11 cardio pulmoner resuscitation

8/12/2019 11 Cardio Pulmoner Resuscitation

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Emphasis on High-Quality CPR

blood flow is optimized by using the recommended chest compression

force and duration and maintaining a chest compression rate of

approximately 100 compressions per minute. These guidelines

recommend that all rescuers minimize interruption of chest compressions CPR instruction should emphasize the importance of allowing complete

chest recoil between compressions.

(Circulation.2005; 112: IV19-IV34)

2005 Guidelines


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Emphasis on High-Quality CPR

To provide effective chest compressions, push

hard and push fast. compress the adult chest

at a rate of at least 100 compressions per

minute with a compression depth of at least 2

inches/5 cm. allow complete recoil of the

chest after each compression, to allow the heart

to fill completely before the next compression.

minimize the frequency and duration of

interruptions in compressions to maximize the

number of compressions delivered per minute.

(Berg, et al. Circulation.2010;122;S685-S705)

2010 Guidelines


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Highlights

This is a re-emphasis from 2005.

For effective compressions:

Push fast

Push hard

Allow chest to fully recoil

Minimize any interruptions

Applies to both lay and healthcare providers.


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Rationale For Change

High-quality chest compressions within CPR

continues to be a critical focal point.

Well-performed compressions increase the

likelihood of survival.


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Compression Hand Position

The rescuer should compress the lower half of the victims sternum in

the center (middle) of the chest, between the nipples. The rescuer should

place the heel of the hand on the sternum in the center (middle) of the

chest between the nipples and then place the heel of the second hand ontop of the first so that the hands are overlapped and parallel.


2005 Guidelines


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Compression Hand Position

The rescuer should place the heel of one hand

on the center (middle) of the victims chest

(which is the lower half of the sternum) and the

heel of the other hand on top of the first so that

the hands are overlapped and parallel.


2010 Guidelines


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Highlights

Hands in center of the chest.

Lower half of breastbone

Second hand on top of the first.

Not on lowest part of breastbone.



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Use of the nipple line as a landmark for

hand placement was found to be unreliable.


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Compression Rate

There is insufficient evidence from human studies to identify a single

optimal chest compression rate. Animal and human studies support a

chest compression rate of >80 compressions per minute to achieve

optimal forward blood flow during CPR. We recommend a compressionrate of about 100compressions per minute.

(Circulation. 2005; 112: IV19-IV34)

2005 Guidelines


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Compression Rate

It is reasonable for laypersons and healthcare

providers to compress the adult chest at a

rate of at least 100 compressions per minute

with a compression depth of at least 2 inches

(5 cm.)

(Berg, et al. Circulation. 2010;122;S685-S705)

2010 Guidelines


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It has been found that higher survival rates are

associated with an increase in the number of

compressions provided per minute.


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Child/Infant Compression Rate

Push fast; push at a rate of approximately 100 compressions per

minute.

(Circulation. 2005; 112: IV156-IV166)

2005 Guidelines


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Child/Infant Compression Rate

Push fast; push at a rate of at least100

compressions per minute.


2010 Guidelines


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Highlights

Rescuers tend to compress slower.

At least100 compressions per minute.

It is okay to be a little faster.



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It has been found that higher survival rates are

associated with an increase in the number of

compressions provided per minute.


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Compression Depth

It is reasonable for laypersons and healthcare

providers to compress the adult chest at a rate of

at least 100 compressions per minute with a

compression depth of at least 2 inches/5 cm.


2010 Guidelines


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Highlights

At least2 inches on an adult.

It is okay to compress a little deeper.

Not enough information to define upper limit.



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Research indicates the tendency for CPR

providers to not compress deep enough, even

with the emphasis to "push hard."


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Child/Infant Compression Depth

Push hard: push with sufficient force to depress the chest

approximatelyone third to one half the anterior-posterior diameter of the

chest.


2005 Guidelines


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Child/Infant Compression Depth

Chest compressions of appropriate rate and

depth. Push fast: push at a rate of at least

100 compressions per minute. Push hard:

push with sufficient force to depress at leastone third the anterior-posterior (AP)

diameter of the chest or approximately 1

inches (4 cm) in infants and 2 inches (5 cm)

in children.


2010 Guidelines


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Highlights

At least1/3 of the anterior/posterior diameter

of chest.

About 2 inches for children and about 1

inches for infants. It is okay to compress a little deeper



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Research indicates the tendency for CPR

providers to not compress deep enough, even

with the emphasis to "push hard."


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Breathing Assessment

While maintaining an open airway, look, listen, and feel for breathing.


2005 Guidelines


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Breathing Assessment

After activation of the emergency response system, all rescuers should

immediately begin CPR for adult victims who are unresponsive with no

breathing or no normal breathing (only gasping).


2010 Guidelines


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Highlights

No more look, listen, and feel.

Quick lookfor no breathing or no normal

breathing.

Agonal breaths remain a concern.



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CPR Sequence - Lay

For an unresponsive person who is not breathing or not breathing

normally, begin CPR by opening the airway and giving 2 rescue breaths

followed with 30 chest compressions. Repeat cycles of 30:2 (ABC

method).

(Summary from Circulation.2005; 112: IV19-IV34)

2005 Guidelines


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CPR Sequence - Lay

For an unresponsive person, activate EMS,

then assess breathing. If the person is not

breathing or not breathing normally, begin CPR

with 30 compressions followed by opening theairway and giving 2 rescue breaths. Repeat

cycles of 30:2 (CABmethod).

(Summary from Berg, et al. Circulation.

2010;122;S685-S705)

2010 Guidelines


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Highlights

Initial assessment steps: Assess responsiveness

Activate EMS

Assess breathing

Perform CPR

CABbegin CPR cycles with compressions,

followed by airway and breathing.

