CPRCPR

CPR Saves LivesCPR Saves Lives

– Cardiopulmonary Resuscitation or CPR and Cardiopulmonary Resuscitation or CPR and defibrillation within 3-5 minutes can save over 50% defibrillation within 3-5 minutes can save over 50% of cardiac arrest victimsof cardiac arrest victims

– CPR followed by AED saves thousands of lives each CPR followed by AED saves thousands of lives each yearyear

– In most cases CPR helps keep victim alive until EMS In most cases CPR helps keep victim alive until EMS or AED arrivesor AED arrives

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Circulatory System Circulatory System BasicsBasics

Circulatory SystemCirculatory System

• Circulatory system consists of heart, blood, and Circulatory system consists of heart, blood, and blood vessels. blood vessels.

• Transports blood to lungsTransports blood to lungs• Delivers carbon dioxide and picks up oxygenDelivers carbon dioxide and picks up oxygen• Transports oxygen and nutrients to all parts of Transports oxygen and nutrients to all parts of

bodybody• Helps regulate body temperatureHelps regulate body temperature• Helps maintain body’s fluid balanceHelps maintain body’s fluid balance

Anatomy of the HeartAnatomy of the Heart

Coronary ArteriesCoronary Arteries

Major ArteriesMajor Arteries

Circulatory System Circulatory System EmergenciesEmergencies

Circulatory System EmergenciesCirculatory System Emergencies

• Any condition that affects respiration reduces Any condition that affects respiration reduces ability to deliver oxygenability to deliver oxygen

• Heart conditionsHeart conditions• Severe bleedingSevere bleeding• ShockShock• StrokeStroke

Cardiac ArrestCardiac Arrest

• Cardiac Arrest (sudden stopping of the heart) Cardiac Arrest (sudden stopping of the heart) may occur as a result of heart attack may occur as a result of heart attack

• Brain damage begins 4 - 6 minutes after Brain damage begins 4 - 6 minutes after cardiac arrestcardiac arrest

• Brain damage becomes irreversible in 8 - 10 Brain damage becomes irreversible in 8 - 10 minutesminutes

• Dysrhythmia, an abnormal heartbeat, may Dysrhythmia, an abnormal heartbeat, may also reduce heart’s pumping effectivenessalso reduce heart’s pumping effectiveness

Causes of Cardiac ArrestCauses of Cardiac Arrest

– Heart attackHeart attack– DrowningDrowning– SuffocationSuffocation– StrokeStroke– Allergic reactionAllergic reaction– Diabetic emergencyDiabetic emergency– Prolonged seizuresProlonged seizures– Drug overdoseDrug overdose– Electric shockElectric shock– Certain injuriesCertain injuries

Chain of SurvivalChain of Survival

• Early Access Early Access • Early CPR Early CPR • Early Defibrillation Early Defibrillation • Early Advanced CareEarly Advanced Care

Cardiopulmonary Resuscitation (CPR)Cardiopulmonary Resuscitation (CPR)

– CPR helps keep patient alive by circulating some CPR helps keep patient alive by circulating some oxygenated blood to vital organsoxygenated blood to vital organs

– VentilationsVentilations move oxygen into lungs where it is move oxygen into lungs where it is picked up by bloodpicked up by blood

– CompressionsCompressions on sternum increase pressure on sternum increase pressure inside chest, moving some blood to brain/other inside chest, moving some blood to brain/other tissuestissues

– CPR effective only for a short time CPR effective only for a short time

– CPR should be started as soon as possibleCPR should be started as soon as possible

– In some instances, the heart may start again In some instances, the heart may start again spontaneously with CPRspontaneously with CPR

Basic SkillsBasic SkillsRescue BreathingRescue Breathing

Chest CompressionsChest Compressions

Rescue BreathingRescue Breathing

• The risk of infection from CPR is extremely low but the US Occupational Safety and Health Administration requires that healthcare workers use standard precautions in the workplace, including CPR

• Standard Precautions include using barrier devices such as a face maskface mask or bag-maskbag-mask device when giving breaths.

