Presence Regional EMS February 2014 BLS CE

 Review the steps to performing quality CPR.  Demonstrate techniques of quality CPR.  Using a variety of scenarios demonstrate the use of an AED.  Discuss the steps to take once the patient has return of a pulse after a cardiac arrest event.

 The complete cessation of cardiac activity  Absence of a carotid pulse  Was terminal before CPR and external defibrillation were developed in the 1960s

 Few cardiac arrest patients survive outside a hospital without a rapid sequence of events. ◦ Chain of survival:  Early recognition and activation of EMS  Immediate bystander CPR  Early defibrillation  Early advanced cardiac life support  Integrated post-arrest care

 CPR prolongs period during which defibrillation can be effective.  Has resuscitated patients with cardiac arrest from ventricular fibrillation  Nontraditional responders are being trained in AED use.

 “Hearts and Brains are going to die” ◦ Peter Safar MD  EMS has the most opportunity to perform CPR, so we should be good at performing good, quality CPR

 Why is CPR Important ◦ Studies have shown that the general population will start CPR only 1/3 of the time and only 15% of that total is done correctly ◦ Chest Compressions can be started within 18 seconds of arriving at the patient, whereas Airway first can delay compressions by 1-2 minutes or more

1.Make sure the scene is SAFE! 2.Check responsiveness and breathing 3.If alone call and get an AED 4.Check for a pulse and if no pulse present begin CPR  Always start CPR with Compressions First!

 Chest compressions and breaths are the same for adults, child, and infant if you are alone ◦ Adult age starts at the onset of puberty (12-14 years of age) ◦ Child is age 1year to the onset of puberty ◦ Infant is anyone under the age of 1year

 Push hard and fast  Rate should be at least 100 per minute  Provide 30 compressions then 2 breaths  Make sure you allow the chest to re-expand completely at the end of each compression

5.Open the airway with head tilt-chin lift 6.Place the mask on the patient’s face 7.Use the E-C clamp technique 8.Deliver each breath over 1 second

 Practice good CPR on manikins with your group.

 The AED should be applied as soon as possible to the patients bare chest ◦ Make sure the pads adhere to the skin  Remove all clothing from the area where the pads need to be placed  Remove any medication patches from the area  Shave any chest hair, the pads need to be on as much bare skin as possible  If the patient has an implanted pacemaker, place the pad at least inch away

 While there are many styles of AEDs they all work the same. The first step is to turn the unit on and follow the voice prompts.

Assess compression effectiveness if CPR is in progress. If the patient is unresponsive and CPR has not been started, begin providing chest compressions and rescue breaths at a ratio of 30 compressions to 2 breaths, continuing until an AED arrives and is ready for use.

Turn on the AED. Apply the AED pads to the chest and attach the pads to the AED. Stop CPR.

Verbally and visually clear the patient. Push the Analyze button, if there is one. Wait for the AED to analyze the cardiac rhythm. If no shock is advised, perform five cycles (2 minutes) of CPR and then reanalyze the cardiac rhythm. If a shock is advised, recheck that all are clear, and push the Shock button. After the shock is delivered, immediately resume CPR beginning with chest compressions.

After five cycles (2 minutes) of CPR, reanalyze the cardiac rhythm. Do not interrupt chest compressions for more than 10 seconds. If shock is advised, clear the patient, push the Shock button, and immediately resume CPR. If no shock is advised, immediately resume CPR. Transport, and contact medical control as needed.

 Practice using the AED trainer on the manikin in various cardiac arrest scenarios.

 If a patient is breathing independently: ◦ Administer oxygen. ◦ Check pulse.  If a patient has a pulse but breathing is inadequate, assist ventilations.

1.Make sure the scene is SAFE! 2.Check responsiveness and breathing 3.If alone call and get an AED 4.Check for a pulse and if no pulse present begin CPR  Always start CPR with Compressions first!  If despite adequate ventilation and oxygenation, pulse is <60, begin chest compressions

 One rescuer: Begin cycles of 30 chest compressions and 2 breaths  Two rescuers: Begin cycles of 15 chest compressions and 2 breaths  Rate should be at least 100 per minute

Place the heel of one or both hands in the center of the chest, in between the nipples, avoiding the xiphoid process. Compress the chest one third the anterior-posterior diameter of the chest at a rate of at least 100 times/min. Coordinate compressions with ventilations in a 30:2 ratio (one rescuer) or 15:2 (two rescuers), pausing for ventilations.

Position the infant on a firm surface while maintaining the airway. Place two fingers in the middle of the sternum just below a line between the nipples. Use two fingers to compress the chest one third to one half its depth at a rate of at least 100 per minute. Allow the sternum to return to its normal position between compressions.

 There are some safety considerations with the use of an AED on children: ◦ If the AED has child pads, use these on children between the ages of 1-8 years. ◦ A manual defibrillator is preferred for defibrillation of infants. ◦ Some AEDs have a key or switch that will deliver a child shock dose.

 If the AED does not have child pads or a child key or switch, adult pads may be used. Use of adult dose is better than no attempt at defibrillation!

1. What is the ratio of compressions to ventilations in adult CPR? 2. True/False: Never use an AED on a patient with an implanted pacemaker. 3. True/False: AED’s can be used on children even if child pads aren’t available. 4. True/False: AEDs can be placed on awake talking patients to monitor their rhythm. 5. List the 5 links in the Chain of Survival.

6. True/False: Always remove medication patches from the patient’s chest before applying an AED. 7. True/False: Chest compressions should be initiated on children 8 years and younger if their heart rate is <60 despite adequate oxygenation and ventilation. 8. True/False: It is acceptable to continue chest compressions while an AED is analyzing.

9. A patient with cardiac arrest secondary to ventricular fibrillation has the greatest chance for survival if: A. CPR is initiated within 10 minutes. B. oxygen and rapid transport are provided. C. defibrillation is provided within 2 minutes. D. paramedics arrive at the scene within 5 minutes.

10. When using the AED to defibrillate a patient in cardiac arrest, you should: A. analyze the cardiac rhythm every 60 seconds. B. check for a pulse following each defibrillation. C. deliver up to three shocks in a row if indicated. D. immediately resume CPR following defibrillation.

1. 30 compressions to 2 breaths 2. False 3. True 4. False 5. Early access, Early CPR, Early Defib, Early Advanced Care, Integrated Post-Arrest Care 6. True 7. True 8. False 9. C 10. D