09 cardiac emergencies and cpr
TRANSCRIPT
-
8/13/2019 09 Cardiac Emergencies and CPR
1/57
9-1
CardiacEmergencies andCPRLesson 9
-
8/13/2019 09 Cardiac Emergencies and CPR
2/57
9-2
Introduction Basic 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 cardiopulmonary resuscitation (CPR) CPR is commonly given to patients in cardiacarrest as a result of heart attack
-
8/13/2019 09 Cardiac Emergencies and CPR
3/57
Review of
CirculatorySystem
Circulatory systemconsists of heart, blood,
and blood vessels.
-
8/13/2019 09 Cardiac Emergencies and CPR
4/57
9-4
Cardiovascular System: PrimaryFunctions
Transports blood to lungs Delivers carbon dioxide and picks up oxygen
Transports oxygen and nutrients to allparts of body Helps regulate body temperature
Helps maintain bodys fluid balance
-
8/13/2019 09 Cardiac Emergencies and CPR
5/57
9-5
Anatomy and Physiology of theHeart
Ventricles pump blood through two loops or cycles inbody
Right ventricle pumps blood to lungs to pick up oxygenand release carbon dioxide
Blood returns to left atrium and then flows into leftventricle Left ventricle pumps oxygenated blood through arteries
to all areas of body Blood returns through veins to right atrium, to be
pumped again to lungs Within heart, valves prevent back flow of blood so that itmoves only in one direction through these cycles
-
8/13/2019 09 Cardiac Emergencies and CPR
6/57
Heart is composed of aunique type of muscle(myocardium) that contractsto make pumping action.
Heart Muscle
-
8/13/2019 09 Cardiac Emergencies and CPR
7/57
Contractions arecontrolled by electricalsignals under nervoussystem control
Heart Muscle
-
8/13/2019 09 Cardiac Emergencies and CPR
8/57
9-8
Arteries Arterial blood is oxygenated, bright red, and
under pressure 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 artery of lower arm Arteries are generally deeper in body than veins
and more protected
-
8/13/2019 09 Cardiac Emergencies and CPR
9/57
Pulse When left ventriclecontracts, wave of blood
is sent through arteriescausing pulsing bloodpressure changes in
arteries that can bepalpated in certain bodylocations
A pulse can be feltanywhere an arterypasses near skin surfaceand over a bone
Palpate carotid pulse oneither side of neck
-
8/13/2019 09 Cardiac Emergencies and CPR
10/57
Pulse continued Palpate femoral pulsein crease between
abdomen and thigh Palpate radial pulse on
the palm side of wrist
proximal to base ofthumb Palpate brachial pulse
on the inside of armbetween elbow and
shoulder
-
8/13/2019 09 Cardiac Emergencies and CPR
11/57
9-11
Capillaries
Arteries progressively branch into smallervessels 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 bodycells
-
8/13/2019 09 Cardiac Emergencies and CPR
12/57
9-12
Veins
From capillaries, blood drains back to heartthrough extensive system of veins
Venous blood is dark red, deoxygenated, and
under less pressure than arterial blood Blood flows more evenly through veins, which
dont have a pulse
Veins have valves that prevent blood backflow
-
8/13/2019 09 Cardiac Emergencies and CPR
13/57
9-13
Heart Rate
Heart rate, measured as pulse, is affected bymany factors
With exercise, fever, or emotional excitement,
heart rate increases to meet bodys greater needfor oxygen
Various injuries and illnesses may eitherincrease or decrease heart rate
-
8/13/2019 09 Cardiac Emergencies and CPR
14/57
9-14
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
-
8/13/2019 09 Cardiac Emergencies and CPR
15/57
9-15
Circulatory System:Emergencies continued
Heart attack Can lead to cardiac arrest
Ventricular fibrillation Heart muscle flutters rather than pumping
blood
-
8/13/2019 09 Cardiac Emergencies and CPR
16/57
9-16
Cardiac Arrest
Heart may stop (cardiac arrest) as a result ofheart attack
Brain damage begins 4 - 6 minutes after cardiac
arrest Brain damage becomes irreversible in 8 - 10
minutes
Dysrhythmia, an abnormal heartbeat, may alsoreduce hearts pumping effectiveness
-
8/13/2019 09 Cardiac Emergencies and CPR
17/57
9-17
Causes of Cardiac Arrest
Heart attack Drowning Suffocation Stroke Allergic reaction
