New Guidelines On Cpr

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New Guidelines On Cpr

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  • Why Change? 80% of cardiac arrests occur out with hospital setting. Number of compressions may be most important factor Chest compressions provide circulatory support during cardiac arrest Studies show that number, rate and quality of chest compressions are usually far from optimal
  • New Guidelines On Cpr

    1. 1. New International Guidelines on Cardiopulmonary Resuscitation Last update dec 2005 CPR
    2. 2. Chain of Survival Early Early Early Early Access CPR Defibrillation Advanced Care Early Defibrillation
    3. 3. For each minute that CPR & defibrillation is delayed Survival is reduced by 7 to 10%
    4. 4. Causes of circulation arrest <ul><li>Cardiac </li></ul><ul><li>Ischemic heart disease (myocardial infarction,) </li></ul><ul><li>Arrhythmias of different origin and character </li></ul><ul><li>Electrolytic disorders </li></ul><ul><li>Valvular disease </li></ul><ul><li>Cardiac tamponade </li></ul><ul><li>Ruptured aneurysm of aorta </li></ul><ul><li>Extra-cardiac </li></ul><ul><li>airway obstruction </li></ul><ul><li>acute respiratory failure </li></ul><ul><li>shock </li></ul><ul><li>drug overdose </li></ul><ul><li>electrocution </li></ul><ul><li>poisoning </li></ul>
    5. 5. <ul><ul><li>The goal of CPR is to produce the best Coronary Perfusion Pressure (CPP) </li></ul></ul><ul><ul><li>Cardiac arrest survival is dependent upon: </li></ul></ul><ul><ul><ul><ul><li>Early CPR. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>CPR performed properly . </li></ul></ul></ul></ul>Importance of CPR
    6. 6. Important Points <ul><ul><li>Five key aspects to Great CPR </li></ul></ul>! <ul><ul><li>Rate </li></ul></ul><ul><ul><li>Depth </li></ul></ul><ul><ul><li>Release </li></ul></ul>
    7. 7. Compression-Decompression <ul><li>Compression </li></ul><ul><li>Heard is squeezed between sternum & spine. </li></ul><ul><li>intrathoracic pressure Increase to force blood out of the heard . </li></ul><ul><li>Decompression </li></ul><ul><li>Allow complete chest recoil after each compression to maximize the vacuum in the thoracic cavity to force blood flow back to the heard </li></ul>
    8. 8. Important Points <ul><ul><li>Five key aspects to Great CPR </li></ul></ul>! <ul><ul><li>Rate </li></ul></ul><ul><ul><li>Depth </li></ul></ul><ul><ul><li>Release </li></ul></ul><ul><ul><li>Ventilation </li></ul></ul>
    9. 9. <ul><ul><li>Ventilation: </li></ul></ul><ul><ul><ul><ul><li>Inspiration phase of no more than 1 second. </li></ul></ul></ul></ul>New Guidelines for Ventilation
    10. 10. Important Points <ul><ul><li>Five key aspects to Great CPR </li></ul></ul>! <ul><ul><li>Rate </li></ul></ul><ul><ul><li>Depth </li></ul></ul><ul><ul><li>Release </li></ul></ul><ul><ul><li>Uninterrupted </li></ul></ul><ul><ul><li>Ventilation </li></ul></ul>
    11. 11. Important Points CPR “protocols” scripted to minimize hands-off time ! Initial assessment Reducing Pulse Checks
    12. 12. CPR PROTOCOL
    13. 13. Check the victim for a response ( AVPU ). <ul><li>Is person unresponsive? </li></ul>Are you okay? ACTIVATE EMS CALL 999
    14. 14. Head tilt and chin lift Open the airway & Maintain the airway open
    15. 15. Look listen and feel for normal breathing & LOOK FOR SIGS OF LIFE . Check for breathing
    16. 16. START CHEST COMPRESSION push hard and push fast 30 / 2 If no signs of life are present
    17. 17. Place the heel of one hand in the centre of the victim’s chest. Place the heel of your other hand on top of the first hand. press down on the sternum 4—5 cm Land mark
    18. 18. For one rescuer : After 30 compressions open the airway again using head tilt and chin lift give two breaths while watching the chest rise . For two rescuers : Rotate compressors every 2–3 minutes to minimize fatigue.
    19. 19. Main changes in adult CPR <ul><li>The decision to start CPR is made if a victim is unresponsive and not breathing normally. </li></ul><ul><li>Rescuers should place their hands on the center of the chest , rather than to spend more time using the ‘rib margin’ technique. </li></ul><ul><li>Each rescue breath is given over 1 sec rather than 2 sec </li></ul><ul><li>The ratio of compressions to ventilations is 302 . </li></ul><ul><li>Minimize interruptions in chest compressions. </li></ul><ul><li>Rotate compressors every 2–3 minutes to minimize fatigue. </li></ul>
