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Cardio pulmonary resuscitation 2011


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Cardio pulmonary resuscitation 2011

  1. 1. CARDIO PULMONARY RESUSCITATION Basic Life Support ANY ATTEMPT AT RESUSCITATION IS BETTER THAN NO ATTEMPT AT ALL (Australian Resuscitation Council) (Revised March 2011)
  2. 2. Chain of Survival <ul><li>1 st link Early recognition and call for help </li></ul><ul><li>2 nd link Early CPR </li></ul><ul><li>3 rd link Early defibrillation </li></ul><ul><li>4 th link Early advanced cardiac life support </li></ul>
  3. 3. What is a cardiac arrest? <ul><li>A condition where there is cessation of heart action evidenced as:- </li></ul><ul><li>No signs of life </li></ul><ul><ul><li>unresponsive / unconscious </li></ul></ul><ul><ul><li>no normal breathing </li></ul></ul><ul><ul><li>no purposeful movement </li></ul></ul><ul><li>Common Causes: </li></ul><ul><ul><li>Cardiac conditions such as AMI (heart attack) </li></ul></ul><ul><ul><li>Respiratory arrest </li></ul></ul>
  4. 4. What is a respiratory arrest? <ul><li>A condition where spontaneous respiratory effort is ineffective or has ceased and cardiac output is still present </li></ul><ul><li>If recognised and treated promptly may prevent deterioration into a cardiac arrest </li></ul><ul><li>Common Causes : </li></ul><ul><ul><li>asthma </li></ul></ul><ul><ul><li>allergic reaction </li></ul></ul><ul><ul><li>foreign body airway obstruction </li></ul></ul>
  5. 5. The aims of CPR <ul><li>Buys time until reversible causes can be found and treated eg blood loss </li></ul><ul><li>Maintain the supply of blood to vital organs ( to preserve heart and brain function) </li></ul><ul><li>May increase the chance of successful defibrillation </li></ul><ul><li>Slows the deterioration of ventricular fibrillation into asystole </li></ul>
  6. 6. DRSABCD <ul><li>D - Danger </li></ul><ul><li>R - Response </li></ul><ul><li>S - Send for help </li></ul><ul><li>A - Airway </li></ul><ul><li>B - Breathing </li></ul><ul><li>C - Circulation/compressions </li></ul><ul><li>D - Defibrillation </li></ul>
  7. 7. DANGER <ul><li>Assess scene for Danger to both patient/yourself </li></ul><ul><li>Ensure use of personal protective equipment at all times (eg gloves/masks etc) </li></ul><ul><li>Check for water, electricity, body fluids, vomit, blood and check for scene safety </li></ul><ul><li>Move patient to a safer place if needed, but try to avoid moving them if possible in case of other injuries </li></ul><ul><li>Remember to be mindful of your back </li></ul>
  8. 8. RESPONSE <ul><li>Do not shake and shout - touch to the shoulder </li></ul><ul><li>Speak loudly “are you all right?” </li></ul><ul><li>Has the victim fainted or are they unconscious? ( If he responds, leave as you find him, and find out what is wrong, reassess regularly) </li></ul><ul><li>A casualty who is unresponsive should be considered unconscious </li></ul>
  9. 9. SEND for help <ul><li>Send for help </li></ul><ul><li>Ensure the closest Automatic External Defibrillator (AED) has been retrieved </li></ul><ul><li>Note the time </li></ul>
  10. 10. AIRWAY <ul><li>Place a hand on the victims’ forehead </li></ul><ul><li>Fingertips to the point of the chin </li></ul><ul><li>Gently tilt the head and lift the chin to open the airway </li></ul><ul><li>Check for absence of signs of life – unconscious, not breathing normally and unresponsive </li></ul>
  11. 11. Airway <ul><li>Assess the airway, ensuring it is </li></ul><ul><li> - open </li></ul><ul><li>- clear </li></ul><ul><li>Jaw thrust can be used </li></ul><ul><li>Look in mouth for obstruction </li></ul><ul><ul><li>teeth, tongue, vomit, foreign object </li></ul></ul><ul><li>Ensure airway is clear </li></ul><ul><ul><li>If airway obstructed with fluid (vomit or blood) roll patient onto their side & clear airway or use suction if available </li></ul></ul>
  12. 12. Airway <ul><li>Airway management takes precedence over any injury </li></ul><ul><ul><li>If spinal injury is suspected maintain alignment & support head </li></ul></ul><ul><ul><li>Minimise bending and twisting of the neck </li></ul></ul><ul><li>Visible material may be removed by rolling onto side and drain by gravity (ARC 2010) </li></ul><ul><li>Leave well fitting dentures insitu </li></ul>
