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CPR

CPR. American Heart Association Guidelines. The Chain of Survival. Immediate recognition of cardiac arrest and activation of the emergency response system Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions. The Chain of Survival. Rapid defibrillation

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CPR

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  1. CPR American Heart Association Guidelines

  2. The Chain of Survival • Immediate recognition of cardiac arrest and activation of the emergency response system • Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions.

  3. The Chain of Survival • Rapid defibrillation • Effective advance life support • Integrated post-cardiac arrest care

  4. C – A – B • C- Chest Compressions • A- Airway • B- Breathing • http://cprguidelines.net/files/2010/10/2010-CPR-Guidelines.jpg

  5. BLS Steps • Assess the victim for a response and look for normal or abnormal breathing. If there is no response and no breathing or normal breathing, shout for help. • If you are alone, activate the emergency response system and get an AED if available and return to the victim.

  6. BLS Steps • Check the victim’s pulse (take at least 5 but no more than 10 seconds) • If you do not definitely feel a pulse within 10 seconds, perform 5 cycles of compressions and breaths (30:2 ratio), starting with compressions (C-A-B sequence)

  7. Chest Compressions • Compressions at least a 100/min • Compression depth of at least 2 inches in adults • Compression depth of 1 ½ inch for infants and 2 inches in children • Allow for complete chest recoil, minimize interruptions in compressions, and avoid excessive ventilation.

  8. http://itsmeso.files.wordpress.com/2013/01/cpr-lay-rescuer-algo.jpghttp://itsmeso.files.wordpress.com/2013/01/cpr-lay-rescuer-algo.jpg

  9. http://1.bp.blogspot.com/_EUrRZc4XR6Y/TNQQb76xNtI/AAAAAAAAAVU/Pad8FcWgzws/s1600/2.jpghttp://1.bp.blogspot.com/_EUrRZc4XR6Y/TNQQb76xNtI/AAAAAAAAAVU/Pad8FcWgzws/s1600/2.jpg

  10. Remembers • Make sure the victim is on a firm hard surface, if not you are just pushing the victim into the soft surface. • Place your hand in the middle of the victims chest, at the nipple line. • Keep your arms straight.

  11. Airways • Head Tilt – Chin Lift: relieves airway obstruction in a unresponsive victim. • Place one hand on victims forehead and push with your palm to tilt the head back. • Place the fingers of your other hand under the bony part of the lower jaw near the chin. • Lift the jaw to bring the chin forward.

  12. Head Tilt – Chin Lift Technique for Rescue Breaths 2 breaths for every 30 compression. Barrier devices are used when giving rescue breaths; face shields, mouth-to-mask, or bag-mask devices.

  13. Airways • Jaw Thrust – is used if there is a suspect head or neck injury and is done by 2 rescuers. • Place one hand on each side of the victims head, resting your elbows on the surface on which the victim is lying. • Place your fingers under the angles of the victim's lower jaw and lift with both hands, displacing the jaw forward. • If the lips close, push the lower lip with your thumb to open the lips.

  14. Barrier Devices • Mouth-to-mask device can be used by 1 or 2 rescuers. • Position yourself at the victims side. • Place mask on victim's face, using the bridge or the nose as a guide for correct position. • Seal mask against the face: • Using the hand that is closer to the top of the victim's head, place your index finger and thumb along the edge of the mask. • Place the thumb of your second hand along the bottom edge of the mask.

  15. Barrier Devices • Place the remaining fingers of your second hand along the bony margin of the jaw and lift the jaw. Perform head tilt-chin lift to open the airway. • While you lift the jaw, press firmly and completely around the outside edge of the mask to seal the mask against the face. • Deliver air over 1 second to make the victim’s chest rise.

  16. Barrier Devices • Bag-Mask: Is the most commonly used devices by healthcare providers. Is not recommend for one resucuer and requires instruction and practice. • Position yourself directly above the victim’s head. • Place mask on the victim’s face, using the bridge of the nose as a guide for correct postion.

  17. Barrier Devices • Use the E-C clamp technique to hold the mask in place while you lift the jaw to hold the airway open. • Squeeze the bag to give breaths (1 second each) while watching for chest rise. Deliver all breaths over 1 second whether or not you use supplementary oxygen.

  18. E-C Clamp Method • Perform head tilt • Place the mask on the face with the narrow portion at the bridge of the nose. • Use the thumb and index finger of one hand to make a “C” on the side of the mask, pressing the edges of the mask to the face. • Use the remaining fingers to lift the angles of the jaw (3 fingers form an “E”), open the airway, and press the face to the mask.

  19. 2 Person CPR • The first rescuer remains with the victim and start CPR immediately, beginning with chest compressions. • The second rescuer activates the emergency response system and gets an AED if available. • The second rescuer will set up and use the AED as soon as possible. • The rescuers will then give compressions and breaths, but switching roles every 5 cycles of CPR (every 2 minutes).

  20. 2 Person CPR • Rescuer 1: At the victim’s side • Perform chest compressions • Count compressions aloud • Compress at least 2 inches • Allow for complete chest recoil after each compression • Compress at a rate of at least 100/min • Use a compression-to-breath ratio of 30:2. • Switch duties with the second rescuer every 5 cycles or about 2 minutes, taking <5 seconds to switch.

  21. 2 Person CPR • Rescuer 2: At the victim’s head • Maintain an open airway using either method. • Give breaths watching for chest rise and avoid excessive ventilation. • Encourage the first rescuer to perform compressions that are deep enough and fast enough and to allow complete chest recoil between compressions. • Switch duties with the first rescuer every 5 cycles or about 2 minutes, taking <5 seconds to switch.

