CPR Lecture 3 PDF

Dr. Ahmad Hammouri Cardiac Arrest C &ardio-Pulmonary Resuscitation (CPR) – BLS - AHA DR. AHMAD HAMMOURI Dr. Ahmad Dr. Ahmad Hammouri Cardiac arrest A cardiac arrest occurs when your heart stops beating. This mean...

Dr. Ahmad Hammouri Cardiac Arrest C &ardio-Pulmonary Resuscitation (CPR) – BLS - AHA DR. AHMAD HAMMOURI Dr. Ahmad Dr. Ahmad Hammouri Cardiac arrest A cardiac arrest occurs when your heart stops beating. This means that your brain and vital organs are starved of oxygen; you become unconscious and stop breathing or do not breath normally. A cardiac arrest is a medical emergency Every minute counts when a person is in cardiac arrest. Without chest compressions and use of a defibrillator, a person in cardiac arrest will not survive. Dr. Ahmad Dr. Ahmad Hammouri Causes of cardiac arrest Your heart's electrical system controls the rate and rhythm of its pumping. A cardiac arrest is usually caused by an electrical malfunction in your heart’s electrical system that causes your heart to stop pumping. Dr. Ahmad Dr. Ahmad Hammouri Signs of cardiac arrest A cardiac arrest happens suddenly and rapidly. It often occurs with no warning. The person in cardiac arrest will: 1. Collapse and fall to the ground 2. Lose consciousness (not rousable, not aware of their surroundings and not responsive to talk or touch). 3. Have no pulse 4. Not breathe or breathe abnormally (gasp for air) Dr. Ahmad Dr. Ahmad Hammouri What is CPR? CPR stands for Cardio-Pulmonary Resuscitation It is a combination of rescue breathing and chest compressions. Aim: CPR helps to keep blood and oxygen circulating to the brain of a person whose heart has stopped beating, until the heart can be restarted. CPR alone does not restore a normal heart rhythm. Compressions-Only CPR (COCPR) is CPR without rescue breaths (also known as ‘hands only CPR’). Both types of CPR double the patient’s survival rates! Dr. Ahmad Dr. Ahmad Hammouri What is AED? Automated External Defibrillator An automated external defibrillator (AED) is a portable electronic device that diagnoses life-threatening abnormal heart rhythms that can cause a cardiac arrest. An AED might be able to treat these abnormal heart rhythms by giving an electric shock to try to ‘restart’ the heart to its normal rhythm. This is known as defibrillation. An automated external defibrillator (AED) will only give a shock if it is necessary. You cannot do any harm by using an automated external defibrillator (AED) on someone who is unconscious. Dr. Ahmad Dr. Ahmad Hammouri Chain of Survival Increase the probability of survival for a victim of cardiac arrest Recognition of cardiac arrest and activation of the emergency response system Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions Rapid defibrillation Advanced resuscitation by Emergency Medical Services and other healthcare providers Post-cardiac arrest care Recovery (including additional treatment, observation, rehabilitation, and psychological support) Dr. Ahmad Dr. Ahmad Hammouri Chain of Survival Recently (2020), AHA added Recovery to chain of survival. It points to care and support during recovery. Recommend that cardiac arrest survivors have multimodal rehabilitation assessment and treatment of physical, neurologic, cardiopulmonary and cognitive impairment. Dr. Ahmad Dr. Ahmad Hammouri Chain of Survival - Pediatrics Although in adults cardiac arrest is often sudden and results from a cardiac cause, in children cardiac arrest is often secondary to respiratory failure and shock. Identifying children with these problems is essential to reduce the likelihood of pediatric cardiac arrest and maximize survival and recovery. Therefore, a prevention link is added in the pediatric chain of survival. Dr. Ahmad Dr. Ahmad Hammouri CPR for Adult Compressions, Airway, Breathing (CAB) Understanding BLS in Adults: safety. Assess the environment for Check for responsiveness of the patient by tapping firmly on or above the collar bone. Activate emergency response system by shouting for help and have another person obtain the AED/ Defibrillator. If a mobile device is available, activate the emergency response system immediately. Check for Pulse and Breathing – not more than 10 seconds. - Begin CPR if no pulse is detected by starting with chest compressions - If pulse is present with agonal breathing, begin rescue breathing immediately. Dr. Ahmad Dr. Ahmad Hammouri High quality chest compressions Chest compressions (CAB): Place palms of hand over the patient’s sternum just above the xiphoid process Chest compressions are 100 to 120 per minute Compression depth should be at least 2 inches in adults Allow for full chest recoil between compression and minimize interruptions to less than 10 seconds Switch compression team members every 2 minutes Compression to ventilation ratio: 30 compressions : 2 rescue breaths (one cycle) Dr. Ahmad Dr. Ahmad Hammouri Dr. Ahmad Dr. Ahmad Hammouri CPR for Adults Dr. Ahmad Dr. Ahmad Hammouri CPR for Adult Air-way and Breathing (CAB): Utilize Head tilt-Chin left or Jaw thrust (Trauma to the cervical spine) Rescue breaths are 1 breath every 6 seconds for respiratory arrest with or without an advanced air-way You want to see visible chest rise and fall with each rescue breath Dr. Ahmad Dr. Ahmad Hammouri AED/ Defibrillator 1.Turn on the AED and follow the AED prompts 2.Open or remove the person's shirt, clearing any wet barrier or medication patches 3.Attach the AED pads to the right anterior chest and left mid-axillary line per pad instructions and plug the pads into the connector 4.Stop chest compressions, confirm everyone is clear by saying "Stand Clear" 5.Push the analyze button and allow the AED to analyze the person's heart rhythm 6.If a shock is recommended, make sure no one is touching the person and repeat "Stand Clear." Once clear, press the shock button. 