Unit 21 Cardiac Arrest and Cardiopulmonary Resuscitation

1. Unit 21 Cardiac Arrest and Cardiopulmonary Resuscitation 韩明华 山东省泰安卫生学校

2. Review • What are the most common causes of upper gastrointestinal hemorrhage? Peptic ulcer disease; erosive gastritis; esophageal varices • Upper GI hemorrhage is characteristically manifested by: Hematemesis and melena • If the blood loss is more than 40% of the total blood volume, it may cause: Hypovolemic shock, with pallor, cool clammy skin, hypotension and tachycardia

3. Learning Objectives • Tell all the steps of the chain of survival and present the importance of each step • Know how to perform one rescuer CPR and two rescuer CPR in adults • Use AED correctly and proficiently

4. BACKGROUND • Approximately 540,000 people die of cardiac arrest per year in China • Survival to hospital discharge presently approximately 5-10% • Typically <20% of bystanderscan perform CPR before arrival of emergency services • Early resuscitation and prompt defibrillation (within 1-2 minutes) can result in >60% survival

5. What is Cardiac Arrest?

6. Causes of Cardiac Arrest • Trauma • Drowning • Electrical shock • Hypersensitivity reactions • Drug overdose • Cardiac dysrhythmias: ventricular fibrillation • CAD/AMI

7. Patient Symptoms of Cardiac Arrest Unconsciousness No breathing No heart sounds No major pulse (carotid or femoral) Dilation of pupils Resulting in… No Oxygen to the Brain or Body Organs

8. Start CPR Immediately • Better chance of survival • Brain damage starts in 4-6 minutes • Brain damage is certain after 10 minutes without CPR

9. CPR-Cardiopulmonary Resuscitation • CPR is the care given to a victim who is not breathing and does not have a pulse. • Revives heart (cardio) and lung (pulmonary) functioning • Keeps blood that contains oxygen flowing to the brain and vital organs until ACLS arrives.

10. How CPR Works • Effective CPR provides 1/4 to 1/3 normal blood flow • Rescue breaths contain 16% oxygen

11. Chain of Survival Early Early Early Early Access CPR Defibrillation Advanced Care Early Defibrillation FAST SPEED IS THE KEY TO SUCCESS

12. Cardiac Chain of Survival • Early recognition and quick call to 1-2-0 • Begin CPR right away • Use AED quickly • EMS get victim to hospital ASAP • Best chance of survival if these things are done QUICKLY!!!

13. CHECK Check the scene for safety: • Make sure there is nothing around that will cause you harm before approaching the victim, such as spilled chemicals, traffic, fire, and other hazardous items.

14. Survey The Scene, then: RAP • R - Responsiveness Are you okay? • Tap shoulder and shout loudly

15. RAP • A - Activate EMS ( if unresponsive) • Call 120 or the local emergency number (If there are other people at the scene, ask them to call for help!) • Make sure you give the 120 operator the correct information!

16. RAP • P - Position on back • On a hard, flat surface • Always be aware of head and spinal cord injuries • Support neck and spinal column

17. Call Steps of CPR

18. ABC • Airway • Breathing • Circulation SAVING A LIFE IS EASY

19. Checking Vital Signs • A – Airway • Open the airway and maintain the airway open • Head tilt chin lift

20. B – Check For Breathing • Look, listen and feel for normal breathing • No longer than 10 seconds

21. Breathing • If the victim is not breathing, give two breaths • Pinch the nose • Seal the mouth with yours • Watch the chest rise • Check for choking • Clear the airway • Mouth to mouth devices • Masks /Shields

22. Compressions • If no signs of life, start chest compression… • Using both hands, give 30 chest compressions at a rate of 100 per minute • Count 1, 2, 3 … 30 / 2 push hard and pushfast

23. Land mark press down on the sternum 1 ½ to 2 inches Place the heel of one hand in the centre of the victim’s chest. Place the heel of your other hand on top of the first hand.

24. 30 : 2 • After 30 compressions open the airway again using head tilt and chin lift give 2 breaths while watching the chest rise.

25. CPR • After 30 chest compressions give: • 2 slow breaths • Continue compressions and breaths at a ratio of 30:2 until help arrives or victim recovers • If the victim starts moving: check breathing

26. Two Partner CPR • Rescuer 1: • RAPAB • Rescuer 2: • place hands for compressions • Compression rate: 30:2 • Switch off when tired

27. Checking for CPR Effectiveness • Does chest rise and fall with rescue breaths? • Have a second rescuer check pulse while you give compressions

28. When Can I Stop CPR? • Victim revives • Trained help arrives • Too exhausted to continue • Unsafe scene • Physician directed (do not resuscitate orders) • Cardiac arrest of longer than 30 minutes • (controversial)

29. Why CPR May Fail • Delay in starting • Improper procedures (ex. Forget to pinch nose) • No ACLS follow-up and delay in defibrillation • Only 15% who receive CPR live to go home • Terminal disease or unmanageable disease (massive heart attack)

30. Complications of CPR • Rib fractures • Laceration of liver, spleen or lungs • Vomiting • Stomach distension

31. Key Points to Adult CPR Here are some Key points you NEED to remember! • Check the person for consciousness • Call for help! • Open the airway and look, listen, and feel for signs of life • Give 30 chest compressions with both hands then open the airway and give 2 rescue breaths. • Continue the 30 to 2 ratio until EMS arrives.

32. CPR-Adult This Video is from the American Heart Association. It will take you through the important steps of CPR for an adult! Click to watch the video!

33. Even With Successful CPR, Most Won’t Survive Without ACLS • ACLS (Advanced Cardiac Life Support) • ACLS includes defibrillation (AED), oxygen, drug therapy

34. AEDAutomated External Defibrillator

35. AED

36. Public access AED

37. Home AED

38. What does an AED do? The AED is programmed to analyze the heart’s electrical activity, and decide whether the electrical shock would help. It then builds up an electric charge and deliver to the patient when you push the button. If a victim truly has no pulse, the AED is the only thing that will bring the victim back to life. CPR only keeps blood and oxygen flowing through the body. CPR alone does NOT restart the heart!

39. Sudden Death Reversal Rates • CPR(only) ……………………… 0-2% • EMS/ER…………………… 5-15% • CPR+AED…….. 30-75%

40. Steps to Using AED

41. Electrode placement Remove electrodes from package Apply to victims :upper right chest left lower side of chest Wet victims should be toweled dry. Hairy chest may need shaving.

42. SWITCH ON AED Some AEDs will automatically switch themselves on when the lid is opened

43. ATTACH PADS TO CASUALTY’S BARE CHEST

44. ANALYSING RHYTHM DO NOT TOUCH VICTIM

45. Stand clear Deliver shock SHOCK INDICATED

46. WARNING! • Don’t Touch Patient During Analysis • Keep Clear of the Victim • While Delivering Shock Trainning Section

47. SHOCK DELIVEREDFOLLOW AED INSTRUCTIONS 30 2

48. IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN RECOVERY POSITION

49. Key Points of Using AED • Turn on AED • Wipe chest dry; Shave chest hair • Attach pads • Analyze rhythm • Deliver shock • WHAT TO DO NEXT- • After shock, give about 2 minutes of CPR.

50. AED-Video This Video is from the European Resuscitation Council.