  13. 13. Airway - Paediatrics <ul><li>Infants: </li></ul><ul><ul><li>head neutral position </li></ul></ul><ul><ul><li>lower jaw supported chin </li></ul></ul><ul><ul><li>no pressure on soft tissues </li></ul></ul><ul><ul><li>If airway not open tilt head back very slightly </li></ul></ul><ul><li>Children should be managed as per adults (ARC 2010) </li></ul>
  14. 14. BREATHING <ul><li>Look, listen and feel for normal breathing </li></ul><ul><li>Normal breathing – roll into the recovery position & continue to observe </li></ul>
  15. 15. BREATHING <ul><li>Confirm help has been called </li></ul><ul><li>If absent or impaired breathing after opening airway commence compressions, NOT rescue breaths </li></ul>
  16. 16. CIRCULATION <ul><li>Check for signs of life </li></ul><ul><ul><li>Unresponsive / unconscious </li></ul></ul><ul><ul><li>No purposeful movement </li></ul></ul><ul><ul><li>Absence of normal breathing </li></ul></ul><ul><li>If victim takes an occasional gasp suspect cardiac arrest </li></ul><ul><li>If no signs of life commence chest compressions </li></ul>
  17. 17. COMPRESSIONS <ul><li>Kneel at the side of the casualty </li></ul><ul><li>Lower half of the sternum in all age groups </li></ul><ul><li>Press 1/3 depth of the chest </li></ul><ul><li>Rate 100 compressions / minute </li></ul><ul><li>Give 30 compressions then 2 rescue breaths </li></ul><ul><li>DO NOT apply pressure over the ribs or abdomen </li></ul>
  18. 18. Adult and child Heel of one hand or two-handed technique to suit size of child
  19. 19. Infant compressions <ul><li>Two fingers </li></ul><ul><li>Two thumbs </li></ul>
  20. 20. Get your technique right <ul><li>Ensure good position </li></ul><ul><li>50% compression, 50% relaxation </li></ul><ul><li>Allow complete chest recoil after each compression </li></ul><ul><li>Place heel of one hand on lower half sternum (centre chest) & place heel of 2 nd hand on top first, fingers parallel to the ribs & raised </li></ul><ul><li>Push with heel of hand </li></ul><ul><li>Shoulders vertically over sternum </li></ul><ul><li>Keep arms straight </li></ul>
  21. 21. Compressions =/images%3Fq%3Dcardiac%2Bcompressions%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8%26sa%3DG
  22. 22. Compressions <ul><li>30:2 – 30 compressions to 2 breaths </li></ul><ul><li>Universal ratio for all infants, children and adults with one or two rescuers </li></ul><ul><li>Ratio 30:2 will achieve 5 cycles in two minutes </li></ul><ul><li>CPR should not be interrupted to check for signs of life (ARC 2006) </li></ul><ul><li>CPR becomes ineffective when person doing compressions becomes tired, change at least every two minutes to reduce fatigue (ARC 2006) </li></ul><ul><li>Team leader monitors effectiveness of compressions & ventilations directing change of rescuers as necessary </li></ul>
  23. 23. Circulation - Duration of CPR <ul><li>Continue CPR until </li></ul><ul><ul><li>Signs of life return </li></ul></ul><ul><ul><li>Advanced Life Support personnel direct advanced resuscitation </li></ul></ul><ul><ul><li>An authorised person pronounces life extinct </li></ul></ul><ul><ul><li>It is impossible to continue </li></ul></ul>
  24. 24. Breathing technique <ul><ul><li>Observe for chest rise with each inflation </li></ul></ul><ul><ul><li>If the chest does not rise ensure correct head tilt, adequate air seal and ventilation </li></ul></ul><ul><ul><li>Various devices available, pocket mask, bag-valve-mask device </li></ul></ul>
  25. 25. Mouth to pocket mask
  26. 26. Bag/Valve/Mask
  27. 27. DEFIBRILLATION <ul><li>The purpose of BLS is to maintain myocardial and cerebral perfusion until defibrillation </li></ul><ul><li>Time is critical, the chance of successful defibrillation decreases with time </li></ul><ul><li>Immediate CPR & early defibrillation provides the best chance of survival in victims with VF or pulseless VT </li></ul>
  28. 28. Back to the chain of survival
