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Cardiopulmonary Resuscitation

Cardiopulmonary Resuscitation. ACLS. PROLONGED LIFE SUPPORT. BLS. A - Airway B - Breathing C - Circulation D- Defibrillation. Time is Critical!. Brain damage begins in 4–6 min Brain damage irreversible in 8–10 min Circulation must be restored within 4 – 6 minutes.

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Cardiopulmonary Resuscitation

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  1. ASP Medical Clinic/ sept 2012

  2. ASP Medical Clinic/ sept 2012

  3. Cardiopulmonary Resuscitation ACLS PROLONGED LIFE SUPPORT BLS A - Airway B - Breathing C - Circulation D- Defibrillation

  4. Time is Critical! • Brain damage begins in 4–6 min • Brain damage irreversible in 8–10 min Circulation must be restored within 4– 6 minutes.

  5. Causes of Cardiac Arrest • Heart disease • Respiratory arrest • Medical emergencies • Drowning and suffocation • Congenital heart defects • Trauma

  6. The cause of cardiac arrest is important BUT do not delay CPR to obtain history

  7. CPR CPR AGE CATEGORIES ADULT 9+ CHILD 1-9 INFANT 0-1

  8. BASIC LIFE SUPPORT Dr.M.Hajikarimi Interventinal cardiologist

  9. Chain of Survival The 5 links in adult chain of survival are: - Early access - Early CPR - Rapid defibrillation Effective advance life support - Integrated post-cardiac arrest care ASP Medical Clinic/ sept 2012

  10. CAB VS ABC??? ASP Medical Clinic/ sept 2012

  11. CAB VS ABC??? The previous sequence of the “ABC” of basic life support—airway, breathing, compression—has been changed to “CAB”—compression, airway, breathing—based on the recognition that compression alone is the better strategy because it minimizes interruptions in perfusion and avoids excessive ventilation ASP Medical Clinic/ sept 2012

  12. EMERGENCY ACTION PRINCIPLES Assessment D = Danger R = Response C = Circulation A = Airway B = Breathing ASP Medical Clinic/ sept 2012

  13. Danger Make sure the scene is safe for you and victim Response Tap the victim’s shoulder and shout, “Are you all right?” No response, activate EMS “999” Check pulse and breathing ASP Medical Clinic/ sept 2012

  14. CHECK RESPONSE ShakeShake shoulders gently Ask “Are you all right?” If he responds • Leave as you find him. • Find out what is wrong. • Reassess regularly.

  15. SHOUT FOR HELP

  16. No more Look, Listen and Feel should not delay activating EMS 3 things remain simultaneously : Response Breathing Pulse ( within 10 second) ASP Medical Clinic/ sept 2012

  17. Check for a pulse (≤ 10 seconds) No pulse..activate EMS… Get AED

  18. CHECK BREATHING

  19. Chest Compression Compress the center of victims' chest Start compression within 10 seconds of recognition of cardiac arrest Allow complete chest recoil after each compression Minimize interruption in compressions (limit lest than 10 sec) Push hard, push fast: compress at a rate of at least 100/min Compress depth at least 2 inches (5cm) ASP Medical Clinic/ sept 2012

  20. TO LOCATE THE LANDMARK FOR EXTERNAL CHEST COMPRESSION • The technique of costal margin that is as follows: 1. Run your index and middle fingers up the lower margin of the rib cage and locate the sternal notch with your middle finger. The index finger is place next to the middle finger on the lower and of the sternum.

  21. CONT. TO LOCATE THE LANDMARK FOR EXTERNAL CHEST COMPRESSION 2. The heel of the other hand (the one nearest the victim’s head) is placed on the lower half of the sternum, and the other hand is placed on the top of the hand on the sternum so that the hands are parallel.

  22. CONT. TO LOCATE THE LANDMARK FOR EXTERNAL CHEST COMPRESSION 3. Your fingers may be either extended or interlaced but must be kept off the chest.

  23. CONT. TO LOCATE THE LANDMARK FOR EXTERNAL CHEST COMPRESSION 4. Lock your elbows into position, the arms are straightened and shoulders directly over the victim’s sternum. Keep the heel of your hand lightly in contact with the chest during the relaxation phase of chest compression to maintain correct hand position.

  24. CONT. Circulation • PUSH HARD- PUSH FAST: equal compression and relaxation allowing recoil of chest wall. • Chest compression – ventilation 30: 2, for 5 cycles (2 minutes rate of 100 per minute. • Depth of 1.5 to 2 inches.

