module ii final

7/31/2019 Module II Final

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Cardiopulmonary Resuscitationand Airway Management


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Introduction

Cardiac arrest is the main cause of sudden cardiacdeath1

Many victims of sudden cardiac arrest can survive if

bystanders act immediately2

1. Raki D, Rumboldt Z, Carevi V, Bagatin J, Poli S, Pivac N, et al. In-hospital cardiac arrest andresuscitation outcomes: rationale for sudden cardiac death approach. Croat Med J. 2005Dec;46(6):907-12.

2. Handley AJ, Koster R, Monsieurs K, Perkins GD, Davies S Bossaert L. European Resuscitation CouncilGuidelines for Resuscitation 2005. Section 2. Adult basic life support and use of automated externaldefibrillators. Resuscitation 2005; 67S1: S7-23


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Introduction

The optimum treatment for ventricular fibrillationcardiac arrest is immediate cardiopulmonaryresuscitation; CPR (combined chest compressionand rescue breathing) plus electrical defibrillation

Handley AJ, Koster R, Monsieurs K, Perkins GD, Davies S Bossaert L. European Resuscitation Council

Guidelines for Resuscitation 2005. Section 2. Adult basic life support and use of automated externaldefibrillators. Resuscitation 2005; 67S1: S7-23


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Important aspects in CPR

Airway Management Basic Life Support (BLS)




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Basic Life Support (BLS)


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Introduction

Basic life support includes maintaining airway andsupporting breathing and circulation without thehelp of any equipment

It comprises of recognition of signs of suddencardiac arrest, heart attack, stroke, obstruction ofairway by a foreign body; cardiopulmonaryresuscitation; and defibrillation with an Automated

External Defibrillator (AED)

Sarin H, Kapoor D. Adult basic life support. Indian J Crit Care Med 2006;10:95-104


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Chain of survival

1. Nolan J. European Resuscitation Council Guidelines for Resuscitation 2005. Section 1.Introduction. Resuscitation 2005; 67S1: S36.

2. Sarin H, Kapoor D. Adult basic life support. Indian J Crit Care Med 2006;10:95-104


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Adult basic life support (BLS)UNRESPONSIVE?

Shout for help

Open airway

NOT BREATHING NORMALLY?

Call National Emergency Number

30 chest compressions

2 rescue breaths30 compressions




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Adult BLS sequence of actions

1. Make sure you, the victim and any bystanders aresafe

2. Check the victim for a response

Handley AJ, Koster R, Monsieurs K, Perkins GD, Davies S Bossaert L. European Resuscitation CouncilGuidelines for Resuscitation 2005. Section 2. Adult basic life support and use of automated externaldefibrillators. Resuscitation 2005; 67S1: S7-23


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3. If he responds

Leave him in the position in which you find him

provided there is no further danger Try to find out what is wrong with him and get help

if needed

Reassess him regularly



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If he does not respond Shout for help

Turn the victim onto his back and then open the

airway using head tilt and chin lift



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Place your hand on his forehead and gently tilt hishead back keeping your thumb and index fingerfree to close his nose if rescue breathing is required

With your fingertips under the point of the victimschin, lift the chin to open the airway



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4.Keeping the airway open, look, listen and feel fornormal breathing

Look for chest movement

Listen at the sounds

Feel for air on your cheek

In the first few minutes after cardiac arrest, a victim may be

barely breathing, or taking infrequent, noisy gasps. Do not

confuse this with normal breathing. Look, listen, and feel for nomore than 10 s to determine whether the victim is breathing

normally. If you have any doubt whether breathing is normal, act

as if it is not normal



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5. If he is breathing normally

Turn him into the recovery position

The European Resuscitation Council (ERC)

recommends the following sequence of actions toplace a victim in the recovery position:

Remove the victims spectacle Kneel beside the victim and make sure that both

legs are straightHandley AJ, Koster R, Monsieurs K, Perkins GD, Davies S Bossaert L. European Resuscitation CouncilGuidelines for Resuscitation 2005. Section 2. Adult basic life support and use of automated externaldefibrillators. Resuscitation 2005; 67S1: S7-23


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Place the arm nearest to you out at right angles tothe body, elbow bent with the hand palmuppermost



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Bring the far arm across the chest, and hold theback of the hand against the victims cheek nearestto you



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With your other hand, grasp the far leg just abovethe knee and pull it up, keeping the foot on theground



