Cardiopulmonary Resuscitation American Heart Association 2011 Guidelines CPR for Health Providers

CPR for Health Care Providers Adult Child Infant

Terminology  BLS / BCLS  ALS / ACLS  Respiratory Arrest  Arrest, Cardiac Arrest, Code, Code Blue  Ventilations

American Heart Association  Research  Training  Public Education

Chain of Survival  Early Access  Early CPR  Early Defibrillation  Early ACLS

The Myth A little CPR & everything turns out O.K.

Definitions  Clinical Death = no pulse & not breathing  Biological Death = Permanent brain death (irreversible) Begins minutes after arrest

CABD’s of CPR  C = Circulation  A = Airway  B = Breathing  D = Defibrillation

Causes of Cardiac Arrest  Heart attack - (or cardiovascular disease)  Trauma  Drowning  Drugs  Electrocution

Cardiovascular Disease  Heart Attack - myocardial infarction (MI)  Stroke - cerebral vascular accident or CVA (now called “brain attack”)  Aneurysm Can Lead To:

Signs of...  Heart attack = chest pain Typical - pressure, “tightness” Vs Atypical - indigestion, jaw pain

and..  DENIAL is common  Activating EMS is the right thing to do if you have chest pain

Sudden Death  Ventricular Fibrillation

Ventricular Fibrillation  The most effective intervention is early defibrillation

Defibrillators Manual Semiautomatic Automatic Public access is AHA goal

Public Access Defibrillation - PAD  Casinos  Airports  City buildings  Senior centers  Gated communities

Stroke or “Brain Attack”  hemiparesis & hemiparalysis  headache, blurred vision  aphasia (speaking problems)  one sided facial droop #1 Risk factor = hypertension Signs and Symptoms:

CVD risk factors  Factors that influence the probability of cardiovascular disease.

CVD risk factors that cannot be changed  Heredity  Gender  Age Race also plays a role

CVD risk factors that you can change.  Smoking  High blood pressure  High cholesterol**  Lack of exercise

note  Cholesterol is found in eggs, meat, & dairy products.

other factors...  Diabetes  Obesity  Excessive stress

note  Having multiple risk factors poses a much greater risk than having only 1 risk factor.

Pediatric safety Injury due to “accident” #1 cause of pediatric death And most are PREVENTABLE seat belts fire safety pools firearms etc...

Pediatrics  Airway problems are common cause of death in infants & children.  Respiratory arrest leading to cardiac arrest.

Basic principles of CPR Obviously dead Reasons to stop CPR Positioning Initial actions CABDs

Obviously Dead (policy 814)  Decapitation  Incineration  Decomposition  Evisceration of heart, lung, or brain

Obviously Dead (policy 814)  Post mortem lividity & rigor mortis (check apical pulse for 60 seconds)  Special situations  MVI with limited resources  entrapment (> 15 minutes extrication time)  ?

Reasons to Stop CPR  Patient Revives.  Patient is turned over to rescuers of equal or greater training.  Doctor tells you to stop.  You are so exhausted you can not continue.

American Heart Association  Infant0-1 year old  Child1year - onset of puberty  AdultPuberty on

Establish unresponsiveness  Shake & Shout THIS IS THE FIRST THING YOU DO WHEN ASSESSING A UNRESPONSIVE PERSON

Activate EMS  Adults  Initiate immediately and get AED  Children and infants  Witnessed – initiate immediately and get AED  Unwitnessed – 5 cycles of CPR, then initiate and get AED

Position the patient  Supine  On a hard surface

CABD’s of CPR  C = Circulation  A = Airway  B = Breathing  D = Defibrillation

AIRWAY  Conscious Vs Unconscious  anatomical obstruction  solid obstruction  liquid obstruction

AIRWAY  Open the airway.  Head tilt, chin lift : preferred method  If suspected neck injury: Modified jaw thrust.

BREATHING  Mouth to mouth  Mouth to nose & mouth  Mouth to stoma  Mouth to mask

BREATHING Rescue Breathing  Adult = 1 every 5-6 seconds  Child = 1 every 3-5 seconds  Infant = 1 every 3-5 seconds

Adequate Ventilation  No resistance  No escape of air from around mask  Chest Rise - stop when chest begins to rise

Complications of rescue breathing GASTRIC DISTENTION is caused by air entering the stomach Over-ventilating Improper head tilt (no tilt)

Cricoid Pressure  Sellicks Manuever  Prevent gastric inflation/passive regurgitation  Assistance during Endotracheal Intubation

CIRCULATION  Chest compressions  Proper speed  Proper depth  Proper position

Speed of Compressions  Adult100 times / min  Child100 times / min  Infant100 times / min

Depth of Compressions  Adult1 1/2 - 2”  Child /2”  Infant1/2 - 1”  OR 1/3 to 1/2 the patient’s body depth.

Hand Position  At the nipple line  Off the zyphoid process 2 fingers = infant 1 hand = child 2 hands = adult

Ratios Compressions to ventilations Adult = 30:2 (1 and 2 rescuer) Child & infant = 30:2 (1 rescuer) 15:2 (2 rescuer)  The pause is important to allow for slow ventilations

Complications of Compressions  fractured ribs  fractured sternum  lacerated lungs  lacerated liver, blood vessels, etc.,,

if you break ribs.. Check your hand position and keep going!

Pulse Checks  Pause to recheck the pulse after 5 cycles.  Then every few minutes after that.  Pulse check with CPR in progress.

Interrupting CPR  5-10 seconds for pulse checks, etc...  10 seconds absolute maximum break & then only when absolutely necessary  During AED rhythm analysis and delivery of shocks

Special Situations  Cold water drowning (no - it doesn’t have to be very cold)  Hypothermia

Good Samaritan Laws should reduce your fear of being sued.

Manikin usage treat with respect.

The End Questions?

Fee Disclaimer  The AHA strongly promotes knowledge and proficiency in CPR and has developed instructional materials for this purpose. Use of these materials does not represent course sponsorship by the AHA, and any fees charged for such a course do not represent income to the association.