  25. CPR – 1 Rescuer • If there is no pulse, find your landmarks, lower half of the sternum, between the nipples

  26. CPR – 1 Rescuer • Begin chest compressions

  27. AIRWAY • Open the airway by the head tilt / chin lift maneuver for all victims • Health care personnel use: • Jaw thrust in trauma patient • CHIN LIFT

  28. Head tilt – chin lift

  29. Head tilt – jaw thrust

  30. Cont. AIRWAY

  31. Breathing Give effective breaths that make chest raise Avoid excessive ventilation Ratio 30:2 Recheck after 5 cycles

  32. Breathing Breathing devices 1-way valve face mask - Deliver air over 1 second to make the victim’s chest raise 2.Bag-Mask - Use the E-C clamp technique to hold mask in place while you lift up the jaw to open airway - Squeeze the bag to give breath (1 second each) while watching for chest rise

  33. Breathing Mouth – to Mouth Mouth – to -Mask If you are uncomfortable doing mouth-to-mouth then skip it and Just do Compressions

  34. Rescue Breathing To perform when victim has pulse but no breathing Give 1 breath every 5 to 6 seconds (about 10 to 12 breaths per minute) Rescuer’s exhaled air contain approximately 17% oxygen and 4% carbon dioxide Give each breath 1 second Each breath should result in visible chest rise Check pulse every 2 minutes

  35. Rescue Breathing Avoid giving breaths too rapidly, too forcefully and with too much volume as it will cause gastric inflation. Gastric inflation can resulting victim vomit, aspiration or pneumonia To reduce risk of gastric inflation: Take 1 second to deliver each breath Deliver air until you make victim’s chest rise

  36. Automated Extenal Defibrillator (AED)

  37. Automated External Defibrillator (AED) AEDs are computerized devices that allow laypersons to attempt defibrillation safely. Here are a few facts about defibrillation: • It is the most effective treatment for Ventricular Fibrillation, the most common initial rhythm present in a victim of sudden cardiac arrest. • The probability of successful defibrillation decreases rapidly over time

  38. Use of an AED power button shock button • Power on the AED • Apply pads to the victim's bare chest • Plug the pads into the AED • "Clear" the victim and allow it to analyze • If a shock is advised, "clear" the victim again and press the shock button • Continue chest compressions • Every 2 minutes the AED will repeat the steps

  39. AUTOMATED EXTERNAL DEFIBRILLATION (AED) • AED is recommended to be used in adults and children 1 year of age and older. • Not recommended for infants below one year and neonates. • Indications: unresponsiveness, absence of breathing, absence of detectable pulse. • Contra indications: responsiveness, presence of breathing, presence of detectable pulse. • For sudden witnessed collapse in adult and child, use the AED once it is available. • For un-witnessed cardiac arrest in the pre-hospital setting, use the AED after 5 cycles of CPR (about 2 minutes) • The AED machine must be able to accurately and reliably recognise paediatric shockable rhythms and be capable of delivering energy dose. • Uses: for adult and children 1 year and above, anywhere, • Health care provider who holds valid certificate in BLS. • Most AEDs are equipped with small pads and means of reducing the energy dose. • If child pads/ system is not available, adult's pads/system can be used but paediatric pads can not be used for adults.

  40. Reassessment • After 5 cycles of compressions and ventilations (30:2), check for return of carotid pulse/ femoral pulse and spontaneous breathing. • According to the findings (after 2 minutes): • There is pulse – place in the recovery position, monitor vital signs until EMS arrives. • There is pulse but no breathing: continue rescue breathing every 5- 6 seconds (10-12 breaths). Recheck pulse every 2 minutes. • No pulse or breathing continue CPR 30:2. , until AED arrives or ACLS provider arrives.

  41. RECOVERY POSITIONIf there is pulse and casualty is breathing. 44 ASP Medical Clinic/ sept 2012 NURSING - KDU COLLEGE

  42. STEP 1 If the victim is breathing normally – place the victim in recovery position. 45 ASP Medical Clinic/ sept 2012 NURSING - KDU COLLEGE

  43. STEP 2 46 ASP Medical Clinic/ sept 2012 NURSING - KDU COLLEGE

  44. STEP 3 47 ASP Medical Clinic/ sept 2012 NURSING - KDU COLLEGE

  45. STEP 4 48 ASP Medical Clinic/ sept 2012 NURSING - KDU COLLEGE

  46. ASP Medical Clinic/ sept 2012

  47. Child CPR • Check for responsiveness • Yell for help but don't leave the victim • Check for breathing • Check for movement • Begin chest compressions • After 30 compressions give 2 breaths • Continue 30 compressions and 2 breaths for 5 cycles or 2 minutes • If still no response, activate 911 and get the AED Max. of 10 seconds

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