(Cardiopulmonary Resuscitation)

Why do CPR?

• To keep blood flowing to the heart, brain and other vital organs

• Provide oxygen to the victim• 70% of cardiac arrest pts are in V-fib. CPR

keeps oxygenated blood flow to the vital organs until defibrillation and advanced care can arrive

• Earlier defibrillation=higher survival rate

Distress vs. Arrest

Cardiac Distress• Occurs when the heart is having problems

pumping

Cardiac Arrest• Occurs when the heart• stops contracting• No blood is pumped• through the blood• vessels.

Causes of Cardiac Arrest

• Cardiac related causes—ex. heart attack, CHF, arrythmias

• Stroke• Untreated respiratory arrest• Medical emergencies (eg, electrical shock,• epilepsy, poisoning)• Drowning• Suffocation• Trauma or shock from massive blood loss

SX of MI (myocardial infarction)

• Chest discomfort—lasts more than 15-20 minutes—not relieved with rest or nitroglycerin

• Some describe pain as intense but not everyone• Feeling of weakness • Other signs may include sweating, nausea,

vomiting or shortness of breath

Providing Care for MI

• Recognize Sx of MI• Convince victim to stop activity• Help them rest comfortably• Administer O2• Call for more advanced personnel

• Assist w/ medications• Monitor vitals• Prepare to give CPR• Advanced Cardiac Life Support (ACLS)

Symptoms of CVA (stroke)

• Sudden numbness or weakness, especially on one side

• Sudden confusion, trouble speaking• Sudden trouble seeing in one eye or both eyes• Sudden trouble walking, dizziness• Sudden severe headache with no known

cause

Adult CPR• Adult CPR• 1. Check victim’s responsiveness• 2. Call 9-1-1 and get AED• 3. Open airway (head tilt-chin lift)• 4. Check breathing (look, listen, & feel) 5-10 sec• 5. If no adequate breathing give 2 breaths• 5. Check circulation• 6. Perform chest compressions (30 compressions hard

and fast) Rate of 100 per minute• 7. Cycles of 30 compressions and 2 breaths• 8. Recheck circulation after approx 2 minute

Establish Unresponsiveness

• Tap victim on shoulder and ask “Are you OK?”

Activate EMS

• If victim is unresponsive, activate EMS immediately

• Instruct a bystander to call• If you are alone, you must activate EMS

before performing any other step• If unresponsive & victim is breathing, place in recovery position

Opening the Airway

• Head tilt – Chin lift• Remove any visible objects from mouth• If victim has possible spinal injury, use jaw thrust without a head

tilt

Check for Breathing

• Look, Listen and Feel for Breathing (for at least 5 seconds and not more than 10)

Agonal Gasps

• Sometimes patients may experience gasps in the first few minutes after sudden cardiac arrest

• These gasps are not adequate breathing and you must give the victim breaths

Give 2 Breaths• Pinch the nose closed with your

thumb and index finger• Take a regular breath and seal

your lips around the victim’s mouth, creating an airtight seal

• Slowly breath air into victim’s mouth until victim’s chest rises

• Remove your mouth to let the air come out

• Repeat one more breath

Check Pulse

• Check carotid pulse• Check for 5-10 seconds• If you are not sure if the

victim has a pulse, start CPR

• Unnecessary CPR is less harmful than not performing CPR that is needed

Hand Placement for Chest Compression

• Place the heel of one hand in the center of the victim’s bare chest between the nipples

• Put the heel of your other hand on the top of your first hand

• Straighten your arms and position your shoulders directly over your hands

Chest Compressions• Push hard and fast—rate of

100 per min• Press down 1 ½- 2 inches with

each compression• For each compression press

straight down• At the end of the

compression allow the chest to recoil or re-expand completely

Recheck Circulation

• Cycle=30 compressions and 2 breaths• Recheck pulse

after 5 cycles

When to Stop CPR

• Victim is revived• Replaced by another equally

trained person or physician assumes responsibility

• Exhaustion• Scene becomes unsafe• Physician direction to stop

Differences in Adult, Child, InfantCalling Pulse Hand Hand

postitionRatio

Adult Call 911 once pt is determined unresponsive

Carotid—if no pulse start CPR

Two hands Center of breastbone between the nipples

30:2 1 or 2 rescuer

Child Call after 5 cycles of CPR

Carotid pulse– if no pulse or <60 with sx start CPR

One or two hands

Center of breastbone between the nipples

30:2 for 1 rescuer15:2 for 2 rescuer

Infant Call after 5 cycles of CPR

Brachial pulse-if no pulse or <60 with sx start CPR

2 fingers or two thumbs

Just below nipple line on breastbone

30:2 for 1 rescuer15:2 for 2 rescuer

Child CPR• Steps very similar to adult except you do 5

cycles of CPR before calling 911 if you are alone

• If pulse <60 with signs of poor perfusion, start CPR

• Also you may only use one hand if child is smaller

• Compress 1/3 to ½ the depth of the chest• If you have 2 rescuers, you switch to 15:2 ratio

Infant CPR

• Place 2-3 fingers in center of chest just below nipple line

• Ration 30:2 for single rescuer

• Ratio 15:2 for two rescuer

• Check brachial pulse in upper arm

2 Rescuer Infant CPR

• Switch to 2 thumb-encircling hands technique

AED (Automated External Defibrillator)

• Most common rhythm is sudden cardiac arrest is ventricular fibrillation

• Earlier defibrillation= increased survival rates

Steps to Use an AED1. Power on AED2. Attach electrode pads to patient (Must be

correct size—Do not use child pads for victims 8 years or older

3. “Clear” the victim and ANALYZE the rhythm4. If the AED advises a shock, “CLEAR” THE VICTIM5. Press the SHOCK button6. After shock, start CPR and after 2 minutes of

CPR, repeat steps 3 and 4

Special AED Situations• Hairy chest—either shave chest or use AED

pads to remove hair then use 2nd set of AED pads

• Water—dry victim’s chest• Implanted defibrillator or pacemaker—place

the AED electrode pad at least 1 inch to side of device

• Transdermal Medication Patches—remove the patch and wipe the area clean

Rescue Breathing

• Adults: 1 breath every 5 to 6 (10-12 breaths per minute)

• Child: 1 breath every 3 to 5 seconds (12- 20 breaths per minute)

• Infant: 1 breath every 3 to 5 seconds (12- 20 breaths per minute)

Relief of Choking

• Adults and children– Abdominal Thrusts until relieved or unconscious– once unconscious, CPR but check airway before giving breaths

Infant Choking

• Infants: Back blows and chest thrusts until relieved or becomes unconscious