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Cardiopulmonary Resuscitation and AED
Remember the BASICS!
Outline
• Introduction to CPR• History• Review of the Circulatory System• Causes of Cardiac Arrest• CPR• AED
Introduction to CPR
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.
Time is Critical!
Begin resuscitation within minutes:
• Patient’s collapse witnessed
• EMS immediately activated
• CPR started immediately
• Defibrillation within minutes
Trained bystanders are not always available or willing to do CPR.
The role of the rescuer is critical in reaching the patient quickly and beginning
resuscitation.
Historical Perspective
• Early 1900s: Shafer Method
Historical Perspective
• 1960s – Peter Safar– Prone position inadequate– Expired air did provide sufficient O2.– Head tilt, chin lift kept patent airway
Historical Perspective
• 1955: Paul Zoll: 1st successful closed chest defibrillation, external pacing
Historical Perspective
• 1930s: In hospital resuscitation team• 1960s: MICU with physicians• 1970: Education in Seattle
– 100,000 laypersons CPR– 911 dispatch education– Paramedic training
• 1979: 1st AED developed– Sensing electrode in pharynx– Shocking electrode on tongue and abdomen
• 1974: Training of laypersons formally sanctioned
Review of the Circulatory System
What is the function of the circulatory system?
The Circulatory System
• Delivers O2 and nutrients
• Removes CO2 and wastes
Why is the function of the circulatory system critical to our survival?
If the heart stops pumping
• Lack of O2 and accumulation of wastes quickly lead to death
Major Arteries
Where are capillaries found and what is their purpose?
Capillaries
• Found throughout the body• Connect smallest arteries to smallest veins• O2, nutrients, and
wastes move through thin walls
• Microscopic
How does a vein differ from an artery?
Veins
• Carry blood back to heart
• Lower pressure
What is the function of blood?
Blood
• The fluid of the circulatory system
• Carries O2, nutrients, and wastes
Heart Physiology
• Left Ventricle contracts – sends wave of blood
• Pressure wave felt as pulse
• No contraction = No blood flow = cardiac arrest
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.
CPR
• Provides minimal amount of circulation/oxygenation until cause of cardiac arrest corrected
• External chest compressions circulate blood
• Artificial ventilations provide O2 to lungs
Causes of Cardiac Arrest
Causes of Cardiac Arrest
• Heart disease• Respiratory arrest• Medical emergencies• Drowning and suffocation• Congenital heart defects• Trauma
The cause of cardiac arrest is
important
BUT
do not delay CPR to obtain history
CPR
• Combines external chest compressions with artificial ventilation
• Provides 30% (or less) of normal circulation
• Only effective for short period of time
CPR – 1 Rescuer
• Assess responsiveness
• Summon EMS• Position the
patient
CPR – 1 Rescuer
• Check for a pulse (≤ 10 seconds)
No pulse..activate EMS…Get AED
CPR – 1 Rescuer
• If there is no pulse, find your landmarks, lower half of the sternum, between the nipples
CPR – 1 Rescuer
• Begin chest compressions
CPR – 1 Rescuer
• Perform 30 chest compressions
• Push hard• Push fast• Allow the chest to
recoil after each compression
CPR – 1 Rescuer
• Administer two ventilations then return to compressions
CPR – 2 Rescuer
1 2
3 4
CPR - Children
• Use heel of one hand
• Keep airway open with other hand
• 30 compressions:2 ventilations if alone (2 rescuers use 15:2)
CPR - Infant
• Give chest thrusts and puffs of air
• 30 compressions:2 ventilations if alone
• 15 compressions: 2 ventilations with 2 rescuers
Sequence of Survival
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.
Sequence of Survival Also known as Chain of Survival
• Recognition and Early Access
• Early CPR
• Defibrillation
• Early Advanced Care
Recognition and Early Access
• Depends on public education
• EMS must be immediately notified
• 9-1-1 dispatchers can provide CPR instructions
Early CPR
• Must begin within 4-6 minutes of collapse
• Public training is necessary
• Rescuers have a critical role
Copyright © 2004 Elsevier (USA). All Rights Reserved
DefibrillationDefibrillation
•Ventricular fibrillationa common cause
ofCardiac arrest•Can only be
corrected with defibrillation
Copyright © 2004 Elsevier (USA). All Rights Reserved
• Chance of success decreases with time
• AEDs save lives!
• Chance of success decreases with time
• AEDs save lives!
DefibrillationDefibrillation
Ventricular FibrillationV-Fib
• The most common cause of sudden cardiac death– Chaotic, disorganized heart activity– Heart muscle cannot pump blood
Ventricular FibrillationV-Fib
• Requires immediate defibrillation
• CPR lengthens window of survival
Early Advanced Care
• Medication• Advanced airway
management• Post-resuscitation
care
AED
AEDs
• Safe, accurate & lightweight
• Easy to operate
What is public access defibrillation?
PAD
• AEDs in public places
• Training the public in CPR/AED
Special Considerations
• Children• Clothing• Body hair• Water• Transdermal
medication patches
• Implanted defibrillators or pacemakers
• Metal surfaces• Jewelry and glasses
AED
Assess • Check your patient
Universal Steps
Power
↓
Patient
↓
Analyze
↓
Shock
Power
• Turn the power on
Patient
• Apply pads to patient
Analyze• Stay clear while
patient’s heart rhythm is analyzed
Clear
• Head to toe and toe to head: everyone is clear!
Shock
• Defibrillate
Patient
• Standard is set of 1 shock
• Immediately restart CPR for 2 minutes then check pulse
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.
Summary
• Survival from cardiac arrest depends on the sequence (chain) of survival.
• Rescuers are critically important in maintaining the sequence (chain) of survival.
CPR Video
Remember Hard and Fast !!
Keep the Beat of Staying Alive !!!