CONTINUOUS CPR Grays Harbor & North Pacific County Version: September 2015

BASIC MECHANICS OF CPR Focus on High Quality CPR:  > 2” Compression Depth  Full chest Recoil  at least 100 compressions per minute  Minimize interruptions - <10 seconds  At least three rescuers would be ideal

STEPS OF CONTINUOUS CPR 1. BSI/ Scene Safety – locate the patient to a workable area 2.Evaluate the need for CPR - Assess Unresponsiveness - Assess Carotid Pulse for approximately 10 seconds - Assess Respirations: Absent/Agonal/Gasping Note: the provider can assesses respirations while assessing carotid pulse, the provider does not perform a manual airway and “look listen feel” is eliminated from the steps

STEPS OF CONTINUOUS CPR 3. Rule outs – No advanced directives or obvious signs of death 4. Defibrillator/AED – place defibrillator at the feet, turn on machine and apply patches to patient Note: Its important to turn the defibrillator on immediately to capture the time stamp when compressions have been initiated, however, do not delay compressions to apply patches these steps can be completed simultaneously

STEPS OF CONTINUOUS CPR 5. Continuous Chest Compressions (CCC) 6. Interposed Ventilations - 10 compression to 1 Ventilation ratio Note: The compressor does not hesitate for ventilations. Compressions continue at a rate 100/min and ventilations at 1 breath every 10 compressions

STEPS OF CONTINUOUS CPR 7. Compressor Calls Out “180” to ready other providers 8. Compressor Calls Out “190” – at this point another provider will “CHARGE” or press the “ANALYZE” button on the LP/AED Note: The compressions continue while the unit is charging or analyzing

STEPS FOR CONTINUOUS CPR 9. Compressor Calls Out “200”  Unit charged  Analyze underlying rhythm  Deliver shock if indicated or “dump” charge in not indicated  Switch positions  Immediately resume compressions after each shock

ALS CONSIDERATIONS Focus on high quality CPR – BLS “owns the code” IV Administration: 1 minute to find IV route No access after 1 minute move to EZ IO Advanced Airway Delay of ETT placement for 4-6 minutes Continue with compressions while ETT is placed if possible

CONSIDERATION FOR TERMINATION OF EFFORTS Termination of efforts may be considered after the patient has been effectively ventilated with ET tube, two rounds of ACLS pharmacology has been given and Medical Control has given approval. Document appropriately

SUMMARY Focus on High Quality CPR:  > 2” Compression Depth  Full chest Recoil – no “camping” on the chest  at least 100 compressions per minute  Minimize interruptions - < 10 seconds  Resume Chest compressions Immediately after each Shock  BLS “owns the code”  Consider termination of efforts