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Keeping his hand pressed against his cheek, pull onthe far leg to roll the victim towards you onto hisside

Adjust the upper leg so that both hip and knee arebent at right angles

Tilt the head back to make sure the airway remainsopen



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Adjust the hand under the cheek, if necessary, tokeep the head tilted

Check breathing regularly Send or go for help/call for an ambulance

Check for continued breathing



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Place the heel of one hand in the centre of thevictims chest



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Place the heel of your other hand on top of the firsthand



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Interlock the fingers of your hands and ensure thatpressure is not applied over the victims ribs. Do notapply any pressure over the upper abdomen or thebottom end of the bony sternum (breastbone)



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Position yourself vertically above the victims chestand, with your arms straight, press down on thesternum 45 cm



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After each compression, release all the pressure onthe chest without losing contact between yourhands and the sternum; repeat at a rate of about100 min-1 (a little less than 2 compressions s-1 )

Compression and release should take equalamounts of time



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6.Combine chest compression with rescue breaths After 30 compressions open the airway again using

head tilt and chin lift

Pinch the soft part of the nose closed, using theindex finger and thumb of your hand on theforehead

Allow the mouth to open, but maintain chin lift

Take a normal breath and place your lips aroundthe mouth, making sure that you have a good seal



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Blow steadily into the mouth while watching for thechest to rise, taking about 1 sec as in normalbreathing; this is an effective rescue breath



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Maintaining head tilt and chin lift, take your mouthaway from the victim and watch for the chest and,with your arms straight, chest to fall as air passesout



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Take another normal breath and blow into thevictims mouth once more, to achieve a total of twoeffective rescue breaths. Then return your handswithout delay to the correct position on the sternum

and give a further 30 chest compressions Continue with chest compressions and rescue

breaths in a ratio of 30:2

Stop to recheck the victim only if he starts

breathing normally; otherwise do not interruptresuscitation



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If your initial rescue breath does not make the chestrise as in normal breathing, then before your nextattempt:

Check the victims mouth & remove any obstruction

Recheck that there is adequate head tilt and chin lift

Do not attempt more than two breaths each timebefore returning to chest compressions

If there is more than one rescuer present, another should takeover CPR every 12 min to prevent fatigue. Ensure theminimum of delay during the changeover of rescuers



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Chest-compression-only CPR may be used as follows:

If you are not able or are unwilling to give rescuebreaths, give chest compressions only

If chest compressions only are given, these shouldbe continuous, at a rate of 100 min- 1

Stop to recheck the victim only if he startsbreathing normally; otherwise do not interruptresuscitation



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7. Continue resuscitation until

Qualified help arrives and takes over

The victim starts breathing normally You become exhausted



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Automated external defibrillator

Automated external defibrillators are sophisticated,reliable computerized devices that use voice andvisual prompts to guide lay rescuers and health-care professionals to safely attempt defibrillation in

cardiac arrest victims 1

Use of AEDs is not recommended for children lessthan 1 year 2

1. Deakin CD, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2005. Section 3. Electricaltherapies: Automated external defibrillators, defibrillation, cardioversion and pacing. Resuscitation 2005;67S1: S25-37.

2. Handley AJ, Koster R, Monsieurs K, Perkins GD, Davies S Bossaert L. European Resuscitation CouncilGuidelines for Resuscitation 2005. Section 2. Adult basic life support and use of automated externaldefibrillators. Resuscitation 2005; 67S1: S7-23.


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Sequence for use of an AED

1. Make sure you, the victim, and any bystanders aresafe

2. If the victim is unresponsive and not breathingnormally, send someone for the AED and to call foran ambulance

3. Start CPR according to the guidelines for BLS



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4. As soon as the defibrillator arrives

Switch on the defibrillator and attach the electrodepads. If more than one rescuer is present, CPRshould be continued while this is carried out

Follow the spoken/visual directions

Ensure that nobody touches the victim while theAED is analyzing the rhythm



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5. If a shock is indicated

Ensure that nobody touches the victim

Push shock button as directed (fully automatic AEDswill deliver the shock automatically)

Continue as directed by the voice/visual prompts



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If no shock indicated

Immediately resume CPR, using a ratio of 30compressions to 2 rescue breaths

Continue as directed by the voice/visual prompts



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6. Continue to follow the AED prompts until

Qualified help arrives and takes over

The victim starts to breathe normally You become exhausted



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