Transcript Chapter 7 - HVA Center for EMS Education

Chapter 7
Professional
Rescuer CPR
National EMS Education
Standard Competencies (1 of 5)
Shock and Resuscitation
Uses assessment information to recognize
shock, respiratory failure or arrest, and
cardiac arrest based on assessment findings
and manages the emergency while awaiting
additional emergency response.
National EMS Education
Standard Competencies (2 of 5)
Assessment
Uses scene information and simple patient
assessment findings to identify and manage
immediate life threats and injuries within the
scope of practice of the EMR.
National EMS Education
Standard Competencies (3 of 5)
Primary Assessment
• Primary assessment for all patient situations
– Level of consciousness
– ABCs
– Identifying life threats
– Assessment of vital functions
• Begin interventions needed to preserve life
National EMS Education
Standard Competencies (4 of 5)
Anatomy and Physiology
Uses simple knowledge of the anatomy and
function of the upper airway, heart, vessels,
blood, lungs, skin, muscles, and bones as the
foundation of emergency care.
National EMS Education
Standard Competencies (5 of 5)
Pathophysiology
Uses simple knowledge of shock and
respiratory compromise to respond to life
threats.
Introduction (1 of 2)
• Cardiopulmonary resuscitation consists of:
– Airway (A)
– Breathing (B)
– Circulation (C)
• Airway and breathing skills may be
lifesaving for a patient whose heart is still
beating.
Introduction (2 of 2)
• To maintain or restore circulation manually,
perform cardiac compressions.
• To maintain both breathing and a heartbeat,
rescue breathing and chest compressions
must be done together.
• Approximately 70% of patients in cardiac
arrest are in a state of ventricular fibrillation.
Anatomy and Function of the
Circulatory System (1 of 8)
• The circulatory system consists of:
– A pump (the heart)
– A network of pipes (blood vessels)
– Fluid (blood)
• The heart
– Located in the chest between the lungs
– Consists of four chambers, two on the right side
and two on the left side
Anatomy and Function of the
Circulatory System (2 of 8)
• The heart (cont’d)
– Each upper chamber is called an atrium.
– Each lower chamber is called a ventricle.
– The four chambers work in a well-ordered
sequence to pump blood to the lungs and to the
rest of the body.
– One-way valves allow the blood to flow in only
one direction.
Anatomy and Function of the
Circulatory System (3 of 8)
Anatomy and Function of the
Circulatory System (4 of 8)
• The arteries carry blood away from the
heart at high pressure.
• Smaller arteries eventually branch into the
capillaries, the smallest pipes in the
circulatory system.
• Veins are thin-walled pipes that carry blood
back to the heart.
Anatomy and Function of the
Circulatory System (5 of 8)
• Four major artery locations:
– The neck (carotid arteries)
– The wrist (radial arteries)
– The arm (brachial arteries)
– The groin (femoral arteries)
• Use these arteries to measure pulse.
– A pulse is generated when the heart contracts
and sends a pressure wave through the artery.
Anatomy and Function of the
Circulatory System (6 of 8)
Anatomy and Function of the
Circulatory System (7 of 8)
• Blood has several components.
– Plasma
– Red blood cells carry oxygen from the lungs to
the body and bring carbon dioxide back to the
lungs.
– White blood cells devour bacteria and other
disease-causing organisms.
– Platelets start the blood-clotting process.
Anatomy and Function of the
Circulatory System (8 of 8)
Cardiac Arrest (1 of 3)
• Cardiac arrest occurs when the heart stops
contracting and no blood is pumped through
the blood vessels.
• Without a supply of blood, the cells of the
body will die.
– Brain damage begins within 4 to 6 minutes.
Cardiac Arrest (2 of 3)
• Causes of cardiac arrest
– Heart and blood vessel diseases
– Respiratory arrest, if untreated
– Medical emergencies such as epilepsy,
diabetes, allergic reactions, electrical shock,
and poisoning
– Drowning
– Suffocation
– Trauma and shock from massive blood loss
Cardiac Arrest (3 of 3)
• A patient who has experienced cardiac
arrest is unconscious and not breathing.
– You cannot feel a pulse and the patient looks
dead.
– Regardless of the cause, the initial treatment is
the same: providing CPR.
Components of CPR (1 of 3)
• CPR requires three types of skills:
– A (airway) skills
– B (breathing) skills
– C (circulation) skills
• Airway and breathing skills
– Determine whether the airway is open.
– Correct a blocked airway with the head tilt–chin
lift or jaw-thrust maneuver.
Components of CPR (2 of 3)
• Airway and breathing skills (cont’d)
– Determine whether the patient is breathing.
– Correct the absence of breathing by performing
rescue breathing.
• Circulation skills
– Check the patient for a pulse.
– If there is no pulse, perform external chest
compressions.
Components of CPR (3 of 3)
• CPR by itself cannot sustain life indefinitely.
– It should be started as soon as possible to give
the patient the best chance for survival.
– Many patients will need defibrillation and
medication to be successfully resuscitated.
