[OS 213] LEC 35 Basic Life Support (B)-1

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<p>OS 210LEC 0X: TITLE</p> <p>OUTLINE </p> <p>I. Introduction</p> <p>II. CPR and the Chain of Survival</p> <p>III. Cardiopulmonary resuscitation (CPR)</p> <p>IV. Techniques and Steps in CPR</p> <p>V. Hands-Only CPR</p> <p>VI. Summary for 2010 Guidelines</p> <p>I.INTRODUCTION</p> <p>Objectives</p> <p> 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</p> <p>The Burden: Heart diseases are the #1 cause of death in the Philippines (DOH data 2004 + 2005)</p> <p> 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</p> <p>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</p> <p> 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.</p> <p> Only 4-6 % of sudden cardiac arrest victims survive because majority of those witnessing the arrest do not know how to perform CPR.</p> <p> It is unpredictable and can happen to anyone, anywhere at anytime</p> <p> Risk increases with age (especially individuals 60 y.o. and above)</p> <p> Pre-existing heart disease is a common cause</p> <p> May strike people with no history of cardiac disease or cardiac symptoms</p> <p> Therefore: effective CPR done immediately after cardiac arrest can double a victims chance of survival ( prompt recognition of the problem and swift action (management)</p> <p> Rescue Breathing/CPR: Do what the patient isnt</p> <p> If not breathing, breathe for her</p> <p> 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 </p> <p>THE NEW CHAIN OF SURVIVAL:1. Early access (immediate recognition and activation)</p> <p>2. Early CPR</p> <p>3. Early defibrillation</p> <p>4. Early advanced care</p> <p>5. Integrated post-cardiac arrest care</p> <p>A. FIRST LINK: ACCESS</p> <p> A well-informed lay person is THE key in the early access link</p> <p> Recognition of signs of heart attack and respiratory failure</p> <p> Call for help immediately if needed</p> <p> Activate the Emergency Medical System (EMS)B. EARLY WARNING SIGNS OF HEART ATTACK</p> <p> Prolonged compressing pain or unusual discomfort in the center of the chest</p> <p> 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</p> <p> Unable to speak, breathe or cough</p> <p> Clutches neck (universal distress signal)</p> <p> Bluish color of skin and lips D. SECOND LINK: EARLY CPR</p> <p> Life saving technique for cardiac and respiratory arrest</p> <p> Rescue breathing and chest compressions</p> <p> For lay persons and medical personnel alikeIII. CARDIOPULMONARY RESUSCITATION (CPR)</p> <p>A. WHY IS EARLY CPR IMPORTANT?</p> <p> 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</p> <p> May increase the chance of defibrillation</p> <p> Contributes to the preservation of heart and brain function</p> <p> Significantly improves survival</p> <p> Prompt CPR is important: beyond 7 minutes with no CPR, you are doomed to failB. HOW DOES CPR WORK?</p> <p> All the living cells of out body need a steady supply of oxygen to keep us alive</p> <p> Important organs of concern during acute CPR: lungs (pulmonary), brain (cerebral), heart (cardiac)</p> <p> 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?</p> <p> As soon as possible!</p> <p> Brain cells begin to die after 4-6 minutes without oxygen D. WHO MAY LEARN CPR?</p> <p> Anyone; does not need to be a doctor, nurse, med student, etc.IV. TECHNIQUES AND STEPS IN CPR</p> <p>WHAT TO DO WHEN YOU FIND A PERSON UNCONSCIOUS IN THE GROUND</p> <p>1. Check area safety</p> <p> Survey the scene</p> <p> See if the scene is safe to do CPR</p> <p> Get an Idea of what happened</p> <p>2. Check Unresponsiveness</p> <p> Tap or gently shake the victim</p> <p> Rescuer shouts: Are you okay?</p> <p> Quick check for normal breathing If the victim is unconscious, rescuer calls for help</p> <p>3. Call for Help: ambulance, emergency services, doctor</p> <p> Rescuer activates the emergency medical services</p> <p> Get AED/Defibrillator</p> <p> Non-responsive, no normal breathing = get a defibrillator!CHECK FOR CONSCIOUSNESS</p> <p>1. PULSE CHECK</p> <p> Palpate for carotid pulse within 10 seconds</p> <p> At the same time check for breathing</p> <p> For trained health care providers only!!!2. MOUTH TO MOUTH BREATHING</p> <p> Begin if there is a DEFINITE PULSE, but NO BREATHING</p> <p> Give one breath every 5-6 seconds (about 12 breaths per minute)</p> <p> Recheck pulse every 2 minutes</p> <p>Mouth to Mouth Breathing and Pulse Check:</p> <p> Deemphasized in the new guidelines</p> <p> For trained healthcare providers only</p> <p> As short and quick as possible</p> <p> Pulse check not more than 10 seconds</p> <p> If unsure, proceed directly to chest compressions3. PROCEED TO C-A-B</p> <p> Compression: Do chest compressions first</p> <p> Airway: does the victim have an open airway (air passage that allow the victim to breathe)?</p> <p> Breathing: is the victim breathing</p> <p>START CPR (C-A-B)</p> <p>COMPRESSION</p> <p> To assist circulation</p> <p> After determining unconsciousness and calling for help, proceed immediately to do chest compressions</p> <p>Procedure: 1. Kneel facing the victims chest</p> <p>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!