36

1. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Cardiopulmonary
Resuscitation
and AED
Chapter 8

2. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Outline
• Introduction to CPR
• Review of the Circulatory System
• Causes of Cardiac Arrest
• CPR
• AED

3. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Introduction
to CPR

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Time is Critical!
• > 300,000 people experience sudden
cardiac death in prehospital settings each
year.
• If resuscitation begins within a few
minutes, many of these individuals have a
chance for survival.

5. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Time is Critical!
To begin resuscitation within a few minutes:
• Patient’s collapse witnessed
• EMS immediately activated
• CPR started immediately
• Defibrillation within minutes

6. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Trained bystanders are not always available
or willing to do CPR.
The role of the FR is critical in reaching the
patient quickly and beginning resuscitation.

7. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Review of
the
Circulatory
System

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What is the function of the
circulatory system?

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The Circulatory System
• Delivers O2 and nutrients
• Removes CO2 and wastes

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Why is the function of the
circulatory system critical to our
survival?

11. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
If the heart stops pumping
• Lack of O2 and accumulation of wastes
quickly lead to death

12. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

13. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Major
Arteries

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Where are capillaries found and
what is their purpose?

15. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Capillaries
• Found throughout the body
• Connect smallest arteries to smallest veins
• O2, nutrients, and
wastes move
through thin
walls
• Microscopic

16. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
How does a vein differ from an artery?

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Veins
• Carry blood back to heart
• Lower pressure

18. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
What is the function of blood?

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Blood
• The fluid of the circulatory system
• Carries O2, nutrients, and wastes

20. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Heart Physiology
• LV contracts – sends wave of blood
• Pressure wave felt as pulse
• No contraction = No blood flow = cardiac
arrest

21. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Time is Critical!
• Brain damage
begins in 4–6 min
• Brain damage
irreversible in 8–10
min
Circulation must be
restored within 4–
6 minutes.

22. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR
• Provides minimal amount of
circulation/oxygenation until cause of
cardiac arrest corrected
• External chest compressions circulate
blood
• Artificial ventilations provide O2 to lungs

23. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Causes of
Cardiac
Arrest

24. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Causes of Cardiac Arrest
• Heart disease
• Respiratory arrest
• Medical emergencies
• Drowning and suffocation
• Congenital heart defects
• Trauma

25. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
The cause of cardiac
arrest is important
BUT
do not delay CPR to
obtain history

26. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR

27. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR
• Combines external chest compressions
with artificial ventilation
• Provides 30% (or less) of normal
circulation
• Only effective for short period of time

28. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR – 1 Rescuer
• Assess
responsiveness
• Summon EMS
• Position the
patient
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29. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR – 1 Rescuer
• Open the airway
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30. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR – 1 Rescuer
• Look, listen, and
feel for breathing
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

31. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR – 1 Rescuer
• If there is no
breathing, give
two breaths, each
lasting 1 second
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

32. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR – 1 Rescuer
• Check for a pulse
(≤ 10 seconds)
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

33. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR – 1 Rescuer
• If there is no
pulse, find your
landmarks, lower
half of the
sternum, between
the nipples
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

34. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR – 1 Rescuer
• Begin chest
compressions
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

35. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR – 1 Rescuer
• Perform 30 chest
compressions
• Push hard
• Push fast
• Allow the chest to
recoil after each
compression
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

36. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR – 1 Rescuer
• Administer two
ventilations then
return to
compressions
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37. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR – 2 Rescuer
1 2
3 4
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

38. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR - Children
• Use heel of one
hand
• Keep airway open
with other hand
• 30 compressions:2
ventilations if alone
(2 rescuers use
15:2)

39. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
CPR - Infant
• Give chest thrusts
and puffs of air
• 30 compressions:2
ventilations if alone
• 15 compressions: 2
ventilations with 2
rescuers

40. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Sequence of
Survival

41. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
The chances of survival from cardiac
arrest depend upon the sequence
(chain) of survival being intact.
All links are equally important and one
weak link can break the chain.

42. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Sequence of Survival
Also known as Chain of Survival
• Recognition and Early Access
• Early CPR
• Defibrillation
• Early Advanced Care

43. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Recognition and Early Access
• Depends on public
education
• EMS must be
immediately
notified
• 9-1-1 dispatchers
can provide CPR
instructions
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

44. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Early CPR
• Must begin within
4-6 minutes of
collapse
• Public training is
necessary
• FR have a critical
role
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

45. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Copyright © 2004 Elsevier (USA). All Rights Reserved
Defibrillation
•Ventricular fibrillation
a common cause of
arrest
•Can only correct with
defibrillation
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

46. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Copyright © 2004 Elsevier (USA). All Rights Reserved
• Chance of success
decreases with
time
• AEDs save lives!
Defibrillation
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

47. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Ventricular Fibrillation
• The most common cause of sudden
cardiac death
– Chaotic, disorganized heart activity
– Heart muscle cannot pump blood

48. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Ventricular Fibrillation
• Requires immediate defibrillation
• CPR lengthens window of survival

49. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Early Advanced Care
• Medication
• Advanced airway
management
• Post-resuscitation
care
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

50. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
AED

51. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
AEDs
• Safe, accurate &
lightweight
• Easy to operate
What is public
access defibrillation?

52. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
PAD
• AEDs in public
places
• Training the public
in CPR/AED

53. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Special Considerations
• Children
• Clothing
• Body hair
• Water
• Transdermal
medication patches
• Implanted
defibrillators or
pacemakers
• Metal surfaces
• Jewelry and glasses

54. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
AED
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

55. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Assess
• Check your
patient
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

56. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Universal Steps
Power
↓
Patient
↓
Analyze
↓
Shock

57. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Power
• Turn the power
on
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

58. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Patient
• Apply pads to
patient
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

59. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Analyze
• Stay clear while
patient’s heart
rhythm analyzed
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60. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Clear
• Head to toe and
toe to head:
everyone is
clear!
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61. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Shock
• Defibrillate
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62. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Patient
• Standard is set of 1
shock
• Immediately restart CPR
for 2 minutes then
check pulse
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

63. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Summary
• Continual beating, or contracting, of the
heart is necessary to keep blood circulating
throughout the body.
• Brain damage begins in 4 to 6 minutes of
cardiac arrest.
• There are many causes of sudden cardiac
death, but the most common is ventricular
fibrillation.

64. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Summary
• Survival from cardiac arrest depends on
the sequence (chain) of survival.
• First Responders are critically important in
maintaining the sequence (chain) of
survival.

65. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Shock,
Shock,
Shock!
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