1. Adult Hospital Life Support Resuscitation/Clinical Skills Department Derby Hospitals NHS Foundation Trust

2. Objectives How to perform safe adult CPR The treatment of the conscious and unconscious choking patient The recovery position Awareness of DNACPR

3. Please spend a minute or two discussing any experience you have had with basic life support. This could be in or out of hospital, on a manikin, a person or just on TV!

4. Why learn adult CPR skills? Approximately 250 cardiac arrests in the Trust annually Maintain adequate ventilation and circulation until expert help arrives

5. Hospital Life Support Demonstration

6. Safe Approach Ensure casualty, any bystanders and you are safe Consider manual handling Infection/sharps

7. Collapsed or sick patient Check for RESPONSE Gentle SHAKE & SHOUT No Response? Shout for HELP

8. Airway Turn onto back CHECK- Remove foreign body/debris OPEN - Head tilt/chin lift or jaw thrust (Consider Tracheostomy/Laryngectomy Patients)

9. Breathing and Circulation LOOK - For normal breathing and signs of life (+/- pulse check) LISTEN - For breath sounds FEEL - For air on your cheek Assess for up to 10 seconds

10. Normal Breathing Use RECOVERY POSITION & ensure expert help has been called

11. No Breathing/Occasional Gasps (No pulse if taken, or not sure) CALL 2222- Resuscitation Team or (9)999 – Emergency Services Immediately Commence 30 CHEST COMPRESSIONS

12. Effective Chest Compressions Heel of the hand in the centre of the chest – other hand on top Position yourself vertically above the patient’s chest with straight arms Compress 4–5 cm allowing chest to recoil after each compression Repeat 30 times at a rate of 100/min

13. Combine Chest Compressions with Rescue Breaths Ensure airway is open, then deliver 2 RESCUE BREATHS Take approx 1 sec for each breath, watching the chest rise normally Immediately continue with 30 CHEST COMPRESSIONS : 2 BREATHS

14. Compression-only CPR If unable or unwilling to give rescue breaths perform chest compressions These should be continuous at a rate of 100/min Stop only if the patient starts breathing normally

15. Keep Going! Unless….. The casualty wakes up/starts breathing normally Expert help arrives and asks you to stop You are exhausted and can no longer continue

16. When the Resuscitation Team Arrive Continue effective CPR until told otherwise Stay nearby to give a brief account of the circumstances of the collapse Give any further information about your patient

17. Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) The in-patient who has a valid DNACPR order Terminal illness with a GP DNACPR order The patient with an Advance Directive Clear evidence that resuscitation is futile

18. Completed, valid DNACPR forms are located in the front of the patient’s medical notes If unsure of patient’s resuscitation status call the Resuscitation Team or 999 as appropriate and start CPR

19. Choking

20. Back Blows Stand to one side and slightly behind Lean casualty forward & support chest with one hand Give up to 5 back blows

21. Abdominal Thrusts Stand behind casualty and lean them forwards Place fist between navel and breastbone Grasp with other hand, pull sharply inwards and upwards Repeat up to 5 times

22. Recovery Position

24. Summary How to perform safe adult CPR The treatment of the conscious and unconscious choking patient The recovery position Awareness of DNACPR

25. Further information can be found following the Resus icon from the intranet home page