The document summarizes new international guidelines on cardiopulmonary resuscitation (CPR) from 2005. It discusses the importance of early CPR, the proper techniques for CPR including chest compressions and ventilations. It provides guidance on CPR protocols for adults, children, and infants. It also outlines the role of defibrillators in reviving someone in ventricular fibrillation and the proper use of automated external defibrillators.

1. New International Guidelines on Cardiopulmonary Resuscitation Last update dec 2005 CPR

2. Chain of Survival Early Early Early Early Access CPR Defibrillation Advanced Care Early Defibrillation

3. For each minute that CPR & defibrillation is delayed Survival is reduced by 7 to 10%

4. Causes of circulation arrest Cardiac Ischemic heart disease (myocardial infarction,) Arrhythmias of different origin and character Electrolytic disorders Valvular disease Cardiac tamponade Ruptured aneurysm of aorta Extra-cardiac airway obstruction acute respiratory failure shock drug overdose electrocution poisoning

5. The goal of CPR is to produce the best Coronary Perfusion Pressure (CPP) Cardiac arrest survival is dependent upon: Early CPR. CPR performed properly . Importance of CPR

6. Important Points Five key aspects to Great CPR ! Rate Depth Release

7. Compression-Decompression Compression Heard is squeezed between sternum & spine. intrathoracic pressure Increase to force blood out of the heard . Decompression Allow complete chest recoil after each compression to maximize the vacuum in the thoracic cavity to force blood flow back to the heard

8. Important Points Five key aspects to Great CPR ! Rate Depth Release Ventilation

9. Ventilation: Inspiration phase of no more than 1 second. New Guidelines for Ventilation

10. Important Points Five key aspects to Great CPR ! Rate Depth Release Uninterrupted Ventilation

11. Important Points CPR “protocols” scripted to minimize hands-off time ! Initial assessment Reducing Pulse Checks

12. CPR PROTOCOL

13. Check the victim for a response ( AVPU ). Is person unresponsive? Are you okay? ACTIVATE EMS CALL 999

14. Head tilt and chin lift Open the airway & Maintain the airway open

15. Look listen and feel for normal breathing & LOOK FOR SIGS OF LIFE . Check for breathing

16. START CHEST COMPRESSION push hard and push fast 30 / 2 If no signs of life are present

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. 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. Main changes in adult CPR The decision to start CPR is made if a victim is unresponsive and not breathing normally. Rescuers should place their hands on the center of the chest , rather than to spend more time using the ‘rib margin’ technique. Each rescue breath is given over 1 sec rather than 2 sec The ratio of compressions to ventilations is 30\2 . Minimize interruptions in chest compressions. Rotate compressors every 2–3 minutes to minimize fatigue.

20. CHILD CPR

21. Ensure the safety of rescuer and child. Check the child’s responsiveness. open the child’s airway by tilting the head and lifting the chin. Keeping the airway open, look, listen and feel for normal breathing (NOMORE THAN 10 SEC) If the child is not breathing Give two initial rescue breaths The rescuer should provide 5 cycles (a cycle is 30 compressions and 2 breaths) of CPR (about 2 minutes) before CALL 999 and get an AED start chest compressions ( 2.5 to 4 cm ). Child CPR One year of age up to 8

22. To perform chest compression in children over 1 year of age, Position yourself vertically above the victim’s chest with your arm straight , compress the lower third of the sternum. (avoid compressing the upper abdomen), place the heel of one hand over the lower third of the sternum ( NIPPLE LINE LEVEL) Land mark

23. Infant CPR

24. Ensure the safety of rescuer and infant . Check the LOC. 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 ) Keeping the airway open, look, listen and feel for normal breathing (NOMORE THAN 10 SEC) If the infant is not breathing Give two initial rescue breaths The rescuer should provide 5 cycles (a cycle is 30 compressions and 2 breaths) of CPR (about 2 minutes) CALL 999 and start chest compressions (1 to 2.5 cm)(100\min). Infant CPR

25. Just below nipple line Compress the sternum with two fingers (One rescuer) 30\2 Just below nipple line Land mark

26. Patient Symptoms when in Ventricular Fibrillation Unconscious No Breathing No Signs ol life Resulting in… No Oxygen to the Brain or Body Organs

27. What does a defibrillator do ? 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.

28. AED Don'ts Don’t use the AED to monitor PTs who are awake or have a pulse Don’t attach the AED to PTs in anticipation of arrest. Don’t defibrillate the PTs when both the PT and the defibrillator are in contact with metal or water . Don’t analyze with the AED while chest compression are in progress.

29. Electrode placement Remove electrodes from package (check expiry date). Apply to PT :superior right chest left lower lateral side of chest Wet PTs should be toweled dry. Hairy chest may need shaving. Can be use with pacemaker, electrode on right side should be beneath pacemaker.

30. CPR (only) ……………………… 0-2% EMS/ER …………………… 5-15% CPR + AED …….. 30 - 75% Sudden Death Reversal Rates

31. Don’t Touch Patient During Analysis Except for pulse check. WARNING! Start chest compressions for 2 minutes immediately after defibrillation. Without pulse check

32. AED Changes Immediately resume CPR for 2 minutes , no rhythm, breathing or pulse check( Compressions do not cause harm if there is a rhythm ). With past guideline AED’s there was a hands off delay of 29-37 seconds between first shock and first compression.

33. AED Algorithm

34. Thank You