How to simply deal with arrested and pre arrested patients - also, how to use defibrillator machines

2. When to
do C. P. R.?

3. Causes
of arrest.
Cardiac arrest:
 Most common in adult than child.
 Due to stoppage of cardiac
contractility or fatal arrhythmias.
 Many causes lead to stoppage of
cardiac output and decrease blood
supply to vital organs, heart, brain,
myocardium, liver, kidneys, lungs.
Respiratory arrest:
 Most common in children than
adult.
 Many causes lead to respiratory
arrest and stoppage of respiration
can cause severe hypoxia and
anoxia.
 Respiratory obstruction one of the
most common reversible cause of
arrest.

4. How to do
C. P. R.? S
• Safety.
S
• Stimulate response.
S
• Shout for help.
S
• Check pulse and
Start C.P.R.

5. How to do
C. P. R.?

6. Chain of
survival.
 In adult:
 In child:
A. E. D
CALL FOR
HELP
C. P. R. ROSC
ROSC
Advanced
life support
Early call
for help
EARLY
C.P.R.
Prevention
of arrest
Advanced
life support

7. Airway
opening
• Simple maneuver
• Head tilt chin left
• Jaw thrust:

8. Airway
opening
• Simple maneuver
• Bag valve mask
• Oropharyngeal and nasopharyngeal

9. Airway
opening
• Advanced airway
• Endotracheal intubation
• Combitube and Laryngeal mask

10. Airway
opening
• Use bag – valve – mask (B. V. M)
to deliver oxygen to the victim.
• After opening airway you should
confirm ventilation by checking
pulse oximetery in addition to
Look, Listen & See.
• N. B.
• B. V. M. alone can deliver only
23% (room air).
• Connection of oxygen source
can increase oxygen delivery
oxygen up to 45%.
• Connection of reservoir to B.
V. M. with oxygen can deliver
oxygen up to 85%.

12. Chest
compression
• Chest compression is done to
squeeze the heart between 2 bones,
vertebral column posteriorly and
sternum anteriorly.
• The aim to insure blood supply to
vital organs, brain, kidneys, liver,
lungs, to maintain oxygenation and
vitality for longer period to decrease
bad prognosis after recovery.
• Chest compression is the most
important part to save lives.

13. Chest
compression
• High quality C.P.R.
– Proper hand position: lower
1/3 of the sternum.
– 1 hand is supported by the
2nd hand.

14. Chest
compression
• High quality C.P.R.
– Depth is at least 5 – 6 cm. in
adult child, and 3 – 5 cm in
infant
– Adequate chest recoil
without hand off.

16. Breathing
• Every cycle of chest
compression should be
followed by 2 breaths by:
• Mouth to mouth.
• Face mask or pocket mask.
• Bag – valve – mask.

17. Breathing
• Every breath is given over 1
sec. and give another sec.
to expel air.
• Chest rise is the best
indicator for adequate
breathing.
• Avoid excessive breathing
and hyperinflation of chest.

20. 1- Rescuer C. P. R in adult
• If I see un responsive victim
while I’m alone:
• Call for help, ambulance with
AED.
• Chick pulse centrally.
• If no pulse start C. P. R.
• 30 successive high quality
chest compressions.
• Chest compression rate 100 –
120 / minute.
• Compression ventilation rate
30:2/ cycle.
• Every 2 minutes or 5 cycles
recheck pulse again.

21. 1- Rescuer C. P. R in adult
• Continue C. P. R. until AED
arrival or the victim
recover.(ROSC)
• Transfer the victim after
ROSC to I. C. U. To receive
advanced care.

23. 2- Rescuer C. P. R. in adult
• Divide C. P. R. work between 2
rescuers:
» One of them does chest
compression.
» The other open the airway
and give 2 breaths.
• The 1st does 30 chest
compressions by rate at least
100 – 120 /min.
• The 2nd maintain airway open,
gives 2 breathes after every
30 compressions, and act as
monitoring for the effective
chest compression.
• Compression – ventilation rate
is 30:2.

24. 2- Rescuer C. P. R. in adult
• Switch role between two
rescuers done every 2 minutes
or 5 cycles.
• Confirmation of pulse also
done every 2 minutes or 5
cycles.

26. Use of
AED
• AED is a computerized
machine that can detect
heart rhythm whether
shockable or not and can be
charged and gives shock.
• It should be available with
the ambulance, or with 1st
aid tools in any place
crowded with people.
• It has a great role in saving
lives.
• Once arrival of AED it should
be used without waiting.

27. Use of
AED

28. Use of
AED
• Instructions to use AED:
– Turn the machine on by pressing
button (ON).
– Follow the instructions of the
machine.
– Put pads over patient bare chest one
of them over the apex of the heart,
the 2nd below right clavicle just right
to the sternum.
– Connect pads into the specific socket.
– Clear away from the patient and leave
the AED to analyze the rhythm and
detect whether it’s shockable or not
and advise if shock needed.
– Start charging by pressing butting (2).
– After charging shock button flash (3)
and the machine is ready to deliver
shock.
– Say clear everybody, confirm all clear,
I’m clear, then, deliver shock.

