRinstructions to untrained

bystanders. The 2005

AHA

Guidelines for CPR and

ECC did note that if the

rescuer was unwilling orunable to provide

ventilations, the rescuer

should provide chest

compressions only.

Hands-Only (compression-only) CPR

is easier for an untrained rescuer to

perform and can be more readily

guidedby dispatchers over the telephone.

In addition, survival rates from

cardiac arrests of cardiac etiology

are similar with either Hands-Only

CPR or CPR with both compressions

and rescue breaths. However, for the trained lay rescuer who is able, the

recommendation remains for the

rescuer to perform both

compressions and ventilations

2010 Recommendation 2005Recommendation

Explanation



The new

recommendation for

chest compression

depth: push down on theadult breastbone at

least 2 inches (5 cm).

Also applies to BLS for

healthcare providers.

Depress adult breastbone

approximately 1 1/2 to 2

inches

(approximately 4 to 5 cm).

Compressions generate critical blood

flow and oxygen and energy delivery

to the heart and brain. Rescuers

often do not push the chest hardenough.

2010Recommendation

2005Recommendation

Explanation



Pediatric Basic Life

Support

Initiate CPR for infants

and children with chest

compressions rather than

rescue breaths (C-A-B

rather than A-B-C). CPR

should begin with 30

compressions (any lone

rescuer) or 15

compressions (for

resuscitation of infants

and children by two

healthcare providers)

rather than with twoventilations.

Cardiopulmonary

resuscitation was

initiated with opening of

the airway and the

provision of 2 breaths

before chest

compressions.

This proposed major change in CPR

sequencing to compressions before

ventilations (C-A-B) led to vigorous

debate among experts in pediatric

resuscitation. Because most pediatric

cardiac arrests are asphyxial, rather

than sudden primary cardiac arrests,

both intuition and clinical data

support the need for ventilations and

compressions for pediatric CPR.

2010Recommendation

2005Recommendation

Explanation



To achieve effective chest

compressions, rescuers

should compress at least

one third of the anterior

posterior diameter of the

chest. This corresponds

to approximately 1-1.5

inches (about 4 cm) in

most infants and about 2

inches (5 cm) in most

children.

Push with sufficient

force to depress the

chest approximately one

third to one half the

anterior posterior

diameter of the chest.

Evidence from radiologic studies of

the chest in children

suggests that compression to one half

the anterior-posterior

diameter may not be achievable.

However, effective chest

compressions require pushing hard,

and based on new data,

the depth of about 1 . inches (4 cm)

for most infants and

about 2 inches (5 cm) in most

children is recommended.

2010Recommendation




For infants, a manual

defibrillator is preferred

to an AED fordefibrillation. If a manual

defibrillator is

not available, an AED

equipped with a pediatric

dose attenuator is

preferred. If neither is

available,

an AED without a

pediatric dose attenuator

may be

used.

Data have shown that

AEDs can be used safely

and effectively inchildren 1 to 8 years of

age. However, there are

insufficient data to make

a recommendation for or

against using an AED in

infants < 1 year of age.

Newer case reports suggest that an

AED may be safe and

effective in infants. Because survivalrequires defibrillation

when a shockable rhythm is present

during cardiac arrest,

delivery of a high-dose shock is

preferable to no shock.

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