Head Tilt-Chin LiftHead Tilt-Chin Lift• Place one hand on the victim’s forehead and

push with your palm to tilt the head back.• Place the fingers of the other hand under the

bony part of the lower jaw near the chin.• Lift the jaw to bring the chin forward.

Jaw Thrust ManeuverJaw Thrust Maneuver• If a victim has a head or neck injury use the jaw

thrust maneuver to open the airway.• Place one hand on each side of the victim’s head• Place your fingers under the angles of the victim’s lower jaw and lift with both hands

Mouth to Mouth BreathingMouth to Mouth Breathing

• Position yourself at the victim’s side• Perform the head tilt / chin lift• Pinch the victim’s nose and cover his mouth

with yours• Deliver air over 1 second to make the chest rise

Mouth to Mask BreathingMouth to Mask Breathing

• Position yourself at the victim’s side.• Place the mask on the victim’s face, using the

bridge of the nose as a guide.• Perform the head tilt / chin lift• Deliver air over 1 second to make the chest rise

Bag-Mask BreathingBag-Mask Breathing• Position yourself at the victim’s side.• Place the mask on the victim’s face, using the bridge of the nose

as a guide.• Using the EC technique, hold the mask in place while you hold the airway open.• Perform the head tilt / chin lift• Squeeze the bag to give breaths (1 second each) watching for the chest rise

Rescue BreathingRescue Breathing• Respiratory Arrest-Respiratory Arrest- an adult, child, or infant has a

pulse but is not breathing effectively• Rescuers should give breaths without compressions.

AdultsAdults Infants and ChildrenInfants and ChildrenGive 1 breath every 5-6 seconds (about 10-12 breaths per minute)

Give 1 breath every 3-5 seconds (about 12-20 breaths per minute)

Give each breath in 1 secondEach breath should make the chest riseCheck the pulse about every 2 minutes

TracheostomiesTracheostomies• Opening created in the airway through which the individual breathes • Rescue breaths must be

given through the stoma

Advanced AirwaysAdvanced Airways

• Secured airways inserted by physicians or paramedics

Chest Chest CompressionsCompressions

Chest Compressions BasicsChest Compressions Basics

• Position yourself at the victim’s side• Make sure the victim is lying face up on a firm

surface• If you suspect a head or neck injury, try to

keep the head, neck, and torso in one line when turning

Hand PlacementHand Placement

• Put the heel of one hand on the center of the victim’s chest on the lower half of the sternum

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

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

Rate and DepthRate and Depth

• Push hard and fast.• Press straight down at least 2 inches • Deliver compressions in a smooth fashion at a

rate of at least 100/min.

One-RescuerOne-Rescuer CPRCPR

1.1. Assess the victim for responseAssess the victim for response and look for normal or abnormal breathing. If there is no response and no breathing, or no normal breathing (i.e. only gasping), shout for help.

Tap and shout, “Are you OK?”

2. If you are alone, activate the emergency activate the emergency response system and get an AEDresponse system and get an AED (or defibrillator) if available and return to the victim.

3. Check the victim’s pulse3. Check the victim’s pulse (take at least 5 seconds but no more than 10 seconds).

4. If you do not definitely feel a pulse within 10 seconds, perform 5 cycles of compressions perform 5 cycles of compressions and breaths (30:2 ratio),and breaths (30:2 ratio), starting with compressions (C-A-B sequence)

CPR SequenceCPR Sequence• ASSESSESASSESSES: Checks for response, no breathing or no : Checks for response, no breathing or no

normal breathing (5-10 seconds)normal breathing (5-10 seconds)• ACTIVATESACTIVATES emergency response system emergency response system• Check for Check for PULSEPULSE (carotid) 5-10 seconds (carotid) 5-10 seconds• GIVES HIGH QUALITY CPR:GIVES HIGH QUALITY CPR:

– Correct Correct HAND PLACEMENTHAND PLACEMENT– ADEQUATE RATEADEQUATE RATE: At least 100/min (30 compressions in 18 : At least 100/min (30 compressions in 18

seconds or less)seconds or less)– ADEQUATE DEPTHADEQUATE DEPTH: 2 inches : 2 inches – MINIMIZES INTERRUPTIONSMINIMIZES INTERRUPTIONS: Gives 2 breaths in less that 10 : Gives 2 breaths in less that 10

secondsseconds

Chest Compressions AlertChest Compressions Alert– Be careful with your hand position Be careful with your hand position – For adults/children, keep your fingers off patient’s For adults/children, keep your fingers off patient’s

chest chest – Do not give compressions over bottom tip of Do not give compressions over bottom tip of

breastbone breastbone – When compressing, keep elbows straight and hands When compressing, keep elbows straight and hands

in contact with patient’s chest at all times in contact with patient’s chest at all times – Compress chest hard and fast, but let chest recoil Compress chest hard and fast, but let chest recoil

completely between compressions. completely between compressions. – Minimize amount of time used giving ventilations Minimize amount of time used giving ventilations

between sets of compressions.between sets of compressions.

AEDAEDAutomated External Automated External

DefibrillatorDefibrillator

AEDAED

• Automated External DefibrillatorAutomated External Defibrillator – computerized devices that can identify cardiac rhythms that need a shock, and then can deliver the shock

• Used to treat victims of sudden cardiac arrest with ventricular fibrillationventricular fibrillation - the heart muscle may “quiver” and/or not contract together to pump blood

• An electric shock can stop the quivering heart fibers• This allows the muscle fibers of the heart to “reset”

so they can begin to contract at the same time

Using the AEDUsing the AED

Power on the AEDPower on the AED

• Open the carrying case or the top of the AED• Turn the power on (some devices will “power

on” automatically when you open the lid.

Power on the AEDPower on the AED

• Open the carrying case or top of the AED• Turn the power on (some devices will “power

on” automatically when you open the lid or case

• The AED will guide you through the steps

Attach AED pads to victim’s bare chest.Attach AED pads to victim’s bare chest.

• Use adult pads for victims 8 years and older• Peel away the backing from the AED pads• Attach the AED pad to the victim’s bare chest

– One in the upper right chest below the collarbone– The other to the side of the left nipple– Attach the pads to the machine

• Attach the AED cable to the device

““Clear” the victim and Analyze the Clear” the victim and Analyze the rhythmrhythm

• Be sure no one is touching the victim• Some AED’s will tell you to push a button to

analyze, others will begin automatically• Some AED’s may take about 5-15 seconds to

analyze

If the AED advises a shock, it will tell If the AED advises a shock, it will tell you to clear the victimyou to clear the victim

• Loudly state a “clear the victim” message• Look to be sure no one is touching the victim• Press the shock button• The shock will produce a sudden contraction

of the victim’s muscles

Resume CPRResume CPR

• If no shock is needed, and after delivering a shock, immediately resume CPR starting with compressions

• After 5 cycles or about 2 minutes, the AED will prompt you to repeat previous steps

• If “no shock advised” immediately restart CPR beginning with chest compressions

Special SituationsSpecial Situations

• Hairy chest – use a razor (in some cases) or quickly remove the AED pad to remove hair

• Water – remove the victim and dry quickly• Implanted defibrillator / pacemaker – do not

place the pad on the device• Transdermal medication – remove the patch

and wipe with a cloth

Operation of an AEDOperation of an AED

• Power on the AED• Attach the padsAttach the pads to the victim’s bare chest and

cable to the device• ““Clear”Clear” the victim and analyzeanalyze the rhythm• If the AED advises a shock, it will tell you to

clear the victim• If no shock is advised

2 Rescuer Sequence with an AED2 Rescuer Sequence with an AED• Check for response and check breathing• Check for pulse• Attempt defibrillation with AED• Power on the AED• Attach the pads to the victim’s bare chest• “Clear” the victim and analyze the rhythm• If the AED advises a shock, it will tell you to clear the victim• If no shock is needed, immediately resume CPR, starting with

compressions• After 5 cycles or about 2 minutes of CPR, the AED will ask you

to clear and analyze the victim

CPR CPR ReviewReview

• What is the rate for performing chest What is the rate for performing chest compressions for a victim of any age?compressions for a victim of any age?

100 per minute

Describe a way you can allow the chest to recoil Describe a way you can allow the chest to recoil completely after each chest compression.completely after each chest compression.

