1. CPR Course Emergency medicine department

2. OBJECTIVES At the end of this course participants should be able to demonstrate: –How to assess the collapsed victim –How to perform chest compression and use AED

3. B asic L ife S upport

4. BACKGROUND Approximately 700,000 cardiac arrests per year in Europe Survival to hospital discharge presently approximately 5-10% Bystander CPR vital intervention before arrival of emergency services Early resuscitation and prompt defibrillation (within 1-2 minutes) can result in >60% survival

5. Sudden Cardiac arrest The most common cause of pulseless arrest in adults outside hospital Ventricular fibrillation is the first suspect Strongly suggested by sudden collapse Chest compression should be the highest priority Defibrillation may be a definite management

6. CHAIN OF SURVIVAL

7. Approach safely Check pulse Open airway 2 rescue breaths Check response Call 115 - AED 30 chest compressions Approach safely AED Check pulse 30 chest compressions Open airway 2 rescue breaths Check response Call 115

8. APPROACH SAFELY! Scene Rescuer Victim Bystanders Approach safely Call 115 AED Check pulse 30 chest compressions Open airway Check response 2 rescue breaths

9. CHECK RESPONSE Approach safely AED Check pulse 30 chest compressions Open airway Check response Call 115 2 rescue breaths

10. Shake shoulders gently Ask “Are you all right?” If he responds: Leave as you find him Find out what is wrong Reassess regularly CHECK RESPONSE

11. If he dose not respond: Check breathing quickly. No or agonal breathing means cardiac arrest. CHECK RESPONSE

12. AGONAL BREATHING Occurs shortly after the heart stops in up to 40% of cardiac arrests Described as barely, heavy, noisy or gasping breathing Recognise as a sign of cardiac arrest

13. SHOUT FOR HELP – CALL 115 Approach safely AED 30 chest compressions Check response Call 115 Check pulse Open airway 2 rescue breaths

14. AED Approach safely AED 30 chest compressions 2 rescue breath Check response Call 115 Check pulse Open airway

15. 15 Probability of Survival Is Related to 2 Intervals: (1) Collapse to Defibrillation and (2) Collapse to CPR Collapse to start of CPR: 1, 5, 10, 15 (min) Collapse to defibrillation interval (min) Probability of survival to hospital discharge

16. CHECK PULSE Approach safely AED 30 chest compressions Open airway 2 rescue breath Check response Call 115 Check pulse 10 seconds

17. The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses or an unresponsive victim is not breathing normally. CHECK PULSE

18. Approach safely AED Check pulse 30 chest compressions Open airway Check response Call 115 2 rescue breaths CHEST COMPRESSIONS

19. Common problems with chest compression Too few chest compressions Chest compressions are too weak Too many ventilations Too many interruptions

20. Place the heel of one hand in the centre of the chest Place other hand on top Interlock fingers Compress the chest –Rate ≥ 100 per min –Depth 5 cm –Equal compression : relaxation When possible change CPR operator every 2 min High Quality CHEST COMPRESSIONS

21. OPEN AIRWAY Approach safely AED 30 chest compressions Open airway 2 rescue breaths Check response Call 115 Check pulse

22. 22 Assess Breathing (not further recommended)

23. 23 Airway Obstruction Most common cause: tongue and/or epiglottis

24. 24 Opening the Airway Jaw thrust Head tilt–chin lift

25. RESCUE BREATHS Approach safely AED Check pulse 30 chest compressions Open airway 2 rescue breaths Check response Call 115

26. RESCUE BREATHS Pinch the nose Take a normal breath Place lips over mouth Blow until the chest rises Avoid excessive ventilation Take about 1 second Allow chest to fall Repeat

27. JAW THRUST (IN TRAUMATIC PATIENT)

28. CONTINUE CPR 302

29. IF YOU HAVE NOT TENDENCY TO BREATHE Chest compression only

30. Hands Only CPR Needs less training Maximize cardiac output Encourage bystander CPR Not recommended for HCP in case of asphyxic arrest (children, drowning, toxicity)

31. Standard CPR (CC+RB) Berg et al, 2001 Ao pressure Time = chest compression

32. Chest Compression alone Berg et al, 2001 Blood pressure Time = chest compression

33. Simplified Adult BLS

34. KEY CHANGES Recognition of cardiac arrest based on assessing unresponsiveness and absence of normal breathing.

35. KEY CHANGES Recognition of cardiac arrest based on assessing unresponsiveness and absence of normal breathing. Look, listen and feel removed from the algorithm.

36. KEY CHANGES Recognition of cardiac arrest based on assessing unresponsiveness and absence of normal breathing. Look, listen and feel removed from the algorithm. Sequences change to CAB rather than ABC.

37. KEY CHANGES Recognition of cardiac arrest based on assessing unresponsiveness and absence of normal breathing. Look, listen and feel removed from the algorithm. Sequences change to CAB rather than ABC. High quality CPR.

38. KEY CHANGES Recognition of cardiac arrest based on assessing unresponsiveness and absence of normal breathing. Look, listen and feel removed from the algorithm. Sequences change to CAB rather than ABC. High quality CPR. Continued de-emphasis on pulse check for health care providers.

39. ANY QUESTIONS?

40. DEFIBRILLATION

41. AED Approach safely Check response Shout for help Call 115 Attach AED Follow voice prompts Start CPR after shock

42. SWITCH ON AED Some AEDs will automatically switch themselves on when the lid is opened

43. ATTACH PADS TO CASUALTY’S BARE CHEST

44. ANALYSING RHYTHM DO NOT TOUCH VICTIM

45. SHOCK INDICATED Stand clear Deliver shock

46. SHOCK DELIVERED FOLLOW AED INSTRUCTIONS 30 2

47. NO SHOCK ADVISED FOLLOW AED INSTRUCTIONS 30 2

48. IF VICTIM STARTS TO BREATHE NORMALLY PLACE IN RECOVERY POSITION

50. Approach safely Check response Shout for help Call 115 - AED Check pulse 30 chest compressions Open airway 2 rescue breaths Approach safely Check response Shout for help Call 115 AED Attach AED Follow voice prompts Start CPR after shock

51. ANY QUESTIONS?

52. Thanks