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Basic Cardiac Life Support Review

B. Basic Cardiac Life Support Review. Topics. Before Beginning Resuscitation Rescue Breathing CPR Clearing Airway Obstructions Applying ECG Electrodes Post–Cardiac Arrest Care. Before Beginning Resuscitation. Back to Topics. Sudden Cardiac Arrest.

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Basic Cardiac Life Support Review

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  1. B Basic Cardiac Life Support Review

  2. Topics Before Beginning Resuscitation Rescue Breathing CPR Clearing Airway Obstructions Applying ECG Electrodes Post–Cardiac Arrest Care

  3. Before Beginning Resuscitation Back to Topics

  4. Sudden Cardiac Arrest • Sudden cardiac arrest, or SCA, can occur without warning to anyone, at any time. • It is one of the leading causes of death among adults in industrialized countries.

  5. Impact • Each year an estimated 295,000 out-of-hospital cardiac arrests in the United States are treated by EMS.

  6. What Happens? • Sudden cardiac arrest happens when the normal electrical impulses in the heart unexpectedly become disorganized. • The normally coordinated mechanical contraction of the heart muscle is lost, and a chaotic, quivering condition known as ventricular fibrillation can occur.

  7. Ventricular Fibrillation Video

  8. Before Beginning Resuscitation • Clinical death • When patient's breathing and heartbeat stop • May be reversible through CPR, other treatments continued on next slide

  9. Before Beginning Resuscitation • Biological death • When brain cells die • Not reversible • Usually within 10 minutes of clinical death continued on next slide

  10. Before Beginning Resuscitation • Cardiopulmonary resuscitation (CPR) • Actions taken to revive person by keeping heart and lungs working • Teamwork is essential to success. • Effort must be tailored to suit specific circumstances of the patient. • Team must adapt the approach to the apparent cause of cardiac arrest.

  11. Assessing the Patient • ABCs • Unresponsiveness • Breathlessness • Pulselessness

  12. Determining Unresponsiveness • First action when you encounter a patient who has collapsed • Tap or gently shake patient. • Shout, "Are you okay?” • If no response to verbal stimuli, pinch the fat of their arm. continued on next slide

  13. Determining Unresponsiveness • If patient is unresponsive, immediately activate EMS. • Unless condition is likely caused by a problem other than heart disease (submersion, injury, drug overdose). • If child or infant, activate EMS after 2 minutes of resuscitation. • Unless reason to think the condition is caused by heart disease

  14. Determining Breathlessness • Make a quick scan of patient for signs of life or breathing. • If these signs are absent, check pulse. • The patient who is breathing adequately does not require resuscitation. • If the patient is not breathing but has a pulse, provide two ventilations.

  15. Determining Pulselessness • Done at same time as evaluating breathing • Feel carotid artery in adult or child. • Feel brachial artery in infant.

  16. Assessing in A-B-C or C-A-B Sequence • Is patient's airway open? • Is patient breathing? • Does patient have circulation of blood (pulse)? continued on next slide

  17. Assessing in A-B-C or C-A-B Sequence • If patient appears lifeless and has no steps, perform in C-A-B order with chest compressions performed before rescue ventilations. • To Remember: Think Fast – Needs a Taxi CAB

  18. Activating EMS • Activate EMS as soon as patient collapses or is discovered in collapse. • If you have assistance, have the other person activate EMS. continued on next slide

  19. Activating EMS • If alone and patient is an adult • First determine unresponsiveness and breathing. • Activate EMS before initiating next steps. • If patient is a child or infant • Perform two minutes resuscitation before activating EMS

  20. Positioning the Patient • Lay patient supine before attempting to open airway and assess breathing and circulation. • Consider spinal precautions. • Open the airway using appropriate maneuver.

  21. Initial Ventilations and Pulse Check • Heart stoppage is the reason most apneic adults are not breathing. • Oxygen often still in patient's bloodstream. • Start CPR with chest compressions, not ventilations, under ordinary circumstances. Do a minimum of 100 compression a minute, aiming for closer to 120. continued on next slide

  22. Initial Ventilations and Pulse Check • When cause of cardiac arrest is respiratory, you may start CPR with ventilations. • Deliver 2 breaths, each over 1 second and enough volume to make chest rise.

  23. Chain of Survival The greatest chance for survival exists when all the links are strong • Early recognition of cardiac arrest and activation of EMS • Immediate CPR with high-quality chest compressions • Rapid defibrillation to the heart • Effective basic and advanced EMS care and transport • Effective post-cardiac arrest care at a hospital

  24. Think About It • Frequently, laypeople are taught a slightly different approach to CPR than that taught to health care providers. How might a layperson's training be different with regard to recognizing cardiac arrest?

  25. Rescue Breathing Back to Topics

  26. Gastric Distention • Rescue breathing can force air into patient's stomach, causing distention. • Can cause two serious problems • Reduced lung volume • Regurgitation continued on next slide

  27. Gastric Distention • Avoiding/preventing gastric distention • Position patient's head properly. • Avoid too forceful ventilations too quickly delivered. • Limit volume of ventilations delivered.