  29. 29. AUTOMATED EXTERNAL DEFIBRILLATOR (AED) <ul><li>Portable, battery operated </li></ul><ul><li>For use by trained first aiders </li></ul><ul><li>Will analyse the rhythm </li></ul><ul><li>AED’s accurately diagnose cardiac rhythms and separate them into 2 groups </li></ul><ul><ul><li>those responsive to defibrillation </li></ul></ul><ul><ul><li>those unresponsive to defibrillation </li></ul></ul><ul><ul><li>Will only ‘shock’ a shockable rhythm </li></ul></ul>
  30. 30. DEFIBRILLATION PADS <ul><li>Soft thin foam pads </li></ul><ul><li>Layer of gel which picks up the electrical signals </li></ul><ul><li>Must adhere firmly to chest wall – no creases </li></ul><ul><li>Direction for placement clearly on pack and pads </li></ul>
  31. 31. USE OF AED <ul><li>Assign tasks if number of people present </li></ul><ul><li>Continue CPR while preparing AED </li></ul><ul><li>Turn on AED </li></ul><ul><li>Attach electrodes </li></ul><ul><li>Follow the prompts </li></ul><ul><li>Ensure no one touches the casualty while the AED analyses the rhythm </li></ul>
  32. 32. Applying the pads <ul><li>Avoid placing pads directly over medication patches, jewellery, ECG electrodes, implanted devices or invasive lines </li></ul>
  33. 33. What to do with the AED <ul><li>Plug in AED pads connector to defibrillator </li></ul><ul><li>Wait for AED to analyse the victims cardiac rhythm </li></ul><ul><li>Follow voice prompts </li></ul><ul><li>If no shock indicated continue to follow the voice prompts and maintain Basic Life Support </li></ul>
  34. 34. USE OF AED (cont) <ul><li>If a shock is indicated – the machine will deliver the shock </li></ul><ul><li>Before you push the shock button </li></ul><ul><ul><li>Perform a visual sweep of the area </li></ul></ul><ul><ul><li>Ensure no one is in contact with the patient or the patients bed </li></ul></ul><ul><ul><li>Ensure oxygen is removed from immediate area </li></ul></ul><ul><ul><li>Remove patient from excessive moisture </li></ul></ul><ul><ul><li>Call out “STAND CLEAR” and recheck the area before you push the orange shock button </li></ul></ul>
  35. 35. What next ? <ul><li>Commence CPR immediately after delivering the shock </li></ul><ul><li>Use a ratio of 30 compressions to 2 breaths </li></ul><ul><li>Follow the voice prompts & continue CPR until signs of life return </li></ul>
  36. 36. CAUTION IN USE OF AED <ul><li>Don’t apply pads over pacemakers </li></ul><ul><li>Don’t apply pads over skin patches/medications </li></ul><ul><li>Be cautious around water </li></ul><ul><li>NEVER attach to anyone not in cardiac arrest </li></ul>
  37. 37. ARRIVAL OF AMBULANCE <ul><li>DO NOT stop CPR </li></ul><ul><li>Ambulance officers - time </li></ul><ul><li>- equipment </li></ul><ul><li>- factual details </li></ul><ul><li>- assessment </li></ul><ul><li>Place victim in recovery position if signs of life return </li></ul>
  38. 38. CESSATION OF CPR <ul><li>Return of signs of life </li></ul><ul><li>The scene becomes unsafe </li></ul><ul><li>Qualified help arrives and takes over </li></ul><ul><li>You are physically unable to continue </li></ul><ul><li>An authorised person pronounces life extinct </li></ul>
  39. 39. CULTURAL AWARENESS <ul><li>Be aware of cultural and linguistic diversity </li></ul><ul><li>Debriefing in an appropriate setting can be very helpful following an intense situation such as a cardiac arrest </li></ul>
  40. 40. CAUTION <ul><li>Motorcyclists – take care when removing helmet </li></ul><ul><li>Pregnant women </li></ul><ul><ul><li>Position on her back with shoulders flat </li></ul></ul><ul><ul><li>Use padding / wedge to give pelvic tilt </li></ul></ul><ul><ul><li>The pelvic tilt obtains lateral displacement of the uterus </li></ul></ul><ul><ul><li>Enhance venous return and reduce pressure on vena cava </li></ul></ul>
  41. 41. Pt in supine position NOTE: compressed inferior vena cava and aorta Pt positioned with pelvic tilt NOTE: compression relieved on the inferior vena cava and aorta X
  42. 42. REMEMBER <ul><li>ANY ATTEMPT AT RESUSCITATION IS BETTER THAN NO ATTEMPT AT ALL </li></ul><ul><li>Australian Resuscitation Council, (2010) </li></ul>