29. Use of
AED
• Instructions to use AED:
– Start C. P. R. again without
waiting anything.
– Do not stop C. P. R. until the
machine re analyze again
after 2 minutes.
– Switching between 2
rescuers is done at analyzing
pause

30. Use of
AED
• Instructions to use AED:
– If the victim on watery or metal
surface you should move him
away for your safety.
– If there is sweeting or water on
victim’s chest you should dry it
before applying the pads.
– If the victim has excessive long
chest hair apply the paddles to
chest firmly then rapidly remove
them then reapply it again to
have good electrical conduction.
– If the victim has a pace – maker
turn it off before applying pads.
– If there is nitroglycerin patch
remove it and clean its site
before giving electrical shock.

31. Use of
AED

33. Changes
for child
• Child is: age group 1 year old to age
of puberty.
• The most common cause of sudden
death in children is hypoxia.
• If you find unresponsive child with
carotid pulsation not felt you
should start C. P. R. first for 2
minutes then if he is not came back
to life you should call for help,
then, Continue chest compression
and C. P. R.
• In 1 – rescuer C. P. R. in child
compression – ventilation rate is
also 30:2 as adult.
• In 2 – rescuers C. P. R. compression
– ventilation ratio become 15:2.

34. Changes
for child
• Switch role and rechecking of
pulse becomes every 10 cycles
(15:2).
• You can use 1 or 2 hands in
chest compression according to
body weight of the child, to
reach adequate depth.

35. Changes
in infant
• Infant is: age group from 1
month– 12 months.
• Feeling the pulse over
brachial artery.
• In 1 – rescuer C. P. R. in infant
compression – ventilation
rate is also 30:2.
• You should use both index
and middle fingers of one
hand over lower ½ of
sternum below imaginary
line between the two nipples

36. Changes
in infant
• In 2 – rescuers C. P. R. compression –
ventilation rate become 15:2.
• Switch role and rechecking of pulse
becomes every 10 cycles (15:2).
• Use both thumbs of both hands beside each
other over lower ½ of sternum, and encircle
the rest of fingers of both hands around
infant chest, and start C. P. R.
• Opening the airway in infants is by putting
the head in neutral position, because of
large occiput of the infant, hyper extension
of the neck may obstruct airway.

37. Use of AED
in child and
infant
• Manual defibrillator is preferred
than AED, but, if you have no choice
use pediatric pads (small sized pads).
• If pediatric pads not available you
may use adult pads instead, but, put
one of the pads over apex of the
heart, and the other on the back,
put the heart between two paddles.

38. Chocking
• Chocking happened when
hard or soft objects
entrapped into throat of
patient during eating or
swallowing.
• It leads to partial or
complete airway
obstruction and may be
lethal.
• If the victim can cough
encourage him to cough.

39. Chocking
• Management in adult:
– Do Heilmlich’s maneuver:
• Stop behind the victim to support
him.
• Put fest of one hand above the
umbilicus and below the sternum
with both hands do backward
upward abdominal pressure on the
abdomen helping the victim to expel
that foreign body out.
• You may do 5 back slaps.
• Continue doing this maneuver until
expelling this object or become
unresponsive.
• If becomes unresponsive, lie him
flat, then start C. P. R. , but before
giving breath look into the mouth if
that object easily removed remove
it before giving breath.

40. Chocking

41. Chocking
• Management in infant:
– Do 5 back slaps followed by
5 anterior chest
compressions until the
object expelled.
– If becomes unresponsive lie
him flat and start C. P. R.
consider removal of the
object before giving breaths.

42. Chocking

43. • Special cases:
– Children or short victims.
– Pregnant women.
– Obese.
– I am alone.
Chocking

44. Advanced
breathing
• In case you can get
endotracheal intubation or any
advanced airway, now you have
secured airway, so chest
compression and ventilation
become independently.
• Chest compression rate
becomes continuously without
stop, by rate 100 – 120 /min.
for 2 minutes,
• Respiratory rate becomes one
breath every 5 – 6 sec. in adult,
and one breath every 3 sec. in
infant.

45. Advanced cardiac life support
• C. P. R. with monitor and drugs:
• We will have better results if we
have well trained heart savers
with good equipment, as this
equipment will help us to
diagnose the cause of cardiac
arrest according to reading
cardiac rhythm.
• Arrange ACLS team from well-
trained personals (team leader –
chest compression – airway –
drugs – monitoring –
defibrillator – recorder) you can
manage situation according to
number of available persons.

46. Advanced cardiac life support
• Rhythm on the monitor may be:
Non – shockable rhythm:
• Asystole: wavy line, or only p-
waves.
• Pulseless electrical activity
(PEA): non – arrest
rhythm without pulse.

47. Advanced cardiac life support
• Rhythm on the monitor may be:
Shockable rhythm:
• Ventilicular fibrillation (V.F.):
coarse bizarre shape
ventilicular waves.
• Ventilicular tachycardia
without pulse (pulseless V.
Tach.)

48. Advanced cardiac life support

49. Advanced cardiac life support

50. Simple
saving lives