به نام ایزد توانا cardiopulmona ry resuscitation
TRANSCRIPT
توانا ایزد نام به
CARDIOPULMONARY RESUSCITATION
definition
Cardiopulmonary resuscitation describe a combined technique of mouth-to-mouth ventilation and closed cardiac chest compressions in a pulseless patient
History
CPR is a term that was first used in the early 1960s
Specific techniques have been revised every 5 to 6 years.
The most recent guidelines were released in October 2010
Chain of Survival3
Simplified Universal Adult BLS Algorithm
729 American Heart Association
CPR
Bsic life support Advanced cardiac life support
Elements of BLS
Noninvasive emergency lifesaving care
For any patient having cardiac arrest, the most important steps are
(1) immediate recognition of unresponsiveness, (2) checking for lack of breathing or lack of normal
breathing (3) activating an emergency response system and
retrieving an automated external defibrillator (AED), (4) checking for a pulse (no more than 10 seconds),
and (5) starting cycles of 30 chest compressions followed
by 2 breaths
Responsiveness
Prior to approaching a victim, the rescuer should make sure that the scene is safe; then the victim is assessed for responsiveness by tapping or questioning (“Are you OK?”).
A quick check for presence of breathing or lack of normal breathing should
occur simultaneously then the emergency response system should be activated, and an AED should be quickly retrieved.
Circulation
The health care provider should take no more than 10 seconds to check for a definitive pulse either at the carotid or femoral artery
IF the patient has No pulse, No signs of life, Or the rescuer is unsure,
THEN compressions should be started immediately
METHOD
The heel of the hand should be placed longitudinally on the lower half of the sternum, between the nipples
The sternum should be depressed at least 5 cm (2 inches) at a rate of at least 100 compressions per minute.
Complete chest recoil is necessary to allow for venous return and is important for effective CPR
The pattern should be 30 compressions to 2 breaths (30:2 equals 1 cycle of CPR), regardless of whether one or two rescuers are present.
How CPR Works
717
“C-A-B” rather than “A-B-C”
New for 2010 Initiate chest
compressions before ventilations.
Why Change? Beginning CPR with
30 compressions rather than 2 ventilations leads to a shorter delay to first compression11-13
providing vital blood flow to the heart and brain.
How can CPR be effective without rescue breathing?
because the oxygen level in the blood remains adequate for the first several minutes after cardiac arrest.4
Animal models suggest gasping do allow for some oxygenation and carbon dioxide (CO2)elimination.9-10
AIR WAY opening
Opening of the airway can be achieved by
Simple head tilt–chin lift technique
Oral or nasal airway Tracheal intubation Laryngeal mask
Breathing
chest compression-alone CPR is not inferior to traditional compression-ventilation CPR, health care providers are still expected to provide assisted ventilation
A lone rescuer, if not an expert in airway management, should not use a bag-mask for ventilation, but should use mouth-to-mouth or mouth-to-mask
Assessing ABCs (8 of 18)
NOTE
Care should be taken to avoid rapid or forceful breaths
Delivered tidal volumes are given over 1 second and should produce visible chest rise.
Delivered tidal volumes are given over 1 second and should produce visible chest rise
A lower than normal minute ventilation (cardiac output is much less than normal) should be the goal (CO2 and brain vasoconstriction and delay neurologic recovery.)
Mouth to Mouth Barrier Devices
Assessing ABCs (12 of 18)
Defibrillation
A defibrillator should be attached to the patient as soon as possible.
Proper electrode pad placement on the chest wall should be to the right of the upper sternal border below the clavicle and to the left of the nipple with the center in the midaxillary line
Alternative locations include anteriorposterior, anterior-left infrascapular, and anterior-right infrascapular. Right anterior axillary to left anterior axillary is not recommended(718)
ENERGY USED FOR DEFIBRILLATION amount of energy (joules) delivered is
dependent on type of defibrillator used Two major defibrillator types
monophasic : deliver a unidirectional energy charge Biphasic : deliver bidirectional energy charge more
successful in terminating ventricular tachycardia (VT) and ventricular fibrillation(VF) In addition, biphasic waveform shocks require less energy than traditional monophasic waveform shocks (120 to 200 J versus 360 J, respectively) and may therefore cause less myocardial damage.
Choking The tongue is the most common
obstruction in the unconscious victim (head tilt- chin lift)
Vomit Foreign body
Balloons Foods
Swelling (allergic reactions/ irritants)
Spasm (water is inhaled suddenly)
Conscious Choking (Adult Foreign Body Airway Obstruction)
Give 5 abdominal thrusts (Heimlich maneuver) Place fist just above
the umbilicus (normal size)
Give 5 upward and inward thrusts Pregnant or obese? 5 chest
thrusts Fists on sternum If unsuccessful, support chest with one
hand and give back blows with the other
If Victim Becomes Unconscious After Giving Thrusts
Call 115 Try to support victim with
your knees while lowering victim to the floor
Assess Begin CPR After chest compressions,
check for object before giving breaths breaths
Choking: Conscious Infants Position with
head downward 5 back blows
(check for expelled object)
5 chest thrusts (check for expelled object)
Repeat
Tracheal intubation
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