</p> <p>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.</p> <p>Figure 1. Procedure for doing proper chest compression.Caveats:</p> <p> Give chest compressions at a rate of AT LEAST 100/minute</p> <p> Compress bone at least 2 inches deep</p> <p> Compress 30 times initially (takes around 15-18 seconds)</p> <p> Minimize interruptions</p> <p> 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</p> <p> Open the airway by using the Head Tilt/Chin Lift Method Place one hand on the victims forehead</p> <p> Place fingers of the other hand under the bony part of the lower jaw near the chin</p> <p> Tilt head and lift jaw avoid closing the victims mouth</p> <p> This maneuver prevents airway obstruction by the epiglottis</p> <p> If you are highly suspecting cervical spine injury, do Jaw Thrust Method instead</p> <p>Figure 2. The Head-tilt or chin-lift maneuverBREATHING</p> <p>Procedure:</p> <p>1. Give 2 one-second breaths</p> <p>2. Maintain airway</p> <p>3. Pinch nose shut</p> <p>4. Open your mouth wide, take a normal breath, and make a tight seal around outside of victims mouth.</p> <p>5. Give 2 full breaths (1 second per breath)</p> <p>6. Observe chest rise and fall; listen and feel for escaping air</p> <p>7. Repeat cycles of 30 compressions and 2 breaths (this will take about 2 minutes= 5 cycles!)</p> <p>Pulse Check</p> <p> Recheck pulse every 2 minutes (Equivalent to 5 cycles CPR)</p> <p> Very brief pulse check should take less than 10 seconds (at the same time check for normal breathing)</p> <p> In case there is any doubt about the presence or absence of pulse continue chest compressions</p> <p> This is for trained healthcare providers only</p> <p>Continue CPR until </p> <p> Help arrives (emergency services, ambulance, doctor, AED)</p> <p> Person is revivedIf the Victim is Breathing, place him/her in the Recovery Position Maintain open airway and position the victim</p> <p> The unresponsive victim with spontaneous respirations should be placed in the recovery position if no cervical trauma is suspected</p> <p> Placement in this position consists of rolling the victim onto his other side to help protect the airway</p> <p>Figure 3. The recovery position.SUMMARY OF STEPS IN CPR</p> <p> Survey the scene.</p> <p> Check responsiveness Hey, are you ok?</p> <p> Call for help! Activate EMS</p> <p> [Quick check pulse within 10 secs] </p> <p> C (Compression): 30x; 100/min; 2 inches deep; push hard and fast</p> <p> A (Airway): head tilt chin lift</p> <p> B (Breathing): 2 breaths (1 second/breath)</p> <p> Cycle 30:2 compression-ventilation</p> <p> [Quick check pulse every 2 mins] Continue until: EMS arrives, patient is revived/has signs of life</p> <p>V. HANDS-ONLY CPR</p> <p>A. INDICATIONS</p> <p> Not trained</p> <p> Do not know mouth to mouth ventilation</p> <p> Not sure about mouth to mouth ventilation</p> <p> Hesitant to do mouth to mouth ventilation</p> <p> Do not want to do mouth to mouth ventilation</p> <p> You can do HANDS ONLY CPR: It only takes two steps to save a life:</p> <p>1. Call for help</p> <p>2. Do chest compressions</p> <p> Hands only CPR should only be used for adult victims who have suddenly collapsed or become unresponsive</p> <p>B. RECOMMENDATIONS </p> <p> All victims of cardiac arrest should receive high-quality chest compressions</p> <p> 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</p> <p> AED arrives</p> <p> EMS providers take over care of the victim</p> <p> If trained in CPR, provide either conventional CPR using 30:2 compression-to-ventilation ratio or hands only CPRVI. SUMMARY OF 2010 BLS GUIDELINES</p> <p>KEY CHANGES:</p> <p> CABV instead of ABC</p> <p> Compress first</p> <p> NO more Look, Listen and Feel</p> <p> Harder ( minimum 2 inches (1.5-2 in for elderly) Faster ( minimum 100/min. (max 100/min for elderly) Deemphasize pulse checks</p> <p> For trained healthcare providers (not more than 10 secs Check for normal breathing together with check for unresponsiveness</p> <p> Hands only CPR for the untrained lay rescuer</p> <p>IMPORTANT POINTS There are no mistakes when you perform CPR</p> <p> The only harm is to delay responding</p> <p> Start chest compressions ( now viewed as the most effective procedures</p> <p> All victims in cardiac arrest need chest compressions</p> <p> Dont stop pushing</p> <p> Keep pushing as long as you ca. 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</p> <p> 80-90% of cardiac emergencies occur at home</p> <p> Training is now simpler and more accessible (reduced steps and simplified) Being trained to do CPR can save a loved one</p> <p> Effective CPR done immediately after cardiac arrest can double a victims chance of survival</p> <p>END OF TRANSCRIPTION</p> <p>Vincen: SIMPLIER. &gt;:D Kelan lang walang coke na hawak o katabi si Dr. Coke na nephrologist at nagtuturo ng IDC 3-5PM? Sinong lecturer ang kamukha ni Peter Griffin from Family Guy? (Clue: Hes just going to have a one-sided conversation.) Hello to my great friends, closest friends, friend-friends, old friends, new friends, and potential friends. Panoorin ang Memento ,The Squid and the Whale, at Requiem for a Dream this weekend kung hindi pa napanood. Justin: Happy birthday Chikki! </p>