Diabetic emergency Prolonged seizures Drug overdose Electric shock Certain injuries
-
8/13/2019 09 Cardiac Emergencies and CPR
18/57
Cardiac Chain of Survival
-
8/13/2019 09 Cardiac Emergencies and CPR
19/57
9-19
Call First vs. Call Fast
Call First If alone with adult victim Any victim of any age seen to collapse
suddenly Call Fast
If alone with child victim
Unresponsive victim in cardiac arrest becauseof respiratory arrest
-
8/13/2019 09 Cardiac Emergencies and CPR
20/57
9-20
Cardiopulmonary Resuscitation(CPR)
CPR helps keep patient alive by circulatingsome oxygenated blood to vital organs
Ventilations move oxygen into lungs where it ispicked up by blood
Compressions on sternum increase pressureinside chest, moving some blood to brain/othertissues
-
8/13/2019 09 Cardiac Emergencies and CPR
21/57
9-21
Cardiopulmonary Resuscitation(CPR) continued
Blood circulation resulting from chestcompressions not as strong as circulation fromheartbeat Can help keep brain/other tissues alive until
normal heart rhythm restored
-
8/13/2019 09 Cardiac Emergencies and CPR
22/57
9-22
Cardiopulmonary Resuscitation(CPR) continued
Often electric shock from AED is needed torestore a heartbeat and CPR can keep patientviable 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
-
8/13/2019 09 Cardiac Emergencies and CPR
23/57
9-23
CPR Saves Lives
CPR and defibrillation within 3-5 minutescan save over 50% of cardiac arrestvictims
CPR followed by AED saves thousands oflives each year
In most cases CPR helps keep victim aliveuntil EMS or AED arrives
-
8/13/2019 09 Cardiac Emergencies and CPR
24/57
9-24
General Technique of CPR If unresponsive, not breathing, and no pulse,
start chest compressions Find the correct hand position
Two hands for adults One or 2 hands for child Two fingers for infant
-
8/13/2019 09 Cardiac Emergencies and CPR
25/57
9-25
General Technique of CPRcontinued
Compress chest hard and fast at a rate of 100compressions/minute Adult = 1 1/2 to 2 inches deep Infant/child = 1/3 to 1/2 chest depth
Release completely between compressions
-
8/13/2019 09 Cardiac Emergencies and CPR
26/57
9-26
General Technique of CPRcontinued
If alone, alternate 30 chest compressionsand 2 ventilations for any age patient
In two-rescuer CPR for infant/child,alternate 15 compressions and 2ventilations Chest-encircling method in infant
Give each ventilation over 1 second Follow local protocol regarding oxygen
-
8/13/2019 09 Cardiac Emergencies and CPR
27/57
9-27
Single-Rescuer CPR
1. Check patients responsiveness, openairway, and determine that patient is notbreathing adequately
2. Give 2 ventilations, each lasting 1 second3. Determine victim has no pulse
-
8/13/2019 09 Cardiac Emergencies and CPR
28/57
9-28
Single-Rescuer CPR
2. Give 2 ventilations,each lasting 1second
3. Determine victim hasno pulse
-
8/13/2019 09 Cardiac Emergencies and CPR
29/57
9-29
Put hand(s) in correct position for chestcompressions
Gi 30 h i f 100
-
8/13/2019 09 Cardiac Emergencies and CPR
30/57
Give 30 chest compressions at rate of 100per minute
Then give 2 ventilations
-
8/13/2019 09 Cardiac Emergencies and CPR
31/57
9-31
Continue CPR until: Patient begins to move AED brought to scene and ready to use
Professional help arrives to take over You are too exhausted to continue
-
8/13/2019 09 Cardiac Emergencies and CPR
32/57
9-32
If patient starts moving, check foradequate breathing
If patient is breathing adequately, putpatient in recovery position and monitorbreathing
When AED arrives, start AED sequence
-
8/13/2019 09 Cardiac Emergencies and CPR
33/57
9-33
Chest Compressions Alert Be careful with your
hand position For adults/children,
keep your fingersoff patients chest
Do not givecompressions over
bottom tip ofbreastbone
-
8/13/2019 09 Cardiac Emergencies and CPR
34/57
9-34
Chest Compressions Alert
When compressing,keep elbowsstraight and hands
in contact withpatients chest at alltimes
-
8/13/2019 09 Cardiac Emergencies and CPR
35/57
9-35
Chest Compressions Alert Compress chest
hard and fast, butlet chest recoilcompletely betweencompressions.Minimize amount oftime used givingventilationsbetween sets ofcompressions.
