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KNOWLEDGE OBJECTIVES:KNOWLEDGE OBJECTIVES:

1. Describe cardiac arrest. 1. Describe cardiac arrest.

2. 2. Enumerate the three conditions of Enumerate the three conditions of cardiac arrestcardiac arrest. .

3. Enumerate the criteria for not starting 3. Enumerate the criteria for not starting CPR and when to STOP CPR. CPR and when to STOP CPR.

SKILL OBJECTIVE:SKILL OBJECTIVE:

• Demonstrate how to provide Demonstrate how to provide Cardiopulmonary Resuscitation to an Cardiopulmonary Resuscitation to an adult, child & infant who are in cardiac adult, child & infant who are in cardiac arrest. arrest.

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Condition in which circulation Condition in which circulation ceases and vital organs are ceases and vital organs are

deprived of oxygen.deprived of oxygen.

This is a combination of chest This is a combination of chest compressions and rescue breathing. compressions and rescue breathing. These must be combined for effective These must be combined for effective resuscitation of the victim of cardiac resuscitation of the victim of cardiac arrest.arrest.

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combination of chest compressions and combination of chest compressions and rescue breathing for cardiac arrest.rescue breathing for cardiac arrest.

Cardiopulmonary Resuscitation

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Maneuver Adult Child Infant

Compression Area Center of the chest along imaginary nipple line Center of the chest 1 finger width below the imaginary nipple line

Depth Approximately 1 ½ to 2 inches

Approximately 1/3 to 1/2 the depth of the chest

How to Compress Heel of 1 hand, other hand on top

Heel of 1 hand or as for adult

2 fingers (middle & ring fingertips)/2 thumb encircling hands

Rate Approximately 100/min

Compression/ Ventilation Ratio

30:2 ( 1 rescuer ) 15:2 ( 2 rescuers )

Number of cycles per 2 minutes

5 cycles

Counting for standardization purposes

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, 30 for 5 cycles in 2 minutes

Table of Comparison on Cardiopulmonary Resuscitation for Adult, Child and Infant

THREE CONDITIONS OF CARDIAC ARREST

Cardio Vascular Collapse. The heart is still beating but its action is so weak that blood is not being circulated through the vascular system to the brain body tissues.

Ventricular Fibrillation. Occurs when the individual fascicles of the heart beat independently rather than the coordinated, synchronized manner that produce rhythmic heart beat.

Cardiac Standstill. It means that the heart has stopped beating.

COUGH CPR. It is a self- initiated CPR, which is possible. Its use, however, is limited to clinical situations in which the patient has a monitored cardiac arrest, the arrest was recognized before loss of consciousness, and the patient can cough forcefully.

COMPRESSION ONLY-CPR

If a person is unwilling or unable to perform mouth-to-mouth ventilation for an adult victim, chest compression only - CPR should be provided rather than no attempt of CPR being made.

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1.1.The patient has a valid : ”DO NOT The patient has a valid : ”DO NOT RESUSCITATE” orderRESUSCITATE” order

2.2.The patient has signs of irreversible deathThe patient has signs of irreversible death

a.a. Rigor mortis Rigor mortis

b.b. Dependent LividityDependent Lividity

c.c. DecapitationDecapitation

d.d. DecompositionDecomposition

CRITERIA FOR NOT STARTING CPR

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3. No physiological benefit can be expected

4.Withholding attempts to resuscitate in the delivery room is appropriate for newly born infants

a. Confirmed gestation < 23 weeks or birth weight

< 400gms.

4. Anencephaly

5. Confirmed Trisomy 13 or 18

1. SPONTANEOUS1. SPONTANEOUS signs of circulation signs of circulation are restored.are restored.

2. TURNED 2. TURNED over to medical services or over to medical services or properly trained and authorized properly trained and authorized personnel.personnel.

3. OPERATOR 3. OPERATOR is already exhausted and is already exhausted and cannot continue CPR.cannot continue CPR.

4. PHYSICIAN 4. PHYSICIAN assumes responsibility assumes responsibility (declares death, takes over, (declares death, takes over, etc.).etc.).

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S - SPONTANEOUS signs of circulation are restored.T - TURNED over to medical services O - OPERATOR is already exhausted and cannot continue CPR.P - PHYSICIAN assumes responsibility S - SCENE becomes unsafe.S - SIGNED waiver to stop CPR.

Adult Child Infant

Airway Head tilt – chin lift

Breathing (Initial)

2 effective breaths at 1 second/breath

Rescue breathing w/o chest compressions 10 – 12 breaths per minute

(approximate)

12 – 20 breaths per minute

(approximate)

Rescue breaths for CPR with advanced airway

8 – 10 breaths per minute

(approximately)

Foreign-body airway obstruction Abdominal thrusts or chest thrusts (responsive)

CPR (unresponsive)

5 Back slaps and 5 chest thrusts (responsive)

CPR (unresponsive)

Circulation Pulse check (10 sec. or less) Carotid artery Brachial or Femoral artery

Compression landmarks Lower half of sternum, between the nipples Just below the nipple line

(lower half of sternum)

Compression method

Push hard and fast

Allow complete recoil

Heel of one hand with the other hand on top

Heel of one hand or as for adult 2 or 3 fingers (2 rescuers): 2 thumbs-encircling hand

Compression rate Approximately 100 compressions per minute

Compression-ventilation ratio 30:2 (one rescuers) 30:2 (lone rescuer)

15:2 (2 rescuer)

Defibrillation AED Use adult pads

Do not use child pads

Use AED after 5 cycles of CPR (out of hospital).

Use pediatric system for children 1 – 8 years if available

For sudden collapse (out-of-hospital) or in-hospital arrest use AED as soon as possible.

Not recommended for infants

Presented by: Dave Jay S. Manriquez RN.