The Cardiac Chain of Survival
(1 of 2)
• The links in the Chain of Survival include:
– Early recognition of cardiac arrest and activation
of the 9-1-1 system
– Early bystander CPR
– Early defibrillation by EMRs or other EMS
personnel
– Early advanced care by paramedics and
hospital personnel
– Integrated post-arrest care
The Cardiac Chain of Survival
(2 of 2)
Source: American Heart Association
When to Start CPR (1 of 2)
• CPR should be started on all nonbreathing,
pulseless patients, unless they are
obviously dead or have a DNR order.
• Signs of death
– Decapitation: The head is separated from the
rest of the body.
– Rigor mortis: Temporary stiffening of muscles
occurs several hours after death.
When to Start CPR (2 of 2)
• Signs of death (cont’d)
– Evidence of tissue decomposition: Actual flesh
decay occurs only after a person has been dead
for more than one day.
– Dependent lividity: Red or purple color occurs
on the parts of the patient’s body that are
closest to the ground.
When to Stop CPR (1 of 2)
• Discontinue CPR only when:
– Effective spontaneous circulation and ventilation
are restored.
– Resuscitation efforts are transferred to another
trained person who continues CPR.
– A physician orders you to stop.
– The patient is transferred to properly trained
EMS personnel.
When to Stop CPR (2 of 2)
• Discontinue CPR only when: (cont’d)
– Reliable criteria for death are recognized.
– You are too exhausted to continue
resuscitation, environmental hazards endanger
your safety, or continued resuscitation would
place the lives of others at risk.
External Cardiac Compression
(1 of 4)
• In an unresponsive patient, scan the chest
quickly for signs of breathing and check for
a pulse.
– Check the carotid pulse and look for signs of
coughing or movement.
– If there is no carotid pulse in an unresponsive
patient, begin chest compressions.
– To perform adult chest compressions, see
Skill Drill 7-1.
External Cardiac Compression
(2 of 4)
• External chest
compressions on an
infant
– To check an infant’s
circulation, feel for the
brachial pulse on the
inside of the upper arm.
External Cardiac Compression
(3 of 4)
• External chest
compressions on an
infant (cont’d)
– If there is no pulse, begin
chest compressions with
your middle and ring
fingers.
– Place the infant on a solid
surface or cradle the
infant in your arm.
– You will not need to use
much force.
External Cardiac Compression
(4 of 4)
• External chest compressions on a child
– Check the carotid pulse.
– Begin chest compressions.
– In smaller children, place the heel of one hand
in the center of the chest, in between the
nipples.
– In larger children, use two hands.
Adult CPR (1 of 2)
• One-rescuer adult CPR
– Follow the steps in Skill Drill 7-2.
– You must deliver chest compressions and rescue
breathing at a ratio of 30:2.
Adult CPR (2 of 2)
• Two-rescuer adult CPR
– To avoid fatigue, the rescuers should switch
roles after every five cycles of CPR.
– Follow the steps in Skill Drill 7-3.
– Switching positions should be accomplished as
smoothly and quickly as possible.
– CPR should not be interrupted for longer than
10 seconds.
Infant CPR (1 of 2)
• One-rescuer infant CPR
– Follow the steps in Skill Drill 7-4.
Infant CPR (2 of 2)
• Two-rescuer infant CPR
– Use the two-thumb/encircling-hands technique
for chest compressions.
– Compress the sternum at a rate of at least 100
compressions per minute.
– Perform a compression-to-ventilation ratio of
15:2.
Child CPR (1 of 3)
• The steps for child CPR are essentially the
same as for an adult.
• Some variations include the following:
– Use less force to ventilate the child.
– In small children, use only one hand to depress
the sternum.
– Use less force to compress the child’s chest.
Child CPR (2 of 3)
• Steps to administer CPR to a child
– Establish the child’s lack of responsiveness and
breathing.
– Check for circulation.
– Provide chest compressions (rate of at least
100/minute).
– Open the airway.
– Give two effective breaths.
Child CPR (3 of 3)
• Steps to administer CPR to a child (cont’d)
– Continue cycles of compressions and
ventilations.
– Reassess the patient after five cycles of CPR
and every 2 minutes thereafter.
Signs of Effective CPR
• A second rescuer feels a carotid pulse while
you are compressing the chest.
• The patient’s skin color improves (from blue
to pink).
• The chest visibly rises during ventilations.
• Compressions and ventilations are
delivered at the appropriate rate and depth.
Complications of CPR
(1 of 4)
• Broken ribs
– You may break a patient’s ribs while delivering
a compression.
– To prevent this problem, use proper hand
positioning and do not let your fingers come in
contact with the ribs.
– If you hear a cracking sound, check and correct
your hand position but continue CPR.
Complications of CPR
(2 of 4)
• Gastric distention
– Occurs when too much air is blown too fast and
too forcefully into the stomach
– Often causes regurgitation
– Ensure you have opened the airway completely
and do not blow excessive amounts of air into
the patient.
– Turn the patient’s body to one side and press
on the upper abdomen.