7.Begin CPR immediately following the shock or if no shock is advised. Perform 2 minutes of CPR and follow the AEDs prompts again. Dr. Ahmad Dr. Ahmad Hammouri AED Pads Dr. Ahmad Dr. Ahmad Hammouri Dr. Ahmad Dr. Ahmad Hammouri Dr. Ahmad Dr. Ahmad Hammouri Dr. Ahmad Dr. Ahmad Hammouri CPR for pediatrics Neonates: 0 – 28 days Infants: 28 days – one year Child: greater than one year but has not reached puberty Adolescents: puberty is present either through armpit hair or breast development Dr. Ahmad Dr. Ahmad Hammouri CPR for pediatrics Understanding basic life support in pediatric patients In Basic Life Support (BLS) for pediatrics, follow the CAB sequence for cardiopulmonary resuscitation (Compression – Airway - Breathing) Verify that the scene is safe, so you don’t become a victim yourself Check for responsiveness for the child. Tab the shoulders or heel of the infant’s foot and shout “are you OK!” If victim dose not respond. Shout for help nearby, activate the Emergency Response System If no one responds, DO NOT LEAVE THE CHILD. Perform one round of CPR prior to finding help Dr. Ahmad Dr. Ahmad Hammouri CPR for pediatrics Assess for pulse and breathing No more that 10 seconds, check for rise and fall of chest and the presence of pulse Pulse check: Infants: Brachial pulse Child: Carotid or Femoral pulse Dr. Ahmad Dr. Ahmad Hammouri CPR for pediatrics Unresponsive, no pulse, not breathing Begin CPR immediately Infants (single rescuer CPR) – 30 chest compressions : 2 breaths Two fingers in the center of the infant’s chest, lower half of the breast bone Two thumbs in the center of the infant’s chest, lower half of the breast bone One hand in the center of the infant’s chest, lower half of the breast bone Infants (two person rescuer) – 15 compressions : 2 breaths Dr. Ahmad Dr. Ahmad Hammouri Dr. Ahmad Dr. Ahmad Hammouri CPR for pediatrics Chest compression should be 1/3rd of the AP diameter of the chest Infants: 1½ inches or 4 cm Children: 2 inches or 5 cm No compressions beyond 6 cm in pediatric patients 100 to 120 compressions per minute in Infants, Childs or Adolescents Dr. Ahmad Dr. Ahmad Hammouri CPR for pediatrics Rescue breaths After every round of chest compressions. During 2- rescuer CPR, do not stop chest compression to give breath. Provide 1 breath every 2 to 3 seconds (20 – 30 / minute) with or without advanced airway (infants at least 30 breaths / minute) You want to see chest raise and fall for confirm appropriate rescue breath EC method with bag-valve mask Dr. Ahmad Dr. Ahmad Hammouri EC method your first and second digits form a "C" over the mask with your thumb pressing down by the nasal bridge, your second digit over the bottom of the mask by the mouth, and your third through fifth digits forming an "E" and applying pressure to the mandible to hold the mask tight. There should be no gaps between the mask and the skin. Dr. Ahmad Dr. Ahmad Hammouri CPR for pediatrics AED placement for infants and children Under 8 years of age – use child pads If available. If child pads are not available, you may use adult pads. Place pads so they do not touch each other. One pad is placed on the chest and the other pad is placed on the back. Pads should sandwich the heart when placed appropriately. 8 years of age and older – use adult pads. DO NOT USE CHILD PADS because they will likely give a shock dose that is too low. Dr. Ahmad Dr. Ahmad Hammouri Rescue breaths - pediatrics If agonal breathing with pulse – no CPR needed Give rescue breaths: 1 breath every 2 – 3 seconds (20 – 30 / minute) with or without advanced air-way Dr. Ahmad Dr. Ahmad Hammouri Defibrillation Vs Synchronized cardioversion Defibrillation is the treatment for immediate life-threatening arrhythmias with which the patient does not have a pulse such as ventricular fibrillation or pulseless ventricular tachycardia. Initial Shock: 2 Joules/Kg Second Shock: 4 Joules/Kg Subsequent Shocks: > or = to 4 Joules/Kg Maximum Shock: 10 Joules/Kg REMEMBER THIS MNEMONIC: 2, 4, 6, 8 THAT'S THE DOSE TO DEFIBRILLATE Dr. Ahmad Dr. Ahmad Hammouri Cardiac arrest Includes 4 entities: ▪Ventricular tachycardia ▪Ventricular fibrillation ▪Pulseless electrical activity ▪Asystole The first 2 are shockable and the second 2 are not shockable Dr. Ahmad Dr. Ahmad Hammouri Dr. Ahmad  A d u l t B a s ic Life Support Algorithm for Dr. A h m a d H a m m o u r i Healthcare Providers Dr. Ahmad  Life Support Algorithm for Healthcare A d u l Dr. Ah m a Providers td H B a s i am m ou r ci Dr. Ahmad  Phmeadd iHaatmrmicouBri asic Life Support Algorithm for Dr. A Healthcare Providers—Single Rescue Dr. Ahmad  Phmeadd iHaatmrmicouBri asic Life Support Algorithm for Dr. A Healthcare Providers—Single Rescue Dr. Ahmad Dr. Ahmad Pediatric HammouriBasic Life Support Algorithm for Healthcare Providers—2 or More Rescuers Dr. Ahmad Dr. Ahmad Pediatric HammouriBasic Life Support Algorithm for Healthcare Providers—2 or More Rescuers Dr. Ahmad Dr. Ahmad Hammouri Thank you DR. AHMAD HAMMOURI Dr. Ahmad