  22. AED

  23. Automatic External Defibrillator • A defibrillator delivers an electronic shock to stop the heart muscles from quivering (ventricular fibrillation). • This allows the muscle fibers of the heart to “reset” so that they can begin to contract at the same time. • Once an organized rhythm occurs, the heart muscle may begin to contract effectively.

  24. How to Use an AED • POWER ON the AED (the AED will then guide you through the next steps). • ATTACH AED 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. Press the SHOCK button when clear. • If no shock is needed, and after any shock delivery, immediately resume CPR, starting with chest compressions. • After 5 cycles or 2 minutes of CPR, the AED will prompt you to repeat steps 3 and 4.

  25. How to Attach AED Pads • Choose adult pads (not child pads or child system) for victims 8 years of age and older. • Peel the backing away from the AED pads. • Attach the adhesive pads to the victim’s bare chest. • Place one on the victim’s upper right chest • Place the other pad on the lower left side of chest. • Attach the AED connecting cable to AED if necessary.

  26. Extra AED Info • Shave the victim’s chest if they have too much hair. • Do not use the AED if the victim is in water, dry off the victim’s chest if they are wet. • Do not place pads over a pacemaker, adjust as needed. • Do not place pads over transdermal medication patch or other objects on the surface of the skin. • On children under 8 years of age, use pediatric pads and make sure the AED delivers a child shock dose, by turning a key or switch.

  27. Infant CPR

  28. Infants • This technique is used from newborns to 12 months. • The rescuer checks for a brachial pulse on an infant, for no more than 10 seconds no less then 5 seconds. • Chest compression depth is approximately 1 ½ inches.

  29. 1 Rescuer Infant CPR • Check infant for a response and check breathing. If no response shout for help. • If someone responds send them to activate EMS and to get an AED. • Check the infants brachial pulse. • If no pulse, or pulse rate of <60/min, perform cycles of chest compression and breaths 30:2. • After 5 cycles, if someone has not already done so, activate EMS and get the AED.

  30. Differences with Infants • Check the brachial pulse. • Start CPR then call 911 • Use 2-3 fingers for chest compressions going at least 1 ½ inches. • During 2 person CPR use the 2 thumb-encircling hands technique and a compression to breath ratio of 15:2.

  31. Choking

  32. Mild Airway Obstruction • Signs: • Good air exchange • Can cough forcefully • May wheeze between coughs • Rescuer Action: • Encourage the victim to cough or keep coughing. • If mild airway obstruction persists call 911. • Do not interfere with the victim’s attempts to expel the foreign body, stay and monitor their condition.

  33. Severe Airway Obstruction • Signs: • Poor or no air exchange • Weak, ineffective cough or no cough at all • High-pitched noise while inhaling or no noise at all • Increased respiratory difficulty • Possible cyanosis (turning blue) • Unable to speak • Clutching the neck with the thumb and fingers making the universal choking sign.

  34. Severe Airway Obstruction • Rescuer Action: • Ask the victim if he or she is choking. If the victim nods yes and cannot talk, severe airway obstruction is present and you must try to relieve it.

  35. Abdominal Thrusts • Abdominal Thrusts or the Heimlich maneuver is used to relieve choking in a responsive victim 1 year or older. • Abdominal Thrusts: • Stand or kneel behind the victim and wrap your arms around the victim’s waist. • Make a fist with one hand • Place your fist thumb side against the victim’s abdomen at the midline above the navel below the sternum.

  36. Abdominal Thrusts • Grasp your fist with your other hand and press your fist into the victim’s abdomen with a quick, forceful upward thrust. • Repeat thrusts until the object is expelled from the airway or the victim becomes unresponsive • Give each new thrust with a separate, distinct movement to relieve the obstruction. • If patient is pregnant or obese perform chest thrust instead.

  37. Unresponsive Choking Victim • Choking victims may initially be responsive and then become unresponsive. • Activate EMS, call 911 • Lower the victim to the ground (adults and children) and begin CPR with chest compressions.(do not check for a pulse) • Every time you open the airway visually check for the object in the victim’s mouth. Do a finger sweep if you can see the object. • Continue doing CPR till help arrives or until the victim is breathing and has a pulse.

  38. Choking Infants • With choking infants a rescuer will use back blows and chest thrusts. • Kneel or sit with the infant in your lap. • Hold the infant facedown with the head slightly lower than the chest, resting on your forearm. Support the infants head and jaw with your hand, not compressing the victim’s throat. Rest your forearm on your lap or thigh to support the infant.

  39. Choking Infants • Deliver 5 back blows forcefully between the infant’s shoulder blades, using the heel of your hand. Use enough force to attempt to dislodge the object. • After the 5 back blows transfer the infant to your other arm so that they are supine and supported in your other arm. • Provide 5 quick downward chest thrusts rate of 1 per second in the middle of the chest, same as CPR compressions.

  40. Choking Infants • Continue the sequence until the object is removed or the infant becomes unresponsive. • If the infant becomes unresponsive discontinue doing back blows and begin CPR. • Checking for the object every time you open the airway. Remove the object if able with a finger sweep. • Continue until object is remove and infant is responsive or EMS arrives.

  41. Rescue Breaths

  42. Rescue Breathing • For adult, children, and infants that are not breathing effectively but have a pulse. • Adults give 1 breath every 5 to 6 seconds. • Children and infants 1 breath every 3 to 5 seconds. • Give 1 breath in 1 second. • Each breath should result in visible chest rise. • Check the pulse about every 2 seconds.

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