Module 5 Cardiac Arrest

5

Cardiac Arrest & Cardiopulmonary Resuscitation

OBJECTIVES KNOWLEDGE OBJECTIVES: 1. Describe cardiac arrest. 2. Enumerate the three conditions of cardiac arrest . 3. Enumerate the criteria for not starting CPR and when to STOP CPR.

SKILL OBJECTIVE:

Demonstrate how to provide

Cardiopulmonary Resuscitation to an

adult, child & infant who are in cardiac

arrest.

Condition in which circulation ceases and vital organs are deprived of oxygen. CARDIAC ARREST

CARDIOPULMONARY RESUSCITATION (CPR) This is a combination of chest compressions and rescue breathing. These must be combined for effective resuscitation of the victim of cardiac arrest.

combination of chest compressions and rescue breathing for cardiac arrest. Cardiopulmonary Resuscitation

Table of Comparison on Cardiopulmonary Resuscitation for Adult, Child and Infant Maneuver Adult Child Infant Compression Area Center of the chest along imaginary nipple line Center of the chest 1 finger width below the imaginary nipple line Depth Approximately 1 ½ to 2 inches Approximately 1/3 to 1/2 the depth of the chest How to Compress Heel of 1 hand, other hand on top Heel of 1 hand or as for adult 2 fingers (middle & ring fingertips)/2 thumb encircling hands Rate Approximately 100/min Compression/ Ventilation Ratio 30:2 ( 1 rescuer ) 15:2 ( 2 rescuers ) Number of cycles per 2 minutes 5 cycles Counting for standardization purposes 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24, 25,26,27, 28,29, 30 for 5 cycles in 2 minutes

THREE CONDITIONS OF CARDIAC ARREST

Cardio Vascular Collapse. The heart is still beating but its action is so weak that blood is not being circulated through the vascular system to the brain body tissues.

Ventricular Fibrillation. Occurs when the individual fascicles of the heart beat independently rather than the coordinated, synchronized manner that produce rhythmic heart beat.

Cardiac Standstill. It means that the heart has stopped beating.

COUGH CPR . It is a self- initiated CPR, which is possible. Its use, however, is limited to clinical situations in which the patient has a monitored cardiac arrest, the arrest was recognized before loss of consciousness, and the patient can cough forcefully.

COMPRESSION ONLY-CPR

If a person is unwilling or unable to perform mouth-to-mouth ventilation for an adult victim, chest compression only - CPR should be provided rather than no attempt of CPR being made.

The patient has a valid : ”DO NOT RESUSCITATE” order

The patient has signs of irreversible death

Rigor mortis

Dependent Lividity

Decapitation

Decomposition

CRITERIA FOR NOT STARTING CPR

3. No physiological benefit can be expected

Withholding attempts to resuscitate in the delivery room is appropriate for newly born infants

Confirmed gestation < 23 weeks or birth weight

< 400gms.

Anencephaly

5. Confirmed Trisomy 13 or 18

WHEN TO STOP CPR 1. SPONTANEOUS signs of circulation are restored. 2. TURNED over to medical services or properly trained and authorized personnel.

3. OPERATOR is already exhausted and cannot continue CPR. 4. PHYSICIAN assumes responsibility (declares death, takes over, etc.).

WHEN TO STOP CPR S - SPONTANEOUS signs of circulation are restored. T - TURNED over to medical services O - OPERATOR is already exhausted and cannot continue CPR. P - PHYSICIAN assumes responsibility S - SCENE becomes unsafe. S - SIGNED waiver to stop CPR.

Adult Child Infant Airway Head tilt – chin lift Breathing (Initial) 2 effective breaths at 1 second/breath Rescue breathing w/o chest compressions 10 – 12 breaths per minute (approximate) 12 – 20 breaths per minute (approximate) Rescue breaths for CPR with advanced airway 8 – 10 breaths per minute (approximately) Foreign-body airway obstruction Abdominal thrusts or chest thrusts (responsive) CPR (unresponsive) 5 Back slaps and 5 chest thrusts (responsive) CPR (unresponsive) Circulation Pulse check (10 sec. or less) Carotid artery Brachial or Femoral artery Compression landmarks Lower half of sternum, between the nipples Just below the nipple line (lower half of sternum) Compression method Push hard and fast Allow complete recoil Heel of one hand with the other hand on top Heel of one hand or as for adult 2 or 3 fingers (2 rescuers): 2 thumbs-encircling hand Compression rate Approximately 100 compressions per minute Compression-ventilation ratio 30:2 (one rescuers) 30:2 (lone rescuer) 15:2 (2 rescuer) Defibrillation AED Use adult pads Do not use child pads Use AED after 5 cycles of CPR (out of hospital). Use pediatric system for children 1 – 8 years if available For sudden collapse (out-of-hospital) or in-hospital arrest use AED as soon as possible. Not recommended for infants