1. RDT HOSPITALS EVERYCARING PERSONSRESPONSIBILITY

2.

• American Heart Association (AHA)

• European Resuscitation Council (ERC)

• Heart and Stroke Foundation of Canada (HSFC)

• Resuscitation Council of Southern Africa (RCSA)

• Australia and New Zealand Council on Resuscitation (ANZCOR)

• Anti-American Heart Foundation (IAHF)

• Japan Resuscitation Council (JRC) International observer to ILCOR

InternationalLiaison Committee on Resuscitation 3.

At least two international experts from different organizations review each topic

Minimum database requirements for every search strategy, include:

• Medline

• EMBase

• Cochrane Systematic Reviews.

Every reviewer rates the level and quality of evidence using a standardized international evidence evaluation form.

There are separate international task forces for each of the following areas: BLS, ALS, Pediatric, Neonatal, ACS/MI, and Stroke.

An additional interdisciplinary task force addresses topics that affect all groups.

InternationalLiaison Committee on Resuscitation 4. HISTORY OF CPR

3000 BC - first artificial mouth to mouth ventilation

1780 first attempt of newborn resuscitation by blowing

1874first experimental direct cardiac massage

1901first successful direct cardiac massage in man

1946first experimental indirect cardiac massage anddefibrillation

1960indirect cardiac massage

1980development of cardiopulmonary resuscitation due tothe works of Peter Safar

5. FACTS AND STATISTICS

DEATH FROM SUDDEN CARDIAC ARREST IS NOT INEVITABLE. IF MORE PEOPLE KNEW CPR, MORE LIVES COULD BE SAVED.

ABOUT 75 PERCENT TO 80 PERCENT OF ALL OUT-OF-HOSPITAL CARDIAC ARRESTS HAPPEN AT HOME & 94% OF SUDDEN CARDIAC ARREST VICTIMS DIE BEFORE REACHING THE HOSPITAL

EFFECTIVE BYSTANDER CPR, PROVIDED IMMEDIATELY AFTER CARDIAC ARREST, CAN DOUBLE A VICTIMSCHANCE OF SURVIVAL.

APPROXIMATELY 95 PERCENT OF SUDDEN CARDIAC ARREST VICTIMS DIE BEFORE REACHING THE HOSPITAL.

ONLY 27.4 PERCENT OF OUT-OF-HOSPITAL SUDDEN CARDIAC ARREST VICTIMS RECEIVE BYSTANDER CPR

CARDIAC ARREST OCCURS TWICE AS FREQUENTLY IN MEN COMPARED TO WOMEN.

THERE HAS NEVER BEEN A CASE OF HIV TRANSMITTED BY MOUTH-TO-MOUTH CPR.

IF CPR IS STARTED WITHIN 4 MINUTES OF COLLAPSE AND DEFIBRILLATION PROVIDED WITHIN 10 MINUTES A PERSON HAS A 40% CHANCE OF SURVIVAL.

SURVIVAL < 6% WORLDWIDE AVERAGE

6. CARDIAC ARREST

CAUSES OF

CARDIAC ARREST

CARDIAC EXTRA-CARDIAC 7. DIAGNOSIS OF CARDIAC ARREST 8. 9. OBJECTIVES OF CPR

Provide oxygen to brain, heart, other vital organs until more expert/definitive medical treatment available.

Speed is critical

Highest discharge rate

CPR within 4 minutes of arrest

ACLS within 8 minutes.

Early bystander intervention

10. PHYSIOLOGY DURING CPR

1. CIRCULATORY PHYSIOLOGY

A. BLOOD FLOW THEORIES

THORACIC PUMP THEORY

CARDIAC PUMP THEORY

CARDIAC OUTPUT

2.

11. ELEMENTS OF BLS

A INITIAL ASSESSMENT,THEN AIRWAYMAINTENANCE

B EXPIRED AIR VENTILATION (RESCUE BREATHING)

CCHEST COMPRESSION.

D DEFIBRILLATION

12. CHAIN OF SURVIVAL

Early access to emergency services

Early CPR

Early defibrillation

Early advanced care

13. PRINCIPLES OF BLS

SHAKE

AND SHOUT

Check responsiveness

Call for help

14. BLS- HELLO + HELP

Determine if the patient is conscious by tapping and shouting "Are you OK?"