    20. 20. CHILD CPR
    21. 21. <ul><li>Ensure the safety of rescuer and child. </li></ul><ul><li>Check the child’s responsiveness. </li></ul><ul><li>open the child’s airway by tilting the head and lifting the chin. </li></ul><ul><li>Keeping the airway open, look, listen and feel for normal breathing (NOMORE THAN 10 SEC) </li></ul><ul><li>If the child is not breathing </li></ul><ul><li>Give two initial rescue breaths </li></ul><ul><li>The rescuer should provide 5 cycles (a cycle is 30 compressions and 2 breaths) of CPR (about 2 minutes) before </li></ul><ul><li>CALL 999 and get an AED </li></ul><ul><li>start chest compressions ( 2.5 to 4 cm ). </li></ul>Child CPR One year of age up to 8
    22. 22. <ul><li>To perform chest compression in children over </li></ul><ul><li>1 year of age, Position yourself vertically above the victim’s chest </li></ul><ul><li>with your arm straight , compress the lower third of the sternum. (avoid compressing the upper abdomen), </li></ul><ul><li>place the heel of one hand over the lower third of the sternum ( NIPPLE LINE LEVEL) </li></ul>Land mark
    23. 23. Infant CPR
    24. 24. <ul><li>Ensure the safety of rescuer and infant . </li></ul><ul><li>Check the LOC. </li></ul><ul><li>open the infant’s airway by tilting on the patient’s ear-side angle of the jaw & tiding the head back ( do not hyperextend the neck ) </li></ul><ul><li>Keeping the airway open, look, listen and feel for normal breathing (NOMORE THAN 10 SEC) </li></ul><ul><li>If the infant is not breathing </li></ul><ul><li>Give two initial rescue breaths </li></ul><ul><li>The rescuer should provide 5 cycles (a cycle is 30 compressions and 2 breaths) of CPR (about 2 minutes) </li></ul><ul><li>CALL 999 and start chest compressions (1 to 2.5 cm)(100min). </li></ul>Infant CPR
    25. 25. Just below nipple line Compress the sternum with two fingers (One rescuer) 302 Just below nipple line Land mark
    26. 26. Patient Symptoms when in Ventricular Fibrillation <ul><li>Unconscious </li></ul><ul><li>No Breathing </li></ul><ul><li>No Signs ol life </li></ul><ul><li>Resulting in… </li></ul>No Oxygen to the Brain or Body Organs
    27. 27. What does a defibrillator do ? <ul><li>The AED is programmed to analyze the heart’s electrical activity, and decide whether the electrical shock would help. It then builds up an electric charge and deliver to the patient when you push the button. </li></ul>
    28. 28. AED Don'ts <ul><li>Don’t use the AED to monitor PTs who are awake or have a pulse </li></ul><ul><li>Don’t attach the AED to PTs in anticipation of arrest. </li></ul><ul><li>Don’t defibrillate the PTs when both the PT and the defibrillator are in contact with metal or water . </li></ul><ul><li>Don’t analyze with the AED while chest compression are in progress. </li></ul>
    29. 29. Electrode placement <ul><li>Remove electrodes from package (check expiry date). </li></ul><ul><li>Apply to PT :superior right chest </li></ul><ul><li>left lower lateral side of chest </li></ul><ul><li>Wet PTs should be toweled dry. </li></ul><ul><li>Hairy chest may need shaving. </li></ul><ul><li>Can be use with pacemaker, electrode on right side should be beneath pacemaker. </li></ul>
    30. 30. <ul><li>CPR (only) ……………………… 0-2% </li></ul><ul><li>EMS/ER …………………… 5-15% </li></ul><ul><li>CPR + AED …….. 30 - 75% </li></ul>Sudden Death Reversal Rates
    31. 31. <ul><li>Don’t Touch Patient During Analysis </li></ul><ul><li>Except for pulse check. </li></ul>WARNING! <ul><li>Start chest compressions for 2 minutes immediately after defibrillation. Without pulse check </li></ul>
    32. 32. AED Changes <ul><li>Immediately resume CPR for 2 minutes , no rhythm, breathing or pulse check( Compressions do not cause harm if there is a rhythm ). </li></ul>With past guideline AED’s there was a hands off delay of 29-37 seconds between first shock and first compression.
    33. 33. AED Algorithm
    34. 34. Thank You

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