Complications of CPR
(3 of 4)
• Regurgitation
– Common during CPR
– To minimize the risk, minimize the amount of air
that enters the stomach.
– If the patient regurgitates during CPR:
• Turn the patient onto his or her side.
• Clear the patient’s mouth of remaining
vomitus.
• Use suction if it is available.
Complications of CPR
(4 of 4)
• Regurgitation (cont’d)
– If the airway is not cleared, two problems may
arise:
• The patient may breathe in the vomitus into
the lungs.
• You may force vomitus into the lungs with the
next artificial ventilation.
– As soon as you have cleared away the vomitus,
continue rescue breathing.
Creating Sufficient Space
for CPR (1 of 2)
• EMRs may find themselves alone with
patients in cardiac arrest.
• You must create or find a space where you
can perform CPR.
– You need 3′ to 4′ of space on all sides of the
patient.
Creating Sufficient Space
for CPR (2 of 2)
• If there is not enough
space around the
patient, you have two
options:
– Quickly rearrange the
furniture in the room
or arrange objects at
the scene to make
space.
– Quickly drag the
patient into an area
that has more room.
Early Defibrillation by EMRs
(1 of 3)
• More than 70% of all out-of-hospital cardiac
arrest patients have an irregular heart
electrical rhythm called ventricular fibrillation
(V-fib).
– V-fib is a rapid, disorganized, and ineffective
vibration of the heart.
– An electric shock applied to the heart will
defibrillate it and reorganize the vibrations into
effective heartbeats.
Early Defibrillation by EMRs
(2 of 3)
• Increasing numbers of
EMS systems are
equipping EMRs with
automated external
defibrillators (AEDs).
– These machines
identify ventricular
fibrillation and advise
the rescuer to deliver
a shock if needed.
Source: LIFEPAK® 1000 Defibrillator courtesy of Physio-Control. Used with
permission of Physio-Control, Inc., and according to the Material Release
Form provided by Physio-Control.
Early Defibrillation by EMRs
(3 of 3)
• Performing automated external defibrillation
– Follow the steps in Skill Drill 7-5.
– AEDs vary in their operation, so learn how to
use your specific AED.
CPR Training
• EMRs should:
– Successfully complete a CPR course through a
recognized agency
– Regularly update their skills by completing a
recognized recertification course
• Your department should schedule periodic
reviews of CPR theory and practice.
Legal Implications of CPR (1 of 2)
• Advance directives and living wills are legal
documents that specify the patient’s wishes
regarding specified medical procedures.
– CPR should be started on all patients unless
signs of obvious death are present.
– If a patient has an advance directive, the
physician at the hospital will determine whether
you should stop CPR.
Legal Implications of CPR (2 of 2)
• Do not hesitate to start CPR on a pulseless,
nonbreathing patient.
– Without your help, the patient will die.
• Abandonment
– Discontinuation of CPR without the order of a
licensed physician or without turning the patient
over to someone who is at least as qualified as
you are
Summary (1 of 4)
• Cardiac arrest occurs when the heart stops
contracting and no blood is pumped through
the blood vessels.
• The chain of survival—early access to care,
early CPR, early defibrillation, early
advanced cardiac life support (ACLS), and
post-arrest care—includes steps essential
to successful emergency cardiac care.
Summary (2 of 4)
• Basic life support for adults and children
follows the same general steps: Check
responsiveness, airway, breathing, and
circulation. Intervene at any point where the
patient’s airway is obstructed, the patient is
not breathing, or the patient has no
circulation.
Summary (3 of 4)
• The single most important cardiac arrest
survival factor is early defibrillation. The
indications for using an automated external
defibrillator (AED) are that the patient is
unresponsive, not breathing, and pulseless.
Summary (4 of 4)
• Once turned on and attached to the
patient’s bare chest, the AED will analyze
the heart rhythm and advise whether a
shock is indicated.
Review
1. A patient who is in cardiac arrest:
A. does not require rescue breathing.
B. does not have a pulse and is not breathing.
C. should be considered dead after 10 minutes of
CPR.
D. requires treatment that is beyond the scope of
practice of the EMR.
Review
Answer:
B. does not have a pulse and is not
breathing.
Review
2. The majority of out-of-hospital cardiac
arrest patients have an irregular heart
electrical rhythm called ventricular
fibrillation. How is this rhythm
characterized?
A. rapid, disorganized, and ineffective
B. slow, disorganized, and ineffective
C. rapid but effective
D. no electrical activity at all
Review
Answer:
A. rapid, disorganized, and ineffective
Review
3. Which of the following is not a sign of
effective CPR?
A. Compressions are delivered at a rate of 50
per minute.
B. You can feel a carotid pulse during chest
compressions.
C. The patient’s skin color turns pink (from blue).
D. The chest visibly rises during ventilations.
Review
Answer:
A. Compressions are delivered at a rate of
50 per minute.
Credits
• Opener: © Glen E. Ellman
• Background slide image (ambulance):
© Comstock Images/Alamy Images
• Background slide images (non-ambulance):
© Jones & Bartlett Learning. Courtesy of
MIEMSS.