Transcript To hear is to forget, To see is to remember, To do is to understand.

Cardiopulmonary
Resuscitation
American Heart Association
2011 Guidelines
CPR for Health Providers
CPR for Health Care
Providers
Adult
Child
Infant
Terminology
 BLS

/ BCLS
ALS / ACLS
 Respiratory
Arrest
 Arrest,
Cardiac
Arrest, Code,
Code Blue
 Ventilations
American Heart Association
 Research
 Training
 Public
Education
Chain of Survival
 Early
Access
 Early CPR
 Early Defibrillation
 Early ACLS
The Myth
A little CPR & everything turns out
O.K.
Definitions
 Clinical
Death = no pulse & not
breathing
 Biological
Death = Permanent brain
death (irreversible)
Begins 4 - 6 minutes after arrest
CABD’s of CPR
C
= Circulation
A = Airway
B = Breathing
D = Defibrillation
Causes of Cardiac Arrest
 Heart
attack (or cardiovascular disease)
 Trauma
 Drowning
 Drugs
 Electrocution
Cardiovascular Disease
Can Lead To:
 Heart
Attack - myocardial infarction (MI)
 Stroke
- cerebral vascular accident or
CVA (now called “brain attack”)
 Aneurysm
Signs of ...
Heart
attack = chest pain
Typical - pressure, “tightness”
Vs
Atypical - indigestion, jaw pain
and..
 DENIAL
is common
 Activating
EMS is the right thing to
do if you have chest pain
Sudden Death
Ventricular
Fibrillation
Ventricular Fibrillation
The
most effective intervention
is early defibrillation
Defibrillators
Manual
Semiautomatic
Automatic
Public access is AHA goal
Public Access Defibrillation PAD
 Casinos
 Airports
 City
buildings
 Senior centers
 Gated communities
Stroke or “Brain Attack”
Signs and Symptoms:
 hemiparesis
& hemiparalysis
 headache, blurred vision
 aphasia (speaking problems)
 one sided facial droop
#1 Risk factor = hypertension
CVD risk factors
Factors
that influence the
probability of cardiovascular
disease.
CVD risk factors that cannot
be changed
 Heredity
 Gender
 Age
Race also plays a role
CVD risk factors that you can
change.
 Smoking
 High
blood pressure
 High cholesterol**
 Lack of exercise
note
 Cholesterol
is found in eggs, meat,
& dairy products.
other factors ...
 Diabetes
 Obesity
 Excessive
stress
note

Having multiple risk factors poses
a much greater risk than having
only 1 risk factor.
Pediatric safety
Injury due to “accident” #1 cause of
pediatric death
And most are PREVENTABLE
seat belts
fire safety
pools
firearms
etc...
Pediatrics
 Airway
problems are common
cause of death in infants & children.
 Respiratory
arrest leading to
cardiac arrest.
Basic principles of CPR
Obviously dead
Reasons to stop CPR
Positioning
Initial actions
CABDs
Obviously Dead (policy 814)

Decapitation
 Incineration
 Decomposition
 Evisceration of
heart, lung, or brain
Obviously Dead (policy 814)
 Post
mortem lividity & rigor mortis
(check apical pulse for 60 seconds)
 Special
 MVI
situations
with limited resources
 entrapment (> 15 minutes extrication time)
?
Reasons to Stop CPR
 Patient
Revives.
 Patient is turned over to rescuers of
equal or greater training.
 Doctor tells you to stop.
 You are so exhausted you can not
continue.
American Heart Association
 Infant
0-1 year old
 Child
1year - onset of puberty
 Adult
Puberty on
Establish unresponsiveness
 Shake
& Shout
THIS IS THE FIRST THING YOU DO
WHEN ASSESSING A
UNRESPONSIVE PERSON
Activate EMS
 Adults
 Initiate
 Children
immediately and get AED
and infants
 Witnessed
– initiate immediately and get
AED
 Unwitnessed – 5 cycles of CPR, then
initiate and get AED
Position the patient
 Supine
 On
a hard surface
CABD’s of CPR
C
= Circulation
A = Airway
B = Breathing
D = Defibrillation
AIRWAY
 Conscious
 anatomical
Vs Unconscious
obstruction
 solid obstruction
 liquid obstruction
AIRWAY
 Open
the airway.
 Head tilt, chin lift : preferred method
 If suspected neck injury: Modified jaw
thrust.
BREATHING
 Mouth
to mouth
 Mouth to nose & mouth
 Mouth to stoma
 Mouth to mask
BREATHING
Rescue Breathing
 Adult
= 1 every 5-6 seconds
 Child = 1 every 3-5 seconds
 Infant = 1 every 3-5 seconds
Adequate Ventilation
 No
resistance
 No escape of air from around mask
 Chest Rise - stop when chest
begins to rise
Complications of rescue
breathing
GASTRIC DISTENTION
is caused by air entering the stomach
Over-ventilating
Improper head tilt (no tilt)
Cricoid Pressure
 Sellicks
Manuever
 Prevent
gastric inflation/passive
regurgitation
 Assistance
Intubation
during Endotracheal
CIRCULATION
 Chest
compressions
 Proper
speed
 Proper depth
 Proper position
Speed of Compressions
 Adult
100
 Child 100
 Infant 100
times / min
times / min
times / min
Depth of Compressions
1 1/2 - 2”
 Child 1 - 1 1/2”
 Infant 1/2 - 1”
 Adult
 OR
1/3 to 1/2 the patient’s body
depth.
Hand Position
 At
the nipple line
 Off
the zyphoid process
2 fingers = infant
1 hand = child
2 hands = adult
Ratios
Compressions to ventilations
Adult = 30:2 (1 and 2 rescuer)
Child & infant = 30:2 (1 rescuer)
15:2 (2 rescuer)

The pause is important to allow for slow
ventilations
Complications of
Compressions
 fractured
ribs
 fractured sternum
 lacerated lungs
 lacerated liver, blood vessels, etc.,,
if you break ribs..
Check your hand position and keep
going!
Pulse Checks
 Pause
to recheck the pulse after 5
cycles.
 Then
every few minutes after that.
 Pulse
check with CPR in progress.
Interrupting CPR
 5-10
seconds for pulse checks, etc...
 10
seconds absolute maximum break &
then only when absolutely necessary
 During
AED rhythm analysis and
delivery of shocks
Special Situations
water drowning (no - it doesn’t
have to be very cold)
 Cold
 Hypothermia
Good Samaritan Laws
should reduce your fear of being
sued.
Manikin usage
treat with respect.
The End
Questions?
Fee Disclaimer
 The
AHA strongly promotes knowledge
and proficiency in CPR and has
developed instructional materials for this
purpose. Use of these materials does
not represent course sponsorship by the
AHA, and any fees charged for such a
course do not represent income to the
association.