11 Cardio Pulmoner Resuscitation
Transcript of 11 Cardio Pulmoner Resuscitation
-
8/12/2019 11 Cardio Pulmoner Resuscitation
1/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
2/79
Emphasis on High-Quality CPR
blood flow is optimized by using the recommended chest compression
force and duration and maintaining a chest compression rate of
approximately 100 compressions per minute. These guidelines
recommend that all rescuers minimize interruption of chest compressions CPR instruction should emphasize the importance of allowing complete
chest recoil between compressions.
(Circulation.2005; 112: IV19-IV34)
2005 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
3/79
Emphasis on High-Quality CPR
To provide effective chest compressions, push
hard and push fast. compress the adult chest
at a rate of at least 100 compressions per
minute with a compression depth of at least 2
inches/5 cm. allow complete recoil of the
chest after each compression, to allow the heart
to fill completely before the next compression.
minimize the frequency and duration of
interruptions in compressions to maximize the
number of compressions delivered per minute.
(Berg, et al. Circulation.2010;122;S685-S705)
2010 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
4/79
Highlights
This is a re-emphasis from 2005.
For effective compressions:
Push fast
Push hard
Allow chest to fully recoil
Minimize any interruptions
Applies to both lay and healthcare providers.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
5/79
Rationale For Change
High-quality chest compressions within CPR
continues to be a critical focal point.
Well-performed compressions increase the
likelihood of survival.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
6/79
Compression Hand Position
The rescuer should compress the lower half of the victims sternum in
the center (middle) of the chest, between the nipples. The rescuer should
place the heel of the hand on the sternum in the center (middle) of the
chest between the nipples and then place the heel of the second hand ontop of the first so that the hands are overlapped and parallel.
(Circulation.2005; 112: IV19-IV34)
2005 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
7/79
Compression Hand Position
The rescuer should place the heel of one hand
on the center (middle) of the victims chest
(which is the lower half of the sternum) and the
heel of the other hand on top of the first so that
the hands are overlapped and parallel.
(Berg, et al. Circulation.2010;122;S685-S705)
2010 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
8/79
Highlights
Hands in center of the chest.
Lower half of breastbone
Second hand on top of the first.
Not on lowest part of breastbone.
Applies to both lay and healthcare providers.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
9/79
Rationale For Change
Use of the nipple line as a landmark for
hand placement was found to be unreliable.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
10/79
Compression Rate
There is insufficient evidence from human studies to identify a single
optimal chest compression rate. Animal and human studies support a
chest compression rate of >80 compressions per minute to achieve
optimal forward blood flow during CPR. We recommend a compressionrate of about 100compressions per minute.
(Circulation. 2005; 112: IV19-IV34)
2005 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
11/79
Compression Rate
It is reasonable for laypersons and healthcare
providers to compress the adult chest at a
rate of at least 100 compressions per minute
with a compression depth of at least 2 inches
(5 cm.)
(Berg, et al. Circulation. 2010;122;S685-S705)
2010 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
12/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
13/79
Rationale For Change
It has been found that higher survival rates are
associated with an increase in the number of
compressions provided per minute.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
14/79
Child/Infant Compression Rate
Push fast; push at a rate of approximately 100 compressions per
minute.
(Circulation. 2005; 112: IV156-IV166)
2005 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
15/79
Child/Infant Compression Rate
Push fast; push at a rate of at least100
compressions per minute.
(Berg, et al. Circulation. 2010;122;S862-S875)
2010 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
16/79
Highlights
Rescuers tend to compress slower.
At least100 compressions per minute.
It is okay to be a little faster.
Applies to both lay and healthcare providers.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
17/79
Rationale For Change
It has been found that higher survival rates are
associated with an increase in the number of
compressions provided per minute.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
18/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
19/79
Compression Depth
It is reasonable for laypersons and healthcare
providers to compress the adult chest at a rate of
at least 100 compressions per minute with a
compression depth of at least 2 inches/5 cm.
(Berg, et al. Circulation. 2010;122;S685-S705)
2010 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
20/79
Highlights
At least2 inches on an adult.
It is okay to compress a little deeper.
Not enough information to define upper limit.
Applies to both lay and healthcare providers.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
21/79
Rationale For Change
Research indicates the tendency for CPR
providers to not compress deep enough, even
with the emphasis to "push hard."
-
8/12/2019 11 Cardio Pulmoner Resuscitation
22/79
Child/Infant Compression Depth
Push hard: push with sufficient force to depress the chest
approximatelyone third to one half the anterior-posterior diameter of the
chest.
(Circulation.2005; 112: IV156-IV166)
2005 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
23/79
Child/Infant Compression Depth
Chest compressions of appropriate rate and
depth. Push fast: push at a rate of at least
100 compressions per minute. Push hard:
push with sufficient force to depress at leastone third the anterior-posterior (AP)
diameter of the chest or approximately 1
inches (4 cm) in infants and 2 inches (5 cm)
in children.