Allow the chest to expand completely between each compression.

After you open the airway and pinch the nose of After you open the airway and pinch the nose of an unresponsive adult or child, what is the an unresponsive adult or child, what is the bestbest way to give mouth-to-mouth breaths? way to give mouth-to-mouth breaths?

Seal your mouth over the victims mouth and give 2 breaths, watching for the chest to rise

What is the What is the bestbest way for a rescuer to know that way for a rescuer to know that a rescue breath is effective?a rescue breath is effective?

The chest will rise with each breath.

You must check adequate breathing before You must check adequate breathing before giving breaths to an unresponsive adult giving breaths to an unresponsive adult victim. You do this by looking for chest rise victim. You do this by looking for chest rise and feeling for airflow through the victim's and feeling for airflow through the victim's nose or mouth. What nose or mouth. What otherother sign should you sign should you assess?assess?

Listen for airflow from the victim’s nose or mouth

When you do not suspect a cervical spine injury, When you do not suspect a cervical spine injury, what is the what is the bestbest way to open an unresponsive way to open an unresponsive victim's airway?victim's airway?

The head tilt / chin lift technique

What should be the next step when you find an What should be the next step when you find an unresponsive adult victim who has agonal unresponsive adult victim who has agonal gasps and you have sent someone to activate gasps and you have sent someone to activate the emergency response system?the emergency response system?

Check the carotid pulse

How do you know when to start cycles of chest How do you know when to start cycles of chest compressions with breaths for an adult?compressions with breaths for an adult?

The victims is unresponsive, is not breathing, and does not have a pulse.

What are the steps common to the operation of What are the steps common to the operation of all AED's in the correct order?all AED's in the correct order?

Power on, attach pads, clear & analyze, clear & deliver shock if advised

After you power on an AED and attach the pads After you power on an AED and attach the pads to the victim, what is the next step you should to the victim, what is the next step you should do?do?

Clear the victim so the AED can analyze the heart rhythm

What might happen if you touch the victim What might happen if you touch the victim while the AED is delivering a shock?while the AED is delivering a shock?

The AED could shock you while it is shocking the victim.

You are using an AED on an adult victim, and the You are using an AED on an adult victim, and the AED gives a "no shock indicated" (or "no shock AED gives a "no shock indicated" (or "no shock advised") message. Until advanced care advised") message. Until advanced care personnel arrive, what should you do next?personnel arrive, what should you do next?

Leave the pads in place and continue CPR

What is the What is the bestbest way to relieve severe choking way to relieve severe choking in a responsive adult?in a responsive adult?

Perform abdominal thrusts

A choking adult becomes unresponsive while A choking adult becomes unresponsive while you are doing abdominal thrusts for severe you are doing abdominal thrusts for severe choking. You ease the victim to the floor and choking. You ease the victim to the floor and send someone to activate your emergency send someone to activate your emergency response system. What should you do next?response system. What should you do next?

Begin CPR, when you open the airway, look for and remove the object if seen, before giving breaths

• Which of the following statements Which of the following statements best best describes why you should minimize describes why you should minimize interruptions when giving chest compressions interruptions when giving chest compressions to any victim of cardiac arrest?to any victim of cardiac arrest?

If you minimize interruptions, you increase the victims chance of survival.

Breathing stops but the heart still continues for Breathing stops but the heart still continues for 2-3 minutes. What is this called?2-3 minutes. What is this called?

Respiratory arrest.

You find a victim lying on his right side. He is not You find a victim lying on his right side. He is not breathing but has a pulse. What should you breathing but has a pulse. What should you do?do?

Give a rescue breath every 5 seconds.

What happens during a cardiac arrest?What happens during a cardiac arrest?

The heart and breathing stop without warning.

Before starting chest compressions, you need to Before starting chest compressions, you need to check for a pulse. What pulse site should you check for a pulse. What pulse site should you use?use?

Carotid

A person shows signs of circulation after CPR A person shows signs of circulation after CPR was started. What should you do?was started. What should you do?

Place the victim in the recovery position, lying on their side.

The purpose of the recovery position is to:The purpose of the recovery position is to:

Prevent aspiration.