Chest compressions
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Chest compressions. Indication. If after 30 seconds of effective bag and mask ventilation with 100% oxygen, heart rate is below 60 per minute. When to stop chest compressions. When heart rate is 60 per minute or more. Principle.

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Chest compressions

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Chest compressions

Chest compressions


Indication

Indication

  • If after 30 seconds of effective bag and mask ventilation with 100% oxygen,

    heart rate is

    below 60 per minute


When to stop chest compressions

When to stop chest compressions

  • When heart rate is 60 per minute or more


Principle

Principle

  • Pump out blood from the heart during compression and fill up blood in the heart during release

  • Must always be accompanied by ventilation with 100% oxygen


Mechanism of chest compressions

Mechanism of Chest Compressions

CompressRelease

sternum

heart

heart


Components

Components

  • Position

    • Neck slightly extended with firm support for the back

    • Lower 1/3rd of sternum between nipple line & sternum

  • Pressure required – depth

    • 1/3rd of the AP diameter of chest

  • Rate

    • 90/min


Chest compressions1

Chest Compressions

Position

  • Lower third of sternum

  • Between nipple line and xiphisternum


Techniques of chest compressions

Thumb method Two-finger method

Techniques of Chest Compressions


Techniques

Techniques

  • Thumb technique

  • Two-finger technique

    # Do not remove thumbs/finger from chest


Thumb technique

Thumb technique

  • Thumbs on sternum, hands on torso & finger supporting the back

  • Thumbs flexed at the first joint

  • Pressure applied vertical


Chest compressions2

Chest Compressions


2 finger technique

2-finger technique

  • Easier with right hand for right handed

  • Index and middle or ring fingers

  • Other hand used to support the back

  • Pressure applied vertically


Chest compressions3

Chest Compressions


Preferred method thumb

Preferred method - thumb

  • Advantages

    • Better control of depth

    • Less tiring

    • Superior generation of peak systolic & coronary perfusion pressure

    • Nails do not hinder performance

  • Disadvantages

    • Difficult when baby is big

    • Umbilicus difficult to cannulate.


  • Compression

    Compression

    • One compression consists downward compression plus the release

    • Actual distance is not a number but depends on size of baby

    • Duration of the downward stroke should be shorter than release to produce max COP


    Rate adequacy

    Rate & adequacy

    Rate

    • 3 CC then 1 ventilation (1:3)

    • 90 CC to 30 ventilation in one minute

      Adequacy

    • Palpate femoral/carotid pulse


    Cycle of events

    Cycle of events

    • One – and – two –and – three – and – breathe – and

    • Consists of 3 compression & one ventilation

    • 120 events in 60 seconds

    • 1 cycles in 2 seconds


    Chest compressions4

    Chest Compressions

    Dangers

    • Broken ribs

    • Lacerated liver

    • Pneumothorax

      Precautions

    • No pressure on the ribs, xiphisternum, abdomen

    • Do not lift thumbs/fingers


    Evaluation after 30 sec of cc bmv

    Evaluation after 30 sec of CC & BMV

    • HR 60 per minute or more Stop CC, continue BMV at 40-60/min

    • If no improvement, check :

      • Effectiveness of BMV

      • Oxygen is 100%

      • Technique of CC is correct


    Key points

    Key points

    • When to do?

    • Why to do ?

    • How to do?

    • Which is best ?

    • When to stop ?

    • What if fails ?


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