Guideline applies to adults, children, and infants.


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The science indicates the importance of not

delaying chest compressions to perform rescue

breaths.

Early chest compression can immediatelycirculate oxygen that is still in the bloodstream.


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CPR Sequence - HCP

For an unresponsive person who is not

breathing or not breathing normally, begin CPR

by opening the airway and giving 2 rescue

breaths followed with 30 chest compressions.Repeat cycles of 30:2 (ABC method).

(Summary from Circulation.2005; 112: IV19-

IV34)

2005 Guidelines


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CPR Sequence - HCP

For an unresponsive person who is not

breathing or not breathing normally, and has no

obvious pulse, activate EMS and begin CPR

with 30 compressions followed by opening theairway and giving 2 rescue breaths. Repeat

cycles of 30:2 (CAB method).

(Summary from Berg, et al. Circulation.

2010;122;S685-S705)

2010 Guidelines


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Highlights

Initial assessment approach: Assess responsiveness and breathing

Activate EMS

Assess pulse

Perform CPR

CABbegin CPR cycles with compressions,

followed by airway and breathing.


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The science indicates the importance of not

delaying chest compressions to perform rescue

breaths.

Early chest compression can immediatelycirculate oxygen that is still in the bloodstream.


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Use of an AED on an Infant

There is insufficient data to make a

recommendation for or against the use of AEDs

for infants 1 year of age.


2005 Guidelines


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Use of an AED on an Infant

Many AEDs have high specificity in

recognizing pediatric shockable rhythms, and

some are equipped to decrease (or attenuate)

the delivered energy to make them suitable forinfants and children < 8 years of age. For

infants an AED equipped with a pediatric

attenuator is preferred for infants. If neither is

available, an AED without a dose attenuator

may be used.

(Link, et al. Circulation.2010;122;S706-S719)

2010 Guidelines


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AEDs designed to be used on adults have been

successful when used on infants with out-of-

hospital cardiac arrest.

Minimal heart muscle damage and goodneurological outcomes were reported.


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Chain of Survival

Early recognition of the emergency and

activation of the emergency medical services

(EMS) or local emergency response system

Early bystander CPREarly delivery of a shock with a defibrillator

Early advanced life support followed by post

resuscitation care delivered by healthcare

providers

(Circulation.

2005; 112: IV12-IV18)

2005 Guidelines


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Chain of Survival

These actions are termed the links in the Chain

of Survival.For adults they include:

Immediate recognition of cardiac arrest andactivation of the emergency response system

Early CPR that emphasizes chest

compressions

Rapid defibrillation if indicated

Effective advanced life support

Integrated postcardiac arrest care.

(Travers, et al. Circulation.2010;122;S676-S684)

2010 Guidelines


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Highlights

Addition of fifth link in chain.

Integrated post-cardiac arrest care.



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Links in the Chain of Survivalindicate the

individual actions that must be strong in

order for a person to survive a sudden

cardiac arrest. The addition of the fifth link, integrated post-

cardiac arrest care, further emphasizes the

additional dependence on longer-term care

for long-term survival.


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Cardiopulmonary

Resuscitation with

Automated

External

Defibrillator

Provider Course CPR/AED


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At the end of this course participants should beable to demonstrate:

How to assess the collapsed victim How to perform chest compression and rescue breathing

(CPR)

How to operate an automated external defibrillator safely

How to place an unconscious breathing victim in the

recovery position

Objectives


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In Europe every 45 seconds a cardiac arresttakes place

Bystander CPR is a vital intervention beforearrival of emergency services

Early resuscitation and prompt defibrillation(within 1-2 minutes) can result in >60% survival

Background


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Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

30 chest compressions

2 rescue breaths


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Approach safely

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112


2 rescue breaths


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Shake shoulders gently

Ask Are you all right?

If he responds

Leave as you find him.

Find out what is wrong.Reassess regularly.

Check response


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Shout for help

Approach safelyApproach safely

Check response

Shout for help

Open airway

Check breathing

Call 112


2 rescue breaths


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Open airway


Check response

Shout for help

Open airway

Check breathing

Call 112


2 rescue breaths


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Check breathing


Check response

Shout for help

Open airway

Check breathing

Call 112


2 rescue breaths


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Look, listen and feel for NORMAL breathing

Check breathing


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Occurs shortly after the heart stops

in up to 40% of cardiac arrests

Described as barely, heavy, noisy or gasping

breathing

Recognise as a sign of cardiac arrest

Abnormal breathing


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Place the heel of one hand in the

centre of the chest

Place other hand on top

Interlock fingers or avoid puttingpressure on the side of the chest

Compress the chest

Rate 100120min-1

Depth 56cm

Equal compression : relaxation

When possible change CPR

operator every 2 min

Chest compressions


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2 Rescue breaths


Check response

Shout for help

Open airway

Check breathing

Call 112


2 rescue breaths


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Rescue breaths

Pinch the nose

Take a normal breath

Place lips over mouth

Blow until the chest rises

Take about 1 second

Allow chest to fallRepeat


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Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112


2 rescue breaths


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Switch on AED

Some AEDs will automatically switch

themselves on when the lid is opened


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Attach pads to victims bare chest


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Analysing Rhythm: Do not touch victim


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Shock indicated

Stand clear

Deliver shock


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30 2

Shock delivered: Follow AED instructions


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No shock advised: Follow AED instructions

30 2


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CPR in children

Adult CPR techniques can be used on children

Compressions at least 1/3 of the depth of thechest


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Any questions?


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Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

30 chest

i

Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 112

Attach AED

11 cardio pulmoner resuscitation

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