© 2011 national safety council 8-1 cardiac emergencies and cpr lesson 8
TRANSCRIPT
© 2011 National Safety Council 8-1
CARDIAC EMERGENCIESAND CPR
LESSON 8
© 2011 National Safety Council 8-2
Introduction
• Basic cardiac life support needed for patient whose breathing or heart has stopped
• Ventilations are given to oxygenate blood when breathing is inadequate or has stopped
• If heart has stopped, chest compressions are given to circulate blood to vital organs
• Ventilation combined with chest compressions is called CPR
• CPR is commonly given to patients in cardiac arrest as a result of heart attack
© 2011 National Safety Council 8-3
Review of Circulatory System
Circulatory system consists of:
• Heart
• Blood
• Blood vessels
© 2011 National Safety Council 8-4
Cardiovascular System: Primary Functions
• Transports blood to lungs
• Delivers carbon dioxide and picks up oxygen
• Transports oxygen and nutrients to all parts of body
• Helps regulate body temperature
• Helps maintain body’s fluid balance
© 2011 National Safety Council 8-5
Anatomy and Physiology of the Heart
• Ventricles pump blood through two loops or cycles in body
• Right ventricle pumps blood to lungs to pick up oxygen and release carbon dioxide
• Blood returns to left atrium and then flows into left ventricle
• Left ventricle pumps oxygenated blood through arteries to all areas of body, and to pick up carbon dioxide
• Blood returns through veins to right atrium, to be pumped again to lungs
• Within heart, valves prevent back flow of blood so that it moves only in one direction through these cycles
© 2011 National Safety Council 8-6
Heart Muscle
• Heart is composed of a unique type of muscle (myocardium) that contracts to make pumping action
© 2011 National Safety Council 8-7
Heart Muscle (continued)
• Contractions are controlled by electrical signals under nervous system control
© 2011 National Safety Council 8-8
Arteries
• Carotid arteries: major arteries passing through neck to head
• Femoral arteries: major arteries to legs passing through thigh
• Brachial arteries: in upper arm
• Radial arteries: major arteries of lower arm
• Arteries are generally deeper in body than veins and more protected
• Arterial blood is oxygenated, bright red and under pressure
© 2011 National Safety Council 8-9
Pulse
• When left ventricle contracts, wave of blood is sent through arteries causing pulsing blood pressure changes in arteries that can be palpated in certain body locations
• A pulse can be felt anywhere an artery passes near skin surface and over a bone
• Palpate carotid pulse on either side of neck
© 2011 National Safety Council 8-10
Pulse (continued)
• Palpate femoral pulse in crease between abdomen and thigh
• Palpate radial pulse on the palm side of wrist proximal to base of thumb
• Palpate brachial pulse on the inside of arm between elbow and shoulder
© 2011 National Safety Council 8-11
Capillaries
• Arteries progressively branch into smaller vessels that eventually reach capillaries
• Capillaries are very small blood vessels connecting arteries with veins throughout body
• Capillaries have thin walls through which oxygen and carbon dioxide are exchanged with body cells
© 2011 National Safety Council 8-12
Veins
• From capillaries, blood drains back to heart through extensive system of veins
• Venous blood is dark red, deoxygenated and under less pressure than arterial blood
• Blood flows more evenly through veins, which don’t have a pulse
• Veins have valves that prevent blood backflow
© 2011 National Safety Council 8-13
Heart Rate
• Heart rate, measured as pulse, is affected by many factors
• With exercise, fever or emotional excitement, heart rate increases to meet body’s greater need for oxygen
• Various injuries and illnesses may either increase or decrease heart rate
© 2011 National Safety Council 8-14
Circulatory System:Emergencies
• Any condition that affects respiration – reduces ability to deliver oxygen
• Severe bleeding – shock
• Stroke – reduces blood flow to brain
• Heart conditions – reduce tissue oxygenation
© 2011 National Safety Council 8-15
Circulatory System: Emergencies (continued)
• Heart attack – can lead to cardiac arrest
• Ventricular fibrillation – heart muscle flutters rather than pumping blood
© 2011 National Safety Council 8-16
Cardiac Arrest
• Heart may stop (cardiac arrest) as a result of heart attack
• Brain damage begins 4-6 minutes after cardiac arrest
• Brain damage becomes irreversible in 8-10 minutes
