Cardiopulmonary Resuscitation and AED

Remember the BASICS!

Outline Introduction to CPR History Review of the Circulatory System Causes of Cardiac Arrest CPR AED

Introduction to CPR

Time is Critical! > 300,000 people experience sudden cardiac death in prehospital settings each year. If resuscitation begins within a few minutes, many of these individuals have a chance for survival.

Time is Critical! Begin resuscitation within minutes: Patient’s collapse witnessed EMS immediately activated CPR started immediately Defibrillation within minutes

Trained bystanders are not always available or willing to do CPR. The role of the rescuer is critical in reaching the patient quickly and beginning resuscitation.

Historical Perspective Early 1900s: Shafer Method

Historical Perspective 1960s – Peter Safar –Prone position inadequate –Expired air did provide sufficient O2. –Head tilt, chin lift kept patent airway

Historical Perspective 1955: Paul Zoll: 1 st successful closed chest defibrillation, external pacing

Historical Perspective 1930s: In hospital resuscitation team 1960s: MICU with physicians 1970: Education in Seattle –100,000 laypersons CPR –911 dispatch education –Paramedic training 1979: 1 st AED developed –Sensing electrode in pharynx –Shocking electrode on tongue and abdomen 1974: Training of laypersons formally sanctioned

Review of the Circulatory System

What is the function of the circulatory system?

The Circulatory System Delivers O 2 and nutrients Removes CO 2 and wastes

Why is the function of the circulatory system critical to our survival?

If the heart stops pumping Lack of O 2 and accumulation of wastes quickly lead to death

Can you name some of the major structures of the human heart?

Major Arteries

Where are capillaries found and what is their purpose?

Capillaries Found throughout the body Connect smallest arteries to smallest veins O 2, nutrients, and wastes move through thin walls Microscopic

How does a vein differ from an artery?

Veins Carry blood back to heart Lower pressure

What is the function of blood?

Blood The fluid of the circulatory system Carries O 2, nutrients, and wastes

Heart Physiology Left Ventricle contracts – sends wave of blood Pressure wave felt as pulse No contraction = No blood flow = cardiac arrest

Time is Critical! Brain damage begins in 4–6 min Brain damage irreversible in 8–10 min Circulation must be restored within 4 – 6 minutes.

CPR Provides minimal amount of circulation/oxygenation until cause of cardiac arrest corrected External chest compressions circulate blood Artificial ventilations provide O 2 to lungs

Causes of Cardiac Arrest

Heart disease Respiratory arrest Medical emergencies Drowning and suffocation Congenital heart defects Trauma

The cause of cardiac arrest is important BUT do not delay CPR to obtain history

CPR Combines external chest compressions with artificial ventilation Provides 30% (or less) of normal circulation Only effective for short period of time

CPR – 1 Rescuer Assess responsiveness Summon EMS Position the patient

CPR – 1 Rescuer Check for a pulse (≤ 10 seconds) No pulse..activate EMS… Get AED

CPR – 1 Rescuer If there is no pulse, find your landmarks, lower half of the sternum, between the nipples

CPR – 1 Rescuer Begin chest compressions

CPR – 1 Rescuer Perform 30 chest compressions Push hard Push fast Allow the chest to recoil after each compression

CPR – 1 Rescuer Administer two ventilations then return to compressions

CPR – 2 Rescuer

CPR - Children Use heel of one hand Keep airway open with other hand 30 compressions:2 ventilations if alone (2 rescuers use 15:2)

CPR - Infant Give chest thrusts and puffs of air 30 compressions:2 ventilations if alone 15 compressions: 2 ventilations with 2 rescuers

Sequence of Survival

The chances of survival from cardiac arrest depend upon the sequence (chain) of survival being intact. All links are equally important and one weak link can break the chain.

Sequence of Survival Also known as Chain of Survival Recognition and Early Access Early CPR Defibrillation Early Advanced Care

Recognition and Early Access Depends on public education EMS must be immediately notified dispatchers can provide CPR instructions

Early CPR Must begin within 4-6 minutes of collapse Public training is necessary Rescuers have a critical role

Copyright © 2004 Elsevier (USA). All Rights Reserved Defibrillation Ventricular fibrillation a common cause of Cardiac arrest Can only be corrected with defibrillation

Copyright © 2004 Elsevier (USA). All Rights Reserved Chance of success decreases with time AEDs save lives! Chance of success decreases with time AEDs save lives! Defibrillation

Ventricular Fibrillation V-Fib The most common cause of sudden cardiac death –Chaotic, disorganized heart activity –Heart muscle cannot pump blood

Ventricular Fibrillation V-Fib Requires immediate defibrillation CPR lengthens window of survival

Early Advanced Care Medication Advanced airway management Post-resuscitation care

AED

AEDs Safe, accurate & lightweight Easy to operate What is public access defibrillation?

PAD AEDs in public places Training the public in CPR/AED

Special Considerations Children Clothing Body hair Water Transdermal medication patches Implanted defibrillators or pacemakers Metal surfaces Jewelry and glasses

AED

Assess Check your patient

Universal Steps Power ↓ Patient ↓ Analyze ↓ Shock

Power Turn the power on

Patient Apply pads to patient

Analyze Stay clear while patient’s heart rhythm is analyzed

Clear Head to toe and toe to head: everyone is clear!

Shock Defibrillate

Patient Standard is set of 1 shock Immediately restart CPR for 2 minutes then check pulse

Summary Continual beating, or contracting, of the heart is necessary to keep blood circulating throughout the body. Brain damage begins in 4 to 6 minutes of cardiac arrest. There are many causes of sudden cardiac death, but the most common is ventricular fibrillation.

Summary Survival from cardiac arrest depends on the sequence (chain) of survival. Rescuers are critically important in maintaining the sequence (chain) of survival.

CPR Video

Remember Hard and Fast !! Keep the Beat of Staying Alive !!!