-
8/13/2019 09 Cardiac Emergencies and CPR
36/57
9-36
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 inineffective blood flow Compressions may be given at too fast a rate Only good-quality CPR improves chances of
survival
-
8/13/2019 09 Cardiac Emergencies and CPR
37/57
9-37
Chest Compressions:Bradycardia in Child
Infant or child being given rescue breathsor oxygen may have a pulse but stillinadequate perfusion
If pulse < 60 beats/minute and infant orchild has signs of poor perfusion, provideCPR
-
8/13/2019 09 Cardiac Emergencies and CPR
38/57
9-38
Two-Rescuer CPR for Adults andChildren
Minimizes timebetween rescuebreaths and
compressions CPR becomes moreeffective
Can more quickly set
up AED Reduces rescuer
fatigue
-
8/13/2019 09 Cardiac Emergencies and CPR
39/57
9-39
Two-Rescuer CPR
Performed in cycles of 30:2 for adult (15:2for infant or child)
One rescuer provides breaths, secondrescuer gives chest compressions
Rescuers switch positions every 2 minutes Change done after full CPR cycle Accomplish change in < 5 seconds
-
8/13/2019 09 Cardiac Emergencies and CPR
40/57
9-40
Two-Rescuer CPR continued
If AED present, one rescuer gives CPRwhile the other sets up unit
If unit advises CPR, rescuers give CPRtogether
Third rescuer can apply cricoid pressure
-
8/13/2019 09 Cardiac Emergencies and CPR
41/57
9-41
Two-Rescuer CPR continued
If you are assisting another trained rescuer whoplaces an advanced airway: Chest compressions given continually
No pauses for ventilations Give ventilations at rate of 8 10 breaths/
minute
-
8/13/2019 09 Cardiac Emergencies and CPR
42/57
9-42
Transitioning from One-RescuerCPR to Two-Rescuer CPR
Second rescuer moves into position on other sideto prepare to take over chest compressions
First rescuer completes a cycle of compressionsand ventilationsWhile first rescuer pauses to check for a pulse,second rescuer finds correct hand position forcompressions
-
8/13/2019 09 Cardiac Emergencies and CPR
43/57
9-43
Transitioning from One-RescuerCPR to Two-Rescuer CPR
When first rescuer says, No pulse, continue CPR,second rescuer begins chest compressions andfirst rescuer then gives only ventilations
-
8/13/2019 09 Cardiac Emergencies and CPR
44/57
9-44
Differences in Two-RescuerTraining
If First Responder started CPR, arriving secondrescuer may have a higher level of training
Rescuer with greater training determines how
CPR should best be continued
-
8/13/2019 09 Cardiac Emergencies and CPR
45/57
9-45
Skill:CPR For Adultor Child(Two Rescuers)
-
8/13/2019 09 Cardiac Emergencies and CPR
46/57
9-46
Rescuer 1 checks ABCs. Rescuer 2locates site for chest compressions.
-
8/13/2019 09 Cardiac Emergencies and CPR
47/57
9-47
If no pulse, rescuer 2 gives 30compressions for adult (15 for child) at
rate of 100/minute.
-
8/13/2019 09 Cardiac Emergencies and CPR
48/57
9-48
Rescuer 1 gives 2 breaths.
C i l f 30 2 f d l (15 2 f
-
8/13/2019 09 Cardiac Emergencies and CPR
49/57
9-49
Continue cycles of 30:2 for adults (15:2 forchild). After 5 cycles (~ 2 minutes) switchpositions.
-
8/13/2019 09 Cardiac Emergencies and CPR
50/57
9-50
Adult or Child Two-Rescuer CPRContinued
Continue CPR until: Patient moves AED brought to scene and ready to use
Advanced help arrives and takes over If patient starts breathing and has pulse, put in
recovery position and monitor ABCs
If AED brought to scene, start AED sequence
Uses different hand position
-
8/13/2019 09 Cardiac Emergencies and CPR
51/57
p Place thumbs of both hands on sternum while fingers
encircle chest Compress breastbone with both thumbs while
squeezing chest with fingers Same rate and depth as usual
Two-Rescuer CPR:
Infants
-
8/13/2019 09 Cardiac Emergencies and CPR
52/57
9-52
Skill:CPR: Infants
Two Rescuers
-
8/13/2019 09 Cardiac Emergencies and CPR
53/57
9-53
Rescuer 1 checks ABCs. Rescuer 2locates site for chest
compressions.
-
8/13/2019 09 Cardiac Emergencies and CPR
54/57
9-54
If no pulse, rescuer 2gives 15 chestcompressions.
-
8/13/2019 09 Cardiac Emergencies and CPR
55/57
9-55
Rescuer 1 gives 2 breaths.
-
8/13/2019 09 Cardiac Emergencies and CPR
56/57
9-56
Infant Two-Rescuer CPRContinued
Continue cycles of 15:2 for ~ 2 minutes thenswitch roles
Continue CPR until:
Infant moves Advanced help arrives and takes over
If infant starts breathing, hold in recovery
position and monitor ABCs
-
8/13/2019 09 Cardiac Emergencies and CPR
57/57
When Not to Perform CPR
Presence of a Do-Not-Resuscitate (DNR)order
Patient obviously dead (decapitation;
incineration; or clear signs of prolongeddeath, such as rigor mortis and dependentlividity)
Not safe to be on the scene and thepatient cannot be moved somewhere safe
A physician pronounces the patient dead