• Dysrhythmia, an abnormal heartbeat, may also reduce heart’s pumping effectiveness
© 2011 National Safety Council 8-17
Causes of Cardiac Arrest
• Heart attack
• Drowning
• Suffocation
• Stroke
• Allergic reaction
• Any condition causing respiratory arrest
• Diabetic emergency
• Prolonged seizures
• Drug overdose
• Electric shock
• Certain injuries
© 2011 National Safety Council 8-18
Cardiac Chain of Survival
© 2011 National Safety Council 8-19
Call First vs. Call Fast
• Call First (to get AED on the way)
- If alone with adult found unresponsive and not breathing normally
- If alone with patient of any age seen to collapse suddenly
• Call Fast
- If alone with child found unresponsive and not breathing normally
- If alone with patient in cardiac arrest because of asphyxial arrest
© 2011 National Safety Council 8-20
CPR
• CPR helps keep patient alive by circulating some oxygenated blood to vital organs
• Artificial ventilation moves oxygen into lungs where it is picked up by blood
• External compressions on sternum increase pressure inside chest, moving some blood to brain/other tissues
© 2011 National Safety Council 8-21
CPR (continued)
• Blood circulation resulting from chest compressions not as strong as circulation from heartbeat
- Can help keep brain and other tissues alive until normal heart rhythm restored
© 2011 National Safety Council 8-22
• Often electric shock from AED is needed to restore a heartbeat and CPR can keep patient viable until then
• CPR effective only for a short time
• CPR should be started as soon as possible
• In some instances, the heart may start again spontaneously with CPR
CPR (continued)
© 2011 National Safety Council 8-23
CPR Saves Lives
• CPR and defibrillation within 3-5 minutes can save over 50% of cardiac arrest patients
• CPR followed by AED saves thousands of lives each year
• In most cases CPR helps keep patient alive until EMS or AED arrives
© 2011 National Safety Council 8-24
General Technique of CPR
• If unresponsive, not breathing normally and no pulse, start chest compressions
• Find the correct hand position
- 2 hands for adults
- 1 or 2 hands for child
- 2 fingers for infant
© 2011 National Safety Council 8-25
General Technique of CPR (continued)
• Compress chest hard and fast at a rate of at least 100 compressions/minute
- Adult = at least two inches deep
- Infant/child = at least one-third chest depth
• Let chest return to normal height between compressions
© 2011 National Safety Council 8-26
General Technique of CPR (continued)
• If alone, alternate 30 chest compressions and two ventilations for any age patient
• In two-rescuer CPR for infant or child, alternate 15 compressions and two ventilations
• Use chest-encircling method in infant
• Give each ventilation over one second
• Follow local protocol regarding oxygen
© 2011 National Safety Council 8-27
Factors That Decrease Effectiveness of Chest Compressions
• Compressions that are too shallow
• A compression rate that is too slow
• Not allowing the chest to recoil fully
• Frequent interruptions of compressions
© 2011 National Safety Council 8-28
Skill: 1-Rescuer CPR
1. Determine that the patient is not breathing normally and has no pulse
© 2011 National Safety Council 8-29
2. Put hand(s) in correct position for chest compressions
© 2011 National Safety Council 8-30
3. Give 30 chest compressions at rate of at least 100 per minute
4. Then give two ventilations
5. Continue cycles of compressions and ventilations
© 2011 National Safety Council 8-31
Continue CPR until:
• Patient is breathing normally and has a pulse
• AED brought to scene and ready to use
• Personnel with more training arrive and take over
© 2011 National Safety Council 8-32
• If patient starts breathing normally and has a pulse but is unresponsive, put patient in recovery position and monitor breathing and pulse
• When an AED arrives, start AED sequence for patient who is not breathing normally and has no pulse
© 2011 National Safety Council 8-33
Chest Compressions Alert
• Be careful with your hand position
• For adults and children, keep your fingers off patient’s chest
• Do not give compressions over bottom tip of breastbone
© 2011 National Safety Council 8-34
Chest Compressions Alert (continued)
• When compressing, keep elbows straight and hands in contact with patient’s chest at all times
© 2011 National Safety Council 8-35
Chest Compressions Alert (continued)
• Compress chest hard and fast, but let chest recoil completely between compressions
• Minimize amount of time used giving ventilations between sets of compressions