(Berg, et al. Circulation.2010;122;S862-S875)
2010 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
24/79
Highlights
At least1/3 of the anterior/posterior diameter
of chest.
About 2 inches for children and about 1
inches for infants. It is okay to compress a little deeper
Applies to both lay and healthcare providers.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
25/79
Rationale For Change
Research indicates the tendency for CPR
providers to not compress deep enough, even
with the emphasis to "push hard."
-
8/12/2019 11 Cardio Pulmoner Resuscitation
26/79
Breathing Assessment
While maintaining an open airway, look, listen, and feel for breathing.
(Circulation.2005; 112: IV19-IV34)
2005 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
27/79
Breathing Assessment
After activation of the emergency response system, all rescuers should
immediately begin CPR for adult victims who are unresponsive with no
breathing or no normal breathing (only gasping).
(Berg, et al. Circulation.2010;122;S685-S705)
2010 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
28/79
Highlights
No more look, listen, and feel.
Quick lookfor no breathing or no normal
breathing.
Agonal breaths remain a concern.
Applies to both lay and healthcare providers.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
29/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
30/79
CPR Sequence - Lay
For an unresponsive person who is not breathing or not breathing
normally, begin CPR by opening the airway and giving 2 rescue breaths
followed with 30 chest compressions. Repeat cycles of 30:2 (ABC
method).
(Summary from Circulation.2005; 112: IV19-IV34)
2005 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
31/79
CPR Sequence - Lay
For an unresponsive person, activate EMS,
then assess breathing. If the person is not
breathing or not breathing normally, begin CPR
with 30 compressions followed by opening theairway and giving 2 rescue breaths. Repeat
cycles of 30:2 (CABmethod).
(Summary from Berg, et al. Circulation.
2010;122;S685-S705)
2010 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
32/79
Highlights
Initial assessment steps: Assess responsiveness
Activate EMS
Assess breathing
Perform CPR
CABbegin CPR cycles with compressions,
followed by airway and breathing.
Guideline applies to adults, children, and infants.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
33/79
Rationale For Change
The science indicates the importance of not
delaying chest compressions to perform rescue
breaths.
Early chest compression can immediatelycirculate oxygen that is still in the bloodstream.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
34/79
CPR Sequence - HCP
For an unresponsive person who is not
breathing or not breathing normally, begin CPR
by opening the airway and giving 2 rescue
breaths followed with 30 chest compressions.Repeat cycles of 30:2 (ABC method).
(Summary from Circulation.2005; 112: IV19-
IV34)
2005 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
35/79
CPR Sequence - HCP
For an unresponsive person who is not
breathing or not breathing normally, and has no
obvious pulse, activate EMS and begin CPR
with 30 compressions followed by opening theairway and giving 2 rescue breaths. Repeat
cycles of 30:2 (CAB method).
(Summary from Berg, et al. Circulation.
2010;122;S685-S705)
2010 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
36/79
Highlights
Initial assessment approach: Assess responsiveness and breathing
Activate EMS
Assess pulse
Perform CPR
CABbegin CPR cycles with compressions,
followed by airway and breathing.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
37/79
Rationale For Change
The science indicates the importance of not
delaying chest compressions to perform rescue
breaths.
Early chest compression can immediatelycirculate oxygen that is still in the bloodstream.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
38/79
Use of an AED on an Infant
There is insufficient data to make a
recommendation for or against the use of AEDs
for infants 1 year of age.
(Circulation.2005; 112: IV156-IV166)
2005 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
39/79
Use of an AED on an Infant
Many AEDs have high specificity in
recognizing pediatric shockable rhythms, and
some are equipped to decrease (or attenuate)
the delivered energy to make them suitable forinfants and children < 8 years of age. For
infants an AED equipped with a pediatric
attenuator is preferred for infants. If neither is
available, an AED without a dose attenuator
may be used.
(Link, et al. Circulation.2010;122;S706-S719)
2010 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
40/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
41/79
Rationale For Change
AEDs designed to be used on adults have been
successful when used on infants with out-of-
hospital cardiac arrest.
Minimal heart muscle damage and goodneurological outcomes were reported.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
42/79
Chain of Survival
Early recognition of the emergency and
activation of the emergency medical services
(EMS) or local emergency response system
Early bystander CPREarly delivery of a shock with a defibrillator
Early advanced life support followed by post
resuscitation care delivered by healthcare
providers
(Circulation.
2005; 112: IV12-IV18)
2005 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
43/79
Chain of Survival
These actions are termed the links in the Chain
of Survival.For adults they include:
Immediate recognition of cardiac arrest andactivation of the emergency response system
Early CPR that emphasizes chest
compressions
Rapid defibrillation if indicated
Effective advanced life support
Integrated postcardiac arrest care.
