Emergency Procedures and CPR

• The topic is emergency procedures, rescue breathing, obstructed airway, cardiac arrest and CPR, AED, CPR with advanced airway and chains of survival.

Emergency Procedures

• Sequence for emergency procedures is Chest compressions - Airway - Breathing (C-A-B).
• Start compressions within 10 seconds; push hard and fast, allow complete chest recoil, minimize interruptions, give effective breaths, avoid excessive ventilation.
• The primary survey should take no more than 60 seconds.
• Step 1 of the primary survey is safety of scene/level of consciousness (no more than 10 seconds), with both done simultaneously.
• Step 2 of the primary survey is activating emergency dispatch.
• Step 3 of the primary survey is breathing/circulation, which can be done simultaneously.
• Actions for step 3 include looking for rise/fall of chest and checking pulse (carotid)-palpate for no more than 5-10 seconds, if no pulse is felt, assume there isn't one.
• Step 4 of the primary survey is defibrillation.

Rescue Breathing

• Airway takes precedence over injury.
• No breathing equals respiratory arrest.
• Techniques include head tilt/chin lift vs jaw thrust.
• Bag valve mask (BVM) is not recommended for 1 rescuer.
• For adults, give 1 breath every 5-6 seconds (10-12 breaths/min).
• For infants/children, give 1 breath every 2-3 seconds (20-30 breaths/min).

Obstructed Airway

• Do not use Heimlich or abdominal thrusts.
• Breaths 1 and 2 not entering indicates repositioning is needed.
• Breaths 3 and 4 not entering indicates obstruction.
• Do not perform finger sweeps.
• Give chest compressions as if doing CPR, and when get to 30 compressions, look in mouth.
• If nothing is there, give 2 breaths and then repeat process.
• If something is in mouth, remove object, and then give rescue breaths.
• If victim is an adult and still conscious, consent must be obtained to do Heimlich.
• If victim is a child, consent is not needed if the child is alone; if a parent is present, consent is needed.
• Check for pulse once airway is cleared.

Cardiac Arrest & CPR

• No pulse, no breath equals cardiac arrest.
• No pulse can result from: Vtach, Vfib, Asystole, PEA.
• CPR always begins with compressions.
• Compression rate for adults: 100/min.
• Depth of compression for adults: at least 2 inches, no more than 2.4 inches.
• Depth of compression for children: ~2 inches, at least 1/3 AP diameter of chest.
• Depth of compression for infants: ~1 ½ inches, at least 1/3 AP diameter of chest.
• Adult CPR: 30 compressions : 2 breaths.
• Do 5 cycles (~2 min) then reassess.
• The compression to breath ratio is the same for 1 or 2 rescuers.
• Child and infant CPR: if alone, do something for 2 min.
• 1 rescuer: 30 compressions : 2 breaths with 1 rescuer.
• 2 rescuers: 15 compressions : 2 breaths if there are two rescuers.
• If pulse is present, rate is dependent on the pulse.
• If less than 60 bpm and signs/symptoms of poor perfusion, do compressions.

AED

• Defibrillation stops the heart by depolarizing all cells, then restarts/resets it.
• Defibrillate only shockable rhythms (Vtach, Vfib).
• There are 4 steps to using an AED.
• Step 1: Turn AED on and plug in pads.
• Step 2: Apply pads only on someone who is pulseless and apneic.
• Follow instructions for adults.
• Never use pediatric pads on adults, use only adult pads.
• Use pediatric pads on children/infants.
• If no peds pads, may use adult pads (ensure they do not touch or overlap—may need to apply anterior/posterior).
• Step 3: Clear to analyze.
• If hear "clear to shock", give another 20-25 compressions (usually have 16-18 seconds before it charges up and you have to clear for shock).
• Step 4: Clear to shock (if appropriate).
• Once an AED is applied, do not remove it. Only an MD can remove it.

CPR With Advanced Airway

• There is no specific ratio for compressions to ventilation because direct access to lungs.
• Still aim for 100 compressions/min.
• Change breathing rate to 1 breath every 6 seconds (10 breaths/min).

Chains of Survival

• In the hospital, may involve rapid response or medical emergency teams.
• Surveillance and Prevention include recognition and activation of Emergency Response system, immediate high quality CPR and advance life support/post arrest care.
• Out of hospital, recognition and activation of Emergency Response System, immediate high quality CPR, rapid defibrillation, basic and advance emergency medical services and advance life support/post arrest care are key.