Chapter 9: Professional Rescuer CPR

Cognitive Objectives

4-1.1 List the reasons for the heart to stop beating.

4-1.2 Define the components of cardiopulmonary resuscitation.

4-1.3 Describe each link in the chain of survival and how it relates to the EMS system.

4-1.4 List the steps of one-rescuer adult CPR.

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Cognitive Objectives

4-1.5 Describe the technique of external chest compressions on an adult patient.

4-1.6 Describe the technique of external chest compressions on an infant.

4-1.7 Describe the technique of external chest compressions on a child.

4-1.8 Explain when the First Responder is able to stop CPR.

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Cognitive Objectives

4-1.9 List the steps of two-rescuer adult CPR.

4-1.10 List the steps of infant CPR.

4-1.11 List the steps of child CPR.

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Affective Objectives

4-1.12 Respond to the feelings that the family of a patient may be having during a cardiac event.

4-1.13 Demonstrate a caring attitude toward patients with cardiac events who request emergency medical services.

4-1.14 Place the interests of the patient with a cardiac event as the foremost consideration when making any and all patient care decisions.

4-1.15 Communicate with empathy with family members and friends of the patient with a cardiac event.

Psychomotor Objectives

4-1.16 Demonstrate the proper technique of chest compressions on an adult.

4-1.17 Demonstrate the proper technique of chest compressions on a child.

4-1.18 Demonstrate the proper technique of chest compressions on an infant.

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Psychomotor Objectives

4-1.19 Demonstrate the steps of adult one-rescuer CPR.

4-1.20 Demonstrate the steps of adult two-rescuer CPR.

4-1.21 Demonstrate child CPR.

4-1.22 Demonstrate infant CPR.

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Knowledge and Attitude Objectives

1. Describe the anatomy and function of the circulatory system.

2. List the reasons for a heart to stop beating.

3. Describe the components of CPR.

4. Explain the links in the cardiac chain of survival.

5. Describe the conditions under which you should start and stop CPR.

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Knowledge and Attitude Objectives

6. Describe the techniques of external chest compressions on an adult, a child, and an infant.

7. Explain the steps of one-rescuer adult CPR.

8. Explain the steps of two-rescuer adult CPR.

9. Explain how to switch rescuer positions during two-rescuer adult CPR.

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Knowledge and Attitude Objectives

10. Explain the steps of infant and child CPR.

11. Describe the signs of effective CPR.

12. State the complications of performing CPR.

13. Describe the importance of creating sufficient space for CPR.

14. Describe the indications for the use of automated external defibrillation.

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Knowledge and Attitude Objectives

15. Describe the steps in using automated external defibrillation.

16. Describe the importance of CPR training.

17. Explain the legal implications of performing CPR.

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Skill Objectives

1. Perform one-rescuer adult CPR.

2. Perform two-rescuer adult CPR.

3. Perform infant CPR.

4. Perform child CPR.

5. Perform automated external defibrillation.

Professional Rescuer CPR

• To maintain breathing and heartbeat, perform rescue breathing and chest compressions together.

• 70% of cardiac arrest patients are in V-fib. – Heart muscle is quivering. – Not effectively pumping blood– AEDs can help these patients.

Circulatory System

• Consists of heart, blood vessels, blood

• Heart pumps blood to lungs and rest of body.

• Pulse is generated when heart contracts.

Major Arteries

• Neck or carotid pulse • Wrist or radial pulse

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Major Arteries

• Arm or brachial pulse • Groin or femoral pulse

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Cardiac Arrest

• Occurs when the heart stops contracting• No blood is pumped through the blood vessels. • Brain damage begins within 4 to 6 minutes after

cardiac arrest.

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Cardiac Arrest

• May be caused by:– Heart attack or stroke– Untreated respiratory arrest– Medical emergencies (eg, electrical shock, epilepsy,

poisoning)– Drowning – Suffocation– Trauma or shock from massive blood loss

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Components of CPR

• Requires three types of skills:– Airway – Breathing– Circulation

• CPR can keep patients alive until more advanced care is administered.

Cardiac Chain of Survival

• Early recognition of cardiac arrest and activation of 9-1-1 system

• Early bystander CPR• Early defibrillation • Early advanced care

When to Start CPR

• CPR should be started on all nonbreathing, pulseless patients, except when reliable signs of death exist:– Decapitation– Rigor mortis– Tissue decomposition– Dependent lividity

When to Stop CPR

• Effective spontaneous circulation and ventilation are restored.

• Care is transferred to another trained person.• Physician assumes responsibility.• Transfer to EMS personnel occurs.• Obvious death is recognized.• You are too exhausted to continue or continuing would

place you or others in danger.

External Cardiac Compressions

• Manual chest-pressing method• Mimics the squeezing and relaxation cycles of a normal

heartbeat• Place patient on a firm, flat surface.

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External Cardiac Compressions

• Technique

– Place heel of one hand in between nipples.

– Place heel of other hand on top and interlock fingers.

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One-Rescuer Adult CPR

• Establish patient’s level of consciousness. • Place patient on back. • Open the airway. • Check for breathing.

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One-Rescuer Adult CPR

• Check for signs of circulation. • Deliver chest compressions and rescue breathing at a

ratio of 30 compressions to two breaths. • Use a rate of 100 compressions per minute.

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Two-Rescuer CPR

• More effective than one-rescuer CPR. • One rescuer delivers ventilations. • The other rescuer gives chest compressions. • Compressions and ventilations should remain rhythmic

and uninterrupted.

Switching CPR Positions

• The rescuer giving chest compressions will get tired if performing CPR for an extended time.

• Switching positions after every five cycles improves quality of compressions.

• Should be accomplished smoothly and quickly

Infant CPR

• Principles are the same, but techniques are modified: – Give small puffs of air. – Use brachial pulse. – Press on middle of sternum with two fingers. – Compress sternum 1/2 to 1 inch.

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Infant CPR

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Two-Rescuer Infant CPR

• Use the two-thumb/encircling hands technique. • Compress the sternum at a rate of 100 compressions

per minute. • Perform compressions and ventilations at a ratio

of 15 to 2.

Child CPR

• Child is defined as a person between 1 year of age and the onset of puberty (12 to 14 years).

• Use less force to ventilate. • In small children, use only one hand. • Use less force to compress the chest.

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Child CPR (2 of 2)

• Locate top and bottom of sternum.• Place the heel of your hand in the center of the chest,

in between the nipples.

Signs of Effective CPR

• Pulse is felt during chest compressions.• Patient’s skin color improves.• Chest visibly rises during ventilations. • Compressions and ventilations are delivered at the

appropriate rate and depth.

Complications of CPR

• Broken ribs – Check and correct your hand position.

• Gastric distention– Caused by too much air blown too fast and too

forcefully into stomach• Regurgitation

– Be prepared to deal with it!

Creating Sufficient Space

• Create or find a space where you can perform CPR. • Have 3 to 4 feet on all sides of patient. • Two options

– Quickly rearrange furniture.– Quickly drag patient into open area.

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Creating Sufficient Space

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Defibrillation

• Roughