به نام ایزد توانا

1. به نام ایزد توانا CARDIOPULMONARY RESUSCITATION

2. definition Cardiopulmonary resuscitation describe a combined technique of mouth-to-mouth ventilation and closed cardiac chest compressions in a pulseless patient

3. History • CPR is a term that was first used in the early 1960s • Specific techniques have been revised every 5 to 6 years. • The most recent guidelines were released in October 2010

4. Chain of Survival3

5. Simplified Universal Adult BLS Algorithm • 729 American Heart Association

6. CPR • Bsic life support Advanced cardiac life support

7. Elements of BLS • Noninvasive emergency lifesaving care • For any patient having cardiac arrest, the most important steps are (1) immediate recognition of unresponsiveness, (2) checking for lack of breathing or lack of normal breathing (3) activating an emergency response system and retrieving an automated external defibrillator (AED), (4) checking for a pulse (no more than 10 seconds), and (5) starting cycles of 30 chest compressions followed by 2 breaths

8. Responsiveness Prior to approaching a victim, the rescuer should make sure that the scene is safe; then the victim is assessed for responsiveness by tapping or questioning (“Are you OK?”).

9. A quick check for presence of breathing or lack of normal breathing should occur simultaneously then the emergency response system should be activated, and an AED should be quickly retrieved.

10. Circulation • The health care provider should take no more than 10 seconds to check for a definitive pulse either at the carotid or femoral artery • IF the patient has • No pulse, • No signs of life, • Or the rescuer is unsure, • THEN compressions should be started immediately

11. METHOD • The heel of the hand should be placed longitudinally on the lower half of the sternum, between the nipples • The sternum should be depressed at least 5 cm (2 inches) at a rate of at least 100 compressions per minute. • Complete chest recoil is necessary to allow for venous return and is important for effective CPR • The pattern should be 30 compressions to 2 breaths (30:2 equals 1 cycle of CPR), regardless of whether one or two rescuers are present.

12. How CPR Works 717

13. “C-A-B” rather than “A-B-C” New for 2010 • Initiate chest compressions before ventilations. Why Change? • Beginning CPR with 30 compressions rather than 2 ventilations leads to a shorter delay to first compression11-13 providing vital blood flow to the heart and brain.

14. How can CPR be effective without rescue breathing? • because the oxygen level in the blood remains adequate for the first several minutes after cardiac arrest.4 • Animal models suggest gasping do allow for some oxygenation and carbon dioxide (CO2)elimination.9-10

15. AIR WAY opening Opening of the airway can be achieved by Simple head tilt–chin lift technique Oral or nasal airway Tracheal intubation Laryngeal mask

16. Breathing • chest compression-alone CPR is not inferior to traditional compression-ventilation CPR, health care providers are still expected to provide assisted ventilation • A lone rescuer, if not an expert in airway management, should not use a bag-mask for ventilation, but should use mouth-to-mouth or mouth-to-mask

17. Assessing ABCs (8 of 18)

19. NOTE • Care should be taken to avoid rapid or forceful breaths • Delivered tidal volumes are given over 1 second and should produce visible chest rise. • Delivered tidal volumes are given over 1 second and should produce visible chest rise • A lower than normal minute ventilation (cardiac output is much less than normal) should be the goal (CO2 and brain vasoconstriction and delay neurologic recovery.)

20. Mouth to Mouth Barrier Devices

21. Assessing ABCs (12 of 18)

22. Defibrillation • A defibrillator should be attached to the patient as soon as possible. • Proper electrode pad placement on the chest wall should be to the right of the upper sternalborder below the clavicle and to the left of the nipple with the center in the midaxillaryline • Alternative locations include anteriorposterior, anterior-left infrascapular, and anterior-right infrascapular. Right anterior axillary to left anterior axillaryis not recommended(718)

23. ENERGY USED FOR DEFIBRILLATION • amount of energy (joules) delivered is dependent on type of defibrillator used • Two major defibrillator types • monophasic : deliver a unidirectional energy charge • Biphasic : deliver bidirectional energy charge more successful in terminating ventricular tachycardia (VT) and ventricular fibrillation(VF) In addition, biphasic waveform shocks require less energy than traditional monophasicwaveform shocks (120 to 200 J versus 360 J, respectively) and may therefore cause less myocardial damage.

24. Choking • The tongue is the most common obstruction in the unconscious victim (head tilt- chin lift) • Vomit • Foreign body • Balloons • Foods • Swelling (allergic reactions/ irritants) • Spasm (water is inhaled suddenly)

25. Conscious Choking(Adult Foreign Body Airway Obstruction) • Give 5 abdominal thrusts (Heimlich maneuver) • Place fist just above the umbilicus (normal size) • Give 5 upward and inward thrusts • Pregnant or obese? 5 chest thrusts • Fists on sternum • If unsuccessful, support chest with one hand and give back blows with the other

26. If Victim BecomesUnconscious After Giving Thrusts • Call 115 • Try to support victim with your knees while lowering victim to the floor • Assess • Begin CPR • After chest compressions, check for object before giving breaths breaths

27. Choking: Conscious Infants • Position with head downward • 5 back blows (check for expelled object) • 5 chest thrusts (check for expelled object) • Repeat

28. Tracheal intubation • 226-230-239