560 likes | 1.06k Views
Introduction. Basic Life Support needed for patient whose breathing or heart has stoppedVentilations are given to oxygenate blood when breathing is inadequate or has stoppedIf heart has stopped, chest compressions are given to circulate blood to vital organsVentilation combined with chest compressions is called cardiopulmonary resuscitation (CPR)CPR is commonly given to patients in cardiac arrest as a result of heart attack.
E N D
1. Cardiac Emergencies and CPR Lesson 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 cardiac arrest as a result of heart attack
3. Review of Circulatory System Circulatory system consists of heart, blood, and blood vessels.
4. Cardiovascular System: Primary Functions Transports blood to lungs
Delivers carbon dioxide and picks up oxygen
Transports oxygen and nutrients to all parts of body
Helps regulate body temperature
Helps maintain body’s fluid balance
5. Anatomy and Physiology of the Heart Ventricles pump blood through two loops or cycles in body
Right ventricle pumps blood to lungs to pick up oxygen and release carbon dioxide
Blood returns to left atrium and then flows into left ventricle
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 it moves only in one direction through these cycles
6. Heart is composed of a unique type of muscle (myocardium) that contracts to make pumping action. Heart Muscle
7. Contractions are controlled by electrical signals under nervous system control Heart Muscle
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
9. Pulse When left ventricle contracts, wave of blood is sent through arteries causing pulsing blood pressure changes in arteries that can be palpated in certain body locations
A pulse can be felt anywhere an artery passes near skin surface and over a bone
Palpate carotid pulse on either side of neck
10. Pulse continued Palpate femoral pulse in crease between abdomen and thigh
Palpate radial pulse on the palm side of wrist proximal to base of thumb
Palpate brachial pulse on the inside of arm between elbow and shoulder
11. Capillaries Arteries progressively branch into smaller vessels 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 body cells
12. Veins From capillaries, blood drains back to heart through extensive system of veins
Venous blood is dark red, deoxygenated, and under less pressure than arterial blood
Blood flows more evenly through veins, which don’t have a pulse
Veins have valves that prevent blood backflow
13. Heart Rate Heart rate, measured as pulse, is affected by many factors
With exercise, fever, or emotional excitement, heart rate increases to meet body’s greater need for oxygen
Various injuries and illnesses may either increase or decrease heart rate
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
15. Circulatory System: Emergencies continued Heart attack
Can lead to cardiac arrest
Ventricular fibrillation
Heart muscle flutters rather than pumping blood
16. Cardiac Arrest Heart may stop (cardiac arrest) as a result of heart attack
Brain damage begins 4 - 6 minutes after cardiac arrest
Brain damage becomes irreversible in 8 - 10 minutes
Dysrhythmia, an abnormal heartbeat, may also reduce heart’s pumping effectiveness
17. Causes of Cardiac Arrest Heart attack
Drowning
Suffocation
Stroke
Allergic reaction
Diabetic emergency
Prolonged seizures
Drug overdose
Electric shock
Certain injuries
18. Cardiac Chain of Survival
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 because of respiratory arrest
20. Cardiopulmonary Resuscitation (CPR) CPR helps keep patient alive by circulating some oxygenated blood to vital organs
Ventilations move oxygen into lungs where it is picked up by blood
Compressions on sternum increase pressure inside chest, moving some blood to brain/other tissues
21. Cardiopulmonary Resuscitation (CPR) continued Blood circulation resulting from chest compressions not as strong as circulation from heartbeat
Can help keep brain/other tissues alive until normal heart rhythm restored
22. Cardiopulmonary Resuscitation (CPR) continued Often electric shock from AED is needed to restore a heartbeat—and CPR can keep patient viable 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
23. CPR Saves Lives CPR and defibrillation within 3-5 minutes can save over 50% of cardiac arrest victims
CPR followed by AED saves thousands of lives each year
In most cases CPR helps keep victim alive until EMS or AED arrives
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
25. General Technique of CPR continued Compress chest hard and fast at a rate of 100 compressions/minute
Adult = 1 1/2 to 2 inches deep
Infant/child = 1/3 to 1/2 chest depth
Release completely between compressions
26. General Technique of CPR continued If alone, alternate 30 chest compressions and 2 ventilations for any age patient
In two-rescuer CPR for infant/child, alternate 15 compressions and 2 ventilations
Chest-encircling method in infant
Give each ventilation over 1 second
Follow local protocol regarding oxygen
27. Single-Rescuer CPR 1. Check patient’s responsiveness, open airway, and determine that patient is not breathing adequately
2. Give 2 ventilations, each lasting 1 second
3. Determine victim has no pulse
28. Single-Rescuer CPR 2. Give 2 ventilations, each lasting 1 second
3. Determine victim has no pulse
33. Chest Compressions Alert Be careful with your hand position
For adults/children, keep your fingers off patient’s chest
Do not give compressions over bottom tip of breastbone
34. Chest Compressions Alert When compressing, keep elbows straight and hands in contact with patient’s chest at all times
35. Chest Compressions Alert Compress chest hard and fast, but let chest recoil completely between compressions.Minimize amount of time used giving ventilations between sets of compressions.
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 in ineffective blood flow
Compressions may be given at too fast a rate
Only good-quality CPR improves chances of survival
37. Chest Compressions: Bradycardia in Child Infant or child being given rescue breaths or oxygen may have a pulse but still inadequate perfusion
If pulse < 60 beats/minute and infant or child has signs of poor perfusion, provide CPR
38. Two-Rescuer CPR for Adults and Children Minimizes time between rescue breaths and compressions
CPR becomes more effective
Can more quickly set up AED
Reduces rescuer fatigue
39. Two-Rescuer CPR Performed in cycles of 30:2 for adult (15:2 for infant or child)
One rescuer provides breaths, second rescuer gives chest compressions
Rescuers switch positions every 2 minutes
Change done after full CPR cycle
Accomplish change in < 5 seconds
40. Two-Rescuer CPR continued If AED present, one rescuer gives CPR while the other sets up unit
If unit advises CPR, rescuers give CPR together
Third rescuer can apply cricoid pressure
41. Two-Rescuer CPR continued If you are assisting another trained rescuer who places an advanced airway:
Chest compressions given continually
No pauses for ventilations
Give ventilations at rate of 8 – 10 breaths/ minute
42. Transitioning from One-Rescuer CPR to Two-Rescuer CPR Second rescuer moves into position on other side to prepare to take over chest compressions
First rescuer completes a cycle of compressions and ventilations While first rescuer pauses to check for a pulse, second rescuer finds correct hand position for compressions
43. Transitioning from One-Rescuer CPR to Two-Rescuer CPR When first rescuer says, “No pulse, continue CPR,” second rescuer begins chest compressions and first rescuer then gives only ventilations
44. Differences in Two-Rescuer Training If First Responder started CPR, arriving second rescuer may have a higher level of training
Rescuer with greater training determines how CPR should best be continued
45. Skill: CPR For Adult or Child
(Two Rescuers)
46. Rescuer 1 checks ABCs. Rescuer 2 locates site for chest compressions.
47. If no pulse, rescuer 2 gives 30 compressions for adult (15 for child) at rate of 100/minute.
48. Rescuer 1 gives 2 breaths.
49. Continue cycles of 30:2 for adults (15:2 for child). After 5 cycles (~ 2 minutes) switch positions.
50. Adult or Child Two-Rescuer CPR Continued 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
51. Uses different hand position
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
52. Skill: CPR: Infants
Two Rescuers
53. Rescuer 1 checks ABCs. Rescuer 2 locates site for chest compressions.
54. If no pulse, rescuer 2 gives 15 chest compressions.
55. Rescuer 1 gives 2 breaths.
56. Infant Two-Rescuer CPR Continued Continue cycles of 15:2 for ~ 2 minutes then switch roles
Continue CPR until:
Infant moves
Advanced help arrives and takes over
If infant starts breathing, hold in recovery position and monitor ABCs
57. When Not to Perform CPR Presence of a Do-Not-Resuscitate (DNR) order
Patient obviously dead (decapitation; incineration; or clear signs of prolonged death, such as rigor mortis and dependent lividity)
Not safe to be on the scene and the patient cannot be moved somewhere safe
A physician pronounces the patient dead