© 2011 National Safety Council 8-36
Problems with CPR Technique
• CPR often ineffective because of poor technique
• Compressions not delivered steadily and constantly during resuscitation efforts
• Often compressions are too shallow, resulting in ineffective blood flow
• Only good-quality CPR improves chances of survival
© 2011 National Safety Council 8-37
Chest Compressions for Bradycardia in Child
• Infant or child being given rescue breaths or oxygen may have a pulse but still inadequate perfusion
• If pulse <60 beats/minute and infant or child has signs of poor perfusion, provide CPR
© 2011 National Safety Council 8-38
2-Rescuer CPR for Adults and Children
• Minimizes time between rescue breaths and compressions
• CPR becomes more effective
• Can more quickly set up AED
• Reduces rescuer fatigue
© 2011 National Safety Council 8-39
2-Rescuer CPR
• Performed in cycles of 30:2 for adult (15:2 for infant or child)
• One rescuer provides breaths, second rescuer gives chest compressions
• Rescuers switch positions every two minutes
- Change done after full CPR cycle
- Accomplish change in <5 seconds
© 2011 National Safety Council 8-40
2-Rescuer CPR (continued)
• If AED present, one rescuer gives CPR while the other sets up unit
• If unit advises CPR, rescuers resume CPR together
© 2011 National Safety Council 8-41
2-Rescuer CPR (continued)
• If you are assisting another trained rescuer who places an advanced airway:
- Chest compressions given continually at rate of at least 100 per minute
- No pauses for ventilations
- Give ventilations with bag mask at rate of 8-10 breaths/minute
© 2011 National Safety Council 8-42
Transitioning from 1-Rescuer CPR to 2-Rescuer CPR
• Second rescuer moves into position on other side to prepare to take over chest compressions
• First rescuer completes a cycle of compressions and ventilations
• While first rescuer gives ventilations, second rescuer finds correct hand position and begins compressions after second ventilation
© 2011 National Safety Council 8-43
Differences in 2-Rescuer Training
• If EMR started CPR, arriving second rescuer may have a higher level of training
• Rescuer with greater training determines how CPR should best be continued
© 2011 National Safety Council 8-44
Skill: CPR FOR ADULT OR CHILD (TWO-RESCUERS)
© 2011 National Safety Council 8-45
• Rescuer 1 checks for unresponsiveness, normal breathing, and pulse
• Rescuer 2 locates site for chest compressions
© 2011 National Safety Council 8-46
• If no pulse, rescuer 2 gives 30 compressions for adult (15 for child) at rate of at least 100/minute
© 2011 National Safety Council 8-47
• Rescuer 1 gives two breaths
© 2011 National Safety Council 8-48
• Continue cycles of 30:2 for adults (15:2 for child)
• After 5 cycles (~2 minutes), quickly switch positions
© 2011 National Safety Council 8-49
• Continue CPR until:
- Patient is breathing normally and has a pulse
- AED brought to scene and readyto use
- Help arrives and takes over
• If patient starts breathing normally and has pulse but is unresponsive, put in HAINES recovery position and monitor breathing and pulse
• If AED brought to scene, start AED sequence
© 2011 National Safety Council 8-50
Infant Two-Rescuer CPR
• Uses different hand position
• Place thumbs of both hands on sternum just below the nipple line while fingers encircle chest
• Compress breastbone with both thumbs
• Same rate and depth as usual
© 2011 National Safety Council 8-51
Skill: CPR FOR INFANTS (TWO-RESCUERS)
© 2011 National Safety Council 8-52
• Rescuer 1 checks for normal breathing and pulse
• Rescuer 2 locates site for chest compressions
© 2011 National Safety Council 8-53
• If no pulse, rescuer 2 gives 15 chest compressions
© 2011 National Safety Council 8-54
• Rescuer 1 gives 2 breaths
© 2011 National Safety Council 8-55
• Continue cycles of 15:2 for ~ 2 minutes, then quickly switch roles
• Continue CPR until:
- Infant is breathing normally and has a pulse
- AED is ready to use
- Advanced help arrives and takes over
• If infant starts breathing normally but is unresponsive, hold in recovery position and monitor breathing and pulse
© 2011 National Safety Council 8-56
When Not to Perform CPR
• A DNR order is present
• Patient obviously irreversibly dead (decapitation; incineration; or clear signs of prolonged death, such as rigor mortis and dependent lividity)
• Not safe to be on the scene and the patient cannot be moved somewhere safe
• A physician pronounces the patient dead