If no response have someone call for the crash cart

15. BLS- Airway

POSITION THE PATIENT ON HIS / HER BACK.

OPEN THE AIRWAY WITH A HEAD-TILT CHIN-LIFT OR

JAW THRUST

FINGER SWEEP

16. AIRWAY ADJUNCTS

AIRWAYS(NASAL & ORAL).

LARYNGEAL MASK AIRWAYS.

17. AIRWAY ADJUNCTS

COMBITUBES

ENDOTRACHEAL TUBES

18. B-BREATHING LOOK- for the chest to rise and fall LISTEN - for air escaping during exhalation FEEL - for the flow of air CHECK BREATHINGFOR NO LONGER THAN 10 SECS 19. B-BREATHING

IS THE VICTIM BREATHING?

YES

IF SAFE, USE RECOVERY POSITION

CALL FOR HELP

REASSESS AT INTERVALS

20. RECOVERY POSITION

MAINTAIN A PATENT AIRWAY

REDUCE THE RISK OF AIRWAY OBSTRUCTION AND ASPIRATION

STABLE POSITION

NEAR A TRUE LATERAL POSITION

HEAD DEPENDENT

NO PRESSURE ON THE CHEST TO IMPAIR BREATHING

21. B-BREATHING

IS THE VICTIM BREATHING?

NO

CALL FOR HELP

GIVE TWO RESCUE BREATHS

22. BLS - BREATHING

RESCUE BREATHING

Give a sufficient tidal volume to producevisible chest rise

Avoid rapid or forceful breaths

Pinch the victims nose, and create an airtight mouth-to-mouth seal

Take a normal breath prior to giving a rescue ventilation & ventilations that are approximately 1 second in length. 23. TYPES OF BREATHING

MOUTH TO MOUTH

MOUTH TO NOSE

MOUTH TO STOMA

BAG AND MASK

24. BLS- CIRCULATION ASSESSMENT Check for a pulse by palpating(feeling) the carotid artery.THE HEALTHCARE PROVIDER SHOULD TAKE NO MORE THAN10 SECONDSCHECK FOR A PULSE 25. BLS- CIRCULATION

DO YOU DEFINITELY FEEL PULSE WITHIN 10 SECONDS?

YES

CONTINUE WITH RESCUE BREATHING

REASSESS FOR SIGNS OF A CIRCULATION ABOUTEVERY MINUTE

26. BLS- CIRCULATION

DO YOU DEFINITELY FEEL PULSE WITHIN

10 SECONDS?

NO

START CHEST COMPRESSIONS

CONTINUE WITH RESCUE BREATHING

27. BLS- CIRCULATION

COMPRESSIONS

Chest compressions consist of rhythmic applications of pressure over the lower half of the sternum

These compressions create blood flow by increasing intrathoracic pressure and directly compressing the heart

Chest compressions can produce systolic arterial pressure peaks of 60 to 80 mm Hg

28. BLS- CIRCULATION

PROPER HAND PLACEMENT

29. BLS- CIRCULATION The victim should lie supine on a hard surface(eg, backboard or floor), with the rescuer kneeling beside the victims thorax Correct compression technique and posture.Elbows straight, eyes looking at the top of your hands, counting each compression 30. COMPRESSIONVENTILLATION RATIO

A compression-ventilation ratio of 30:2 is recommended

Designed to

• increase the number of compressions

• reduce the likelihood of hyperventilation

• minimize interruptions in chest compressions for ventilation

31. COMPRESSIONVENTILLATION RATIO

Once an advanced airway is in place, the compressing rescuer should give continuous chest compressions at a rate of 100 per minute without pauses for ventilation.

The rescuer delivering ventilation provides 8 to 10 breaths per minute.

NOTE: The outcome of chest compressionswithout ventilations is significantlybetter than the outcome of no CPR foradult cardiac arrest

32. DEFIBRILLATION

All BLS providers should be trained to provide defibrillation because VF is the most common rhythm found in adults with witnessed, non traumatic SCA

Survival rates are highest when immediate bystander CPR is provided and defibrillation occurs within 3 to 5 minutes.

Unwitnessed cardiac arrest -rescuers may give a period of CPR (e.g., about 5 cycles or about 2 minutes) before checking the rhythm and attempting defibrillation.

