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Chest compressions

Chest compressions

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Chest compressions

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  1. Chest compressions

  2. Indication • If after 30 seconds of effective bag and mask ventilation with 100% oxygen, heart rate is below 60 per minute

  3. When to stop chest compressions • When heart rate is 60 per minute or more

  4. 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

  5. Mechanism of Chest Compressions CompressRelease sternum heart heart

  6. 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

  7. Chest Compressions Position • Lower third of sternum • Between nipple line and xiphisternum

  8. Thumb method Two-finger method Techniques of Chest Compressions

  9. Techniques • Thumb technique • Two-finger technique # Do not remove thumbs/finger from chest

  10. Thumb technique • Thumbs on sternum, hands on torso & finger supporting the back • Thumbs flexed at the first joint • Pressure applied vertical

  11. Chest Compressions

  12. 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

  13. Chest Compressions

  14. 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.

  15. 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

  16. Rate & adequacy Rate • 3 CC then 1 ventilation (1:3) • 90 CC to 30 ventilation in one minute Adequacy • Palpate femoral/carotid pulse

  17. 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

  18. Chest Compressions Dangers • Broken ribs • Lacerated liver • Pneumothorax Precautions • No pressure on the ribs, xiphisternum, abdomen • Do not lift thumbs/fingers

  19. 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

  20. Key points • When to do? • Why to do ? • How to do? • Which is best ? • When to stop ? • What if fails ?