[os 213] lec 35 basic life support (b)-1

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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



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

The Burden: Heart diseases are the #1 cause of death in the Philippines (DOH data 2004 + 2005)

Followed by vascular system disease, malignant neoplasm, pneumonias, and accidents, in that order There has been a change in causes of mortality (initially due to infectious diseases) now more due to lifestyle-related causes such as stress

Sudden Cardiac Arrest (SCA) and Sudden Cardiac Death (SCD) Approximately 50% of deaths from cardiovascular diseases occur as SCD SCD is the most common mode of death in patients with coronary artery disease SCA reversible loss of cardiac function

SCD irreversible loss of all biologic function Almost 80% of out-of-hospital cardiac arrests occur at home and are witnessed by a family member.

Only 4-6 % of sudden cardiac arrest victims survive because majority of those witnessing the arrest do not know how to perform CPR.

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

Risk increases with age (especially individuals 60 y.o. and above)

Pre-existing heart disease is a common cause

May strike people with no history of cardiac disease or cardiac symptoms

Therefore: effective CPR done immediately after cardiac arrest can double a victims chance of survival ( prompt recognition of the problem and swift action (management)

Rescue Breathing/CPR: Do what the patient isnt

If not breathing, breathe for her

If sudden cardiac death occurs outside the hospital setting, cardiopulmonary resuscitation (CPR) must begin within 4-6 minutes and advanced life support measures must begin within 8 minutes, to avoid brain deathII. CPR AND THE CHAIN OF SURVIVAL

THE NEW CHAIN OF SURVIVAL:1. Early access (immediate recognition and activation)

2. Early CPR

3. Early defibrillation

4. Early advanced care

5. Integrated post-cardiac arrest care


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)B. 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 left side) Pain may be accompanied by sweating, nausea, vomiting and shortness of breath. Inferior wall infarct can have abdominal pain and shortness of breath.C. EARLY WARNING SIGNS OF RESPIRATORY FAILURE

Unable to speak, breathe or cough

Clutches neck (universal distress signal)

Bluish color of skin and lips D. SECOND LINK: EARLY CPR

Life saving technique for cardiac and respiratory arrest

Rescue breathing and chest compressions

For lay persons and medical personnel alikeIII. CARDIOPULMONARY RESUSCITATION (CPR)


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 failB. HOW DOES CPR WORK?

All the living cells of out body need a steady supply of oxygen to keep us alive

Important organs of concern during acute CPR: lungs (pulmonary), brain (cerebral), heart (cardiac)

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 victims lungs to provide oxygen into the blood. When you press on the chest, you move the oxygen-carrying blood through the body.C. WHEN WILL YOU DO CPR?

As soon as possible!

Brain cells begin to die after 4-6 minutes without oxygen D. WHO MAY LEARN CPR?

Anyone; does not need to be a doctor, nurse, med student, etc.IV. TECHNIQUES AND STEPS IN CPR


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


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 compressions3. 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



To assist circulation

After determining unconsciousness and calling for help, proceed immediately to do chest compressions

Procedure: 1. Kneel facing the victims chest

2. Place the heel of your hand on the center of the victims chest. Put your other hand on top of the first with our fingers interlaced. 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. Position 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:

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)

Minimize interruptions

Allow the chest to return to its normal position (to provide sufficient diastolic filling for sufficient CO; (compress = systole). Slogan: Push hard, push fast.AIRWAY

Open the airway by using the Head Tilt/Chin Lift Method Place one hand on the victims forehead

Place fingers of the other hand under the bony part of the lower jaw near the chin

Tilt head and lift jaw avoid closing the victims mouth

This maneuver prevents airway obstruction by the epiglottis

If you are highly suspecting cervical spine injury, do Jaw Thrust Method instead

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


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 victims 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 revivedIf 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