(Travers, et al. Circulation.2010;122;S676-S684)
2010 Guidelines
-
8/12/2019 11 Cardio Pulmoner Resuscitation
44/79
Highlights
Addition of fifth link in chain.
Integrated post-cardiac arrest care.
Applies to both lay and healthcare providers.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
45/79
Rationale For Change
Links in the Chain of Survivalindicate the
individual actions that must be strong in
order for a person to survive a sudden
cardiac arrest. The addition of the fifth link, integrated post-
cardiac arrest care, further emphasizes the
additional dependence on longer-term care
for long-term survival.
-
8/12/2019 11 Cardio Pulmoner Resuscitation
46/79
Cardiopulmonary
Resuscitation with
Automated
External
Defibrillator
Provider Course CPR/AED
-
8/12/2019 11 Cardio Pulmoner Resuscitation
47/79
At the end of this course participants should beable to demonstrate:
How to assess the collapsed victim How to perform chest compression and rescue breathing
(CPR)
How to operate an automated external defibrillator safely
How to place an unconscious breathing victim in the
recovery position
Objectives
-
8/12/2019 11 Cardio Pulmoner Resuscitation
48/79
In Europe every 45 seconds a cardiac arresttakes place
Bystander CPR is a vital intervention beforearrival of emergency services
Early resuscitation and prompt defibrillation(within 1-2 minutes) can result in >60% survival
Background
-
8/12/2019 11 Cardio Pulmoner Resuscitation
49/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
50/79
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
-
8/12/2019 11 Cardio Pulmoner Resuscitation
51/79
Approach safely
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
-
8/12/2019 11 Cardio Pulmoner Resuscitation
52/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
53/79
Shake shoulders gently
Ask Are you all right?
If he responds
Leave as you find him.
Find out what is wrong.Reassess regularly.
Check response
-
8/12/2019 11 Cardio Pulmoner Resuscitation
54/79
Shout for help
Approach safelyApproach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
-
8/12/2019 11 Cardio Pulmoner Resuscitation
55/79
Open airway
Approach safelyApproach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
-
8/12/2019 11 Cardio Pulmoner Resuscitation
56/79
Check breathing
Approach safelyApproach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
-
8/12/2019 11 Cardio Pulmoner Resuscitation
57/79
Look, listen and feel for NORMAL breathing
Check breathing
-
8/12/2019 11 Cardio Pulmoner Resuscitation
58/79
Occurs shortly after the heart stops
in up to 40% of cardiac arrests
Described as barely, heavy, noisy or gasping
breathing
Recognise as a sign of cardiac arrest
Abnormal breathing
-
8/12/2019 11 Cardio Pulmoner Resuscitation
59/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
60/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
61/79
Place the heel of one hand in the
centre of the chest
Place other hand on top
Interlock fingers or avoid puttingpressure on the side of the chest
Compress the chest
Rate 100120min-1
Depth 56cm
Equal compression : relaxation
When possible change CPR
operator every 2 min
Chest compressions
-
8/12/2019 11 Cardio Pulmoner Resuscitation
62/79
2 Rescue breaths
Approach safelyApproach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
-
8/12/2019 11 Cardio Pulmoner Resuscitation
63/79
Rescue breaths
Pinch the nose
Take a normal breath
Place lips over mouth
Blow until the chest rises
Take about 1 second
Allow chest to fallRepeat
-
8/12/2019 11 Cardio Pulmoner Resuscitation
64/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
65/79
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
-
8/12/2019 11 Cardio Pulmoner Resuscitation
66/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
67/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
68/79
Switch on AED
Some AEDs will automatically switch
themselves on when the lid is opened
-
8/12/2019 11 Cardio Pulmoner Resuscitation
69/79
Attach pads to victims bare chest
-
8/12/2019 11 Cardio Pulmoner Resuscitation
70/79
Analysing Rhythm: Do not touch victim
-
8/12/2019 11 Cardio Pulmoner Resuscitation
71/79
Shock indicated
Stand clear
Deliver shock
-
8/12/2019 11 Cardio Pulmoner Resuscitation
72/79
30 2
Shock delivered: Follow AED instructions
-
8/12/2019 11 Cardio Pulmoner Resuscitation
73/79
No shock advised: Follow AED instructions
30 2
-
8/12/2019 11 Cardio Pulmoner Resuscitation
74/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
75/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
76/79
CPR in children
Adult CPR techniques can be used on children
Compressions at least 1/3 of the depth of thechest
-
8/12/2019 11 Cardio Pulmoner Resuscitation
77/79
-
8/12/2019 11 Cardio Pulmoner Resuscitation
78/79
Any questions?
-
8/12/2019 11 Cardio Pulmoner Resuscitation
79/79
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest
i
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
Attach AED