33. 34. MONOPHASIC Vs BIPHASIC

1st-shock efficacy of monophasic < 1st-shock efficacy of biphasic

Goal: delivery of current through chest to the heart to depolarize myocardial cells and eliminate VF/VT

Monophasic:

• delivers current of one polarity

• 1-shock 360J

Biphasic :

• FEMALES

• 2 ND -3 RDLEADING CAUSE OF DEATH IN CHILDHOOD

• DEFINITION

• PROCESS RESULTING IN PRIMARY RESPIRATORY IMPAIRMENT

• FROM SUBMERSION/IMMERSION IN A LIQUID MEDIUM

• CLASSIFICATION

• OUTCOME

47. DROWNING AND BLS

• MODIFICATIONS IN BLS INCLUDE

• RESCUE AND RECOVERY

• • RAPID AND CAUTIOUS RETRIEVAL FROM THE WATER

• • RESCUER MUST ALWAYS BE AWARE OF PERSONAL SAFETY

• AIRWAY-MAINTAIN AIRWAY WITH C- SPINE PRECAUTIONS

• - NO NEED TO CLEAR THEAIRWAY OF ASPIRATED WATER

• BREATHING

• -MOUTH TO MOUTH

• - GIVE 2 RESCUE BREATHS

• CIRCULATION

• - FOLLOW BLS SEQUENCE

• NOTE:

• AVOID ABDOMINAL THRUSTS

• 75% OF VICTIMS VOMIT DURING RESCUE BREATHING

48. 49. 50. BOXES BORDERED WITH DOTTED LINES INDICATE ACTIONS OR STEPS PERFORMED BY THE HEALTHCARE PROVIDER BUT NOT THE LAY RESCUER . 51. HIGH QUALITY CPR

• RATE - PUSH HARD, PUSH FAST 100/MIN

• DEPTH - 1.5 TO 2 inches

• COMPLETE CHEST RECOIL

• MINIMISE INTERRUPTIONS

• CHANGE REGULARLY

• COMPRESSION-VENTILATION RATIO OF 30:2 IS RECOMMENDED

• RESTORE CORONARY & CEREBRAL BLOOD FLOW

52. TYPES OF CPR

• 1. CLOSED COMPRESSION CPR

• 2. ACD CPR

• 3. IAP CPR

• 4. VEST CPR

• 5. INVASIVE CPR

53. HANDS ONLY CPR

• WHAT IS HANDS ONLY CPR?

• CPR WITHOUT MOUTH-TO-MOUTH BREATHS.

• IT IS RECOMMENDED FOR OUT-OF HOSPITAL SETTING

• IT CONSISTS OF TWO STEPS

• • CALL 911

• • PROVIDE HIGH-QUALITY COMPRESSIONS WITHOUT INTERRUPTIONS

• WHO SHOULD RECEIVE ?

• VICTIMS WHO SUDDENLY COLLAPSE

• WHEN AN ADULT SUDDENLY COLLAPSES WITH CARDIAC ARREST, THEIR LUNGS AND BLOOD CONTAIN ENOUGH OXYGEN TO KEEP VITAL ORGANS HEALTHY FOR THE FIRST FEW MINUTES

• IS HANDS ONLY CPR AS EFFECTIVE AS CONVENTIONAL CPR?

• SHOWN TO BE AS EFFECTIVE AS CONVENTIONAL CPR (CPR THAT INCLUDES BREATHS) IN THE FIRST FEW MINUTES OF AN OUT-OF-HOSPITAL SUDDEN CARDIAC ARREST

• . HAS AMERICAN HEART ASSOCIATION CHANGED ITS RECOMMENDATION FOR HEALTHCARE PROVIDERS? NO , IT HAS NOT CHANGED

• IT IS RECOMMENDED FOR ONLY BY-STANDER CPR

54. END-POINTS OF CPR

• ROSC: RESTORATION OF ADEQUATE CARDIAC FUNCTION

• SUCCESSFUL RESUSCITATION: RESTORATION OFNORMAL BRAIN FUNCTION.

• LIKELIHOOD OF ACHIEVING BOTH THESE GOALSDECREASES WITH EVERY MINUTE IN CARDIAC ARREST.

• CARDIAC OUTPUT BY STANDARD CHEST COMPRESSION IS ATBEST