FO1 Marko D Mission EMT-BFO1 Marko D Mission EMT-BBureau of Fire ProtectionBureau of Fire Protection

Emphasis on, and recommendations to improve, delivery of effective chest compression

A single compression-to-ventilation ratio for all single rescuers for all victims

Recommendation that each rescue breath be given over 1 second and should produce visible chest rise

A new recommendation that single shocks, followed by immediate CPR, be used to attempt defibrillation for VF cardiac arrest. Rhythm checks should be performed every two minutes.

Simplified Hand Placement

Give effective chest compressions all rescuers should “push hard and push fast”

Allow the chest to recoil completely after each compression, and use approximately equal compression and relaxation times.

Limit interruptions in chest compressions

The AHA recommends a compression-to ventilation ratio of 30:2

Breathing and CirculationBreathing and Circulation

• Air that enters the lungs contains:Air that enters the lungs contains:– 21% O221% O2– trace of CO2trace of CO2

• Air exhaled from the lungs contains:Air exhaled from the lungs contains:– 16% O216% O2– 4% CO24% CO2

• Clinical deathClinical death (0 - 4 min. - brain damage not (0 - 4 min. - brain damage not likely, 4 - 6 min. - damage probable).likely, 4 - 6 min. - damage probable).

• Biological deathBiological death (6 - 10 min. - brain damage (6 - 10 min. - brain damage probable; over 10 min. - brain damage is certain).probable; over 10 min. - brain damage is certain).

Body SystemBody System

HUMAN BODYHUMAN BODY

The Heart

The Circulatory System

The Circulatory System

Delivers oxygen and nutrients to the tissues.

Removes waste products from the tissues

Pulse Left ventricle contracts, sending a wave of blood through the arteries. This can be felt anywhere an artery passes near

the skin surface over a bone.

Carotid

Radial

Femoral

When the patient has lost a pulse, they are in cardiac arrest. Brain damage begins in 4 - 6 minutes and becomes irreversible in 8 - 10 minutes.

Pulse

Reasons the Heart will Stop

Sudden Death and Heart Disease

Respiratory Arrest, Especially in children

Medical Emergencies

Drowning, Suffocation, Trauma, Bleeding

Regardless of the Regardless of the reason, the First reason, the First

Responder’s emergency Responder’s emergency medical care of cardiac medical care of cardiac

arrest is CPR.arrest is CPR.

Regardless of the Regardless of the reason, the First reason, the First

Responder’s emergency Responder’s emergency medical care of cardiac medical care of cardiac

arrest is CPR.arrest is CPR.

Cardiopulmonary Resuscitation

“The combination of artificial ventilation and external chest

compressions is called cardiopulmonary resuscitation

(CPR).”

CPR Cannot sustain life indefinitely

Must be started as early as possible.

CPR increases the amount of time that defibrillation will be effective.

Chain of Survival

Check the Scene SafetyCheck the Scene Safety

Check for ResponsivenessCheck for ResponsivenessResponseResponseMonitorMonitor

No ResponseNo Response

Activate Medical AssistanceActivate Medical Assistance

Check for Signs of LifeCheck for Signs of LifeIs BreathingIs BreathingMonitor/Monitor/Recovery PositionRecovery Position

No Sign of LifeNo Sign of Life

Give 2 BreathsGive 2 BreathsChest does not rise,Chest does not rise,Retilt the head and ventilateRetilt the head and ventilate

Still chest does not riseStill chest does not risePerform unconscious chokingPerform unconscious choking

Check for pulseCheck for pulse

No Pulse/Not SureNo Pulse/Not Sure

Give cycles of 30ECC and 2RBGive cycles of 30ECC and 2RB

If definite Pulse, BeginIf definite Pulse, BeginRB: 1 breath every RB: 1 breath every

5 seconds for 1 minute5 seconds for 1 minute

Establish unresponsiveness.

Open airway.

Look, listen, feel.

Ventilate.

Check pulse.

Locate compression site.

Begin compressions.

One-Rescuer CPR for Two Minutes

Recheck pulse.

Two-rescuer CPR

RESCUE BREATHING ADULT CHILD INFANT

Opening of airway (Head-Tilt-Chin Lift Maneuver) Maximum tilt of the head Neutral plus position Neutral position

Location for checking of signs of circulation

Carotid pulse (Side of the neck) Carotid pulse Brachial pulse (inner aspect of

upper arm)

Method Mouth-to-mouth or Mouth-to-noseMouth-to-mouth or Mouth-to-

noseMouth-to-mouth & nose

BreathsNormal breath (1 second per breath) Normal breath (1 second per

breath) Gentle, slow breath (1 to 1.5 seconds per breath)

Rate10 to 12 breaths per minute (1 breath

every 4 to 5 seconds)12 breaths in 1 minute

20 breaths per minute (1 breath every 3 seconds)20 breaths in 1 minute

Counting for standardization purposes: Mnemonic ADULT-1 breathe every 5 seconds ; CHILD / INFANT -1 breath every 3 seconds.

Breath 1, 1002, 1003, 1001, breath 1, 1002, 1003, 1002, breath 1, 1002, 1003, 1003, breath… 10010 or up to 10012, breath

Breath 1, 1001, breath 1, 1002, breath 1, 1003, breath…1, 1020, breath

TABLE OF COMPARISON ON RESCUE BREATHING FOR ADULT, CHILD, and INFANT

TABLE OF COMPARISON ON CARDIOPULMONARY RESUSCITATIONFOR ADULT, CHILD, AND INFANT

CPR ADULT CHILD INFANT

Compression Area Center of Chest, between nipplesJust below the nipple

line

DepthApproximately 1 ½ to

2 inches.1/3 to ½ the depth of the chest

How to Compress2 hands. Heel of 1

hand, other hand on top

2 hands1 hand

2 fingers (middle & ring

fingertips).

ADULT CHILD INFANT

RateApproximately 100/min

Compression-ventilation ratio.

30:2 (1 or 2 rescuers)

30:2 (1 rescuer)15:2 (2 rescuer)

Counting for standardization purposes.

1, 2, 3, 4, 5, 6, 7, 8 ,9, 10, 11, 12, 13, 14, 15, 16,17,18,19,20,21,22,23,24,25,26,27,28,29, and 1 then breathe, breathe;

1, 2, 3, 4, 5, 6, 7, 8 ,9, 10, 11, 12, 13, 14, 15, 16,17,18,19,20,21,22,23,24,25,26,27,28,29, and 1 then breathe, breathe;

TABLE OF COMPARISON ON CARDIOPULMONARY RESUSCITATIONFOR ADULT, CHILD, AND INFANT

Infant and Child CPR

“Infants (up to one year old) and children (one to eight

years old) need slightly different care.”

Determine unresponsiveness.

Open airway.

Determine breathlessness.

Ventilate.

Determine pulselessness.

Locate correct hand position.

Compress 1/2 to one inch.

30:2

Child Compression

When to When to Spontaneous signs of Spontaneous signs of circulation are restoredcirculation are restored

Turned over to medical Turned over to medical services or properly trained services or properly trained and authorized personnel.and authorized personnel.

Operator is already exhausted Operator is already exhausted and cannot continue CPR.and cannot continue CPR.

Physician assumes responsibility. Physician assumes responsibility. ( Declares death, take over) ( Declares death, take over)

STOP STOP CPR CPR

Bureau of Fire Protection

“To Save lives and Protect Properties”

Thank you!