  28. Recovery Position • Appropriate position for patients: • Who resume adequate breathing and pulse after rescue breathing or CPR • Who do not require immobilization for possible spinal injury continued on next slide

  29. Recovery Position • Roll patient onto side • Allows for drainage from the mouth and prevents the tongue from falling backward and causing an airway obstruction

  30. CPR Back to Topics

  31. Checking for Circulation • Before beginning CPR, confirm patient is pulseless. Remember CAB.

  32. Checking for Circulation • In adult or child (not infant), check carotid pulse • Locate "Adam's apple." • Place tips of index and middle fingers directly over midline of this structure and slide fingertips to side of patient's neck closest to you. • Typically found in groove between Adam's apple and muscles along side of neck continued on next slide

  33. Checking for Circulation • In infant, check for brachial pulse. • If infant or child has pulse slower than 60 beats per minute, begin CPR.

  34. Checking for Circulation • Providing chest compressions • Compressions cause increased pressure inside the chest and possible actual compression of the heart. • Blood is forced out of the heart and into circulation. • When pressure is released, heart refills. • Next compression sends fresh blood into circulation and the cycle continues.

  35. How to Perform CPR • Providing chest compressions • Patient supine on hard surface. • Place heel of hand on sternum between nipples. • Put other hand on top of first with fingers interlaced. • Straighten arms and lock elbows. continued on next slide

  36. How to Perform CPR • Providing chest compressions • Deliver compressions straight down. • Compress sternum of typical adult at least 2 inches. • Fully release pressure. • Do not bend elbows. • Do not lift hands from sternum. continued on next slide

  37. Key Point in High Performance CPR • NO longer stopping compressions to ventilate- continuous compressions • NO longer rushing the patient out – now staying in place 15-20 minutes ( MD protocols July 2013) • Replacing Longboard with Reeves- easier and quicker to apply when needed. • Pre-planned CPR assignments - shift/station specific- Code Resource Management

  38. Chest Compressions are the Priority • Chest compressions are the #1 priority • BLS skills are the most important focus. GOOD CPR IS KEY. • ALS interventions should occur around chest compressions. • No more pauses for intubation, IV/IO access or listening for breath sounds.

  39. High Performance • The patient should be ventilated every 6 seconds or 10th chest compression. • Give the breath while the chest is recoiling and only giving enough to see chest rise. • Importance is placed on rotating providers through the compression station to ensure high quality compressions. Rotation occurs every 2 minutes. FOR EMT PRACTICAL STATIONS, YOU MUST KEEP TRACK OF THIS ON YOUR OWN. YOUR EVALUATOR WILL NOT.

  40. Emphasizing the Priorities • Pulse checks. • NO pulse checks after shock. (Even if the AED tells you to) • Check pulse only after the AED prompts “No Shock Advised.” If no pulse, immediately begin 2 minutes of CPR. Do not wait for prompts. • Continue to monitor the effectiveness of chest compressions during CPR.

  41. TABLE B-3 CPR for Adults, Children, and Infants

  42. Unresponsive, Not Breathing, and PulselessSkill Steps - Adult Assess Patient • Pause and assess scene. Scene is safe! • Tap or squeeze shoulder. Ask loudly, “Are you okay?” There is no response! • Quickly look at face and chest for normal breathing. Occasional gasps are not normal. Normal breathing is absent! • Alert EMS and get an AED. • Check for obvious pulse. No Pulse!

  43. Unresponsive, Not Breathing, and PulselessSkill Steps - Adult MD HIGH PERFORMANCE CPR Give Chest Compressions • Place heel of one hand on center of chest. Place heel of second hand on top of first. • Using upper body weight, push hard, at least 2 inches in depth. • Push fast, at least 100-120 times per minute. Allow chest to fully rebound. • Provider gives 2 minutes of CPR, then switches with second provider if possible.

  44. Unresponsive, Not Breathing, and PulselessSkill Steps - Adult MD HIGH PERFORMANCE CPR Give Chest Compressions • NO INTERUPTIONS during 2 minute cycle for ANY reason. • ALL ALS treatments should be done while compressions are being performed. (This includes intubation)

  45. Unresponsive, Not Breathing, and PulselessSkill Steps - Adult MD HIGH PERFORMANCE CPR • 1 ventilation every 10th compression OR ever 5-6 seconds.

  46. Unresponsive, Not Breathing, and PulselessSkill Steps - Adult MD HIGH PERFORMANCE CPR • If an AED becomes available, turn it on immediately and follow voice instructions for using it. • Do NOT stop compressions a) when placing pads and b) when AED is charging to shock. • Only check for pulse is AED advises “No Shock Advised”

  47. MD CODE RESOURCE MANAGEMENT 2 Provider Crew: • Provider 1 – Chest Compressions • Provider 2 – Ventilate, AED, Crew leader. 3 Provider Crew: • Provider 1 – Chest compressions • Provider 2 – Ventilate • Provider 3 – Crew leader, AED 4 Provider Crew: • Provider 1 – Chest compressions • Provider 2 – Ventilate • Provider 3 – AED • Provider 4 – Crew leader

  48. Age Groups for CPR • AHA • Infant is younger than 1 year of age • Child is 1 year to puberty • Adult is puberty and older • Maryland • High Performance CPR performed ONLY on those 8 years of age and older. • If younger, do standard CPR at 30:2

  49. CPR Techniques for Children (Age 1 Year–Puberty) • CPR conducted as for an adult except use heel of one hand for chest compressions • Two hands may be used if necessary to achieve proper compression depth

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