1. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Cardiopulmonary Resuscitation and AED Chapter 8

2. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Outline Introduction to CPR Review of the Circulatory System Causes of Cardiac Arrest CPR AED Introduction to CPR Review of the Circulatory System Causes of Cardiac Arrest CPR AED

3. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Introduction to CPR

4. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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. > 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.

5. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Time is Critical! To begin resuscitation within a few minutes: Patient’s collapse witnessed EMS immediately activated CPR started immediately Defibrillation within minutes To begin resuscitation within a few minutes: Patient’s collapse witnessed EMS immediately activated CPR started immediately Defibrillation within minutes

6. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Trained bystanders are not always available or willing to do CPR. The role of the FR is critical in reaching the patient quickly and beginning resuscitation. Trained bystanders are not always available or willing to do CPR. The role of the FR is critical in reaching the patient quickly and beginning resuscitation.

7. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Review of the Circulatory System

8. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. What is the function of the circulatory system?

9. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The Circulatory System Delivers O 2 and nutrients Removes CO 2 and wastes Delivers O 2 and nutrients Removes CO 2 and wastes

10. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Why is the function of the circulatory system critical to our survival?

11. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. If the heart stops pumping Lack of O 2 and accumulation of wastes quickly lead to death

12. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Can you name some of the major structures of the human heart?

13. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

14. Major Arteries

15. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Where are capillaries found and what is their purpose?

16. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Capillaries Found throughout the body Connect smallest arteries to smallest veins O 2, nutrients, and wastes move through thin walls Microscopic Found throughout the body Connect smallest arteries to smallest veins O 2, nutrients, and wastes move through thin walls Microscopic

17. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. How does a vein differ from an artery?

18. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Veins Carry blood back to heart Lower pressure Carry blood back to heart Lower pressure

19. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. What is the function of blood?

20. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Blood The fluid of the circulatory system Carries O 2, nutrients, and wastes The fluid of the circulatory system Carries O 2, nutrients, and wastes

21. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Heart Physiology LV contracts – sends wave of blood Pressure wave felt as pulse No contraction = No blood flow = cardiac arrest LV contracts – sends wave of blood Pressure wave felt as pulse No contraction = No blood flow = cardiac arrest

22. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Brain damage begins in 4–6 min Brain damage irreversible in 8–10 min Circulation must be restored within 4 – 6 minutes.

23. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 Provides minimal amount of circulation/oxygenation until cause of cardiac arrest corrected External chest compressions circulate blood Artificial ventilations provide O 2 to lungs

24. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Causes of Cardiac Arrest

25. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Causes of Cardiac Arrest Heart disease Respiratory arrest Medical emergencies Drowning and suffocation Congenital heart defects Trauma Heart disease Respiratory arrest Medical emergencies Drowning and suffocation Congenital heart defects Trauma

26. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The cause of cardiac arrest is important BUT do not delay CPR to obtain history The cause of cardiac arrest is important BUT do not delay CPR to obtain history

27. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CPR

28. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CPR Combines external chest compressions with artificial ventilation Provides 30% (or less) of normal circulation Only effective for short period of time Combines external chest compressions with artificial ventilation Provides 30% (or less) of normal circulation Only effective for short period of time

29. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CPR – 1 Rescuer Assess responsiveness Summon EMS Position the patient Assess responsiveness Summon EMS Position the patient Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

30. CPR – 1 Rescuer Open the airway Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

31. CPR – 1 Rescuer Look, listen, and feel for breathing Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

32. CPR – 1 Rescuer If there is no breathing, give two breaths, each lasting 1 second Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

33. CPR – 1 Rescuer Check for a pulse (≤ 10 seconds) Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

34. CPR – 1 Rescuer If there is no pulse, find your landmarks, lower half of the sternum, between the nipples Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

35. CPR – 1 Rescuer Begin chest compressions Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

36. CPR – 1 Rescuer Perform 30 chest compressions Push hard Push fast Allow the chest to recoil after each compression Perform 30 chest compressions Push hard Push fast Allow the chest to recoil after each compression Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

37. CPR – 1 Rescuer Administer two ventilations then return to compressions Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

38. CPR – 2 Rescuer 1 2 3 4 Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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

40. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CPR - Infant Give chest thrusts and puffs of air 30 compressions:2 ventilations if alone 15 compressions: 2 ventilations with 2 rescuers Give chest thrusts and puffs of air 30 compressions:2 ventilations if alone 15 compressions: 2 ventilations with 2 rescuers

41. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Sequence of Survival

42. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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. 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.

43. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Sequence of Survival Also known as Chain of Survival Recognition and Early Access Early CPR Defibrillation Early Advanced Care Recognition and Early Access Early CPR Defibrillation Early Advanced Care

44. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Recognition and Early Access Depends on public education EMS must be immediately notified 9-1-1 dispatchers can provide CPR instructions Depends on public education EMS must be immediately notified 9-1-1 dispatchers can provide CPR instructions Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

45. Early CPR Must begin within 4-6 minutes of collapse Public training is necessary FR have a critical role Must begin within 4-6 minutes of collapse Public training is necessary FR have a critical role Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

46. Copyright © 2004 Elsevier (USA). All Rights Reserved Defibrillation Ventricular fibrillation a common cause of arrest Can only correct with defibrillation Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

47. 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 Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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

49. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Ventricular Fibrillation Requires immediate defibrillation CPR lengthens window of survival Requires immediate defibrillation CPR lengthens window of survival

50. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Early Advanced Care Medication Advanced airway management Post-resuscitation care Medication Advanced airway management Post-resuscitation care Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

51. AED

52. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. AEDs Safe, accurate & lightweight Easy to operate What is public access defibrillation? Safe, accurate & lightweight Easy to operate What is public access defibrillation?

53. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. PAD AEDs in public places Training the public in CPR/AED AEDs in public places Training the public in CPR/AED

54. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Special Considerations Children Clothing Body hair Water Transdermal medication patches Children Clothing Body hair Water Transdermal medication patches Implanted defibrillators or pacemakers Metal surfaces Jewelry and glasses

55. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. AED Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

56. Assess Check your patient Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

57. Universal Steps Power ↓ Patient ↓ Analyze ↓ Shock Power ↓ Patient ↓ Analyze ↓ Shock

58. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Power Turn the power on Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

59. Patient Apply pads to patient Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

60. Analyze Stay clear while patient’s heart rhythm analyzed Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

61. Clear Head to toe and toe to head: everyone is clear! Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

62. Shock Defibrillate Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

63. Patient Standard is set of 1 shock Immediately restart CPR for 2 minutes then check pulse Standard is set of 1 shock Immediately restart CPR for 2 minutes then check pulse Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

64. 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. 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.

65. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Summary Survival from cardiac arrest depends on the sequence (chain) of survival. First Responders are critically important in maintaining the sequence (chain) of survival. Survival from cardiac arrest depends on the sequence (chain) of survival. First Responders are critically important in maintaining the sequence (chain) of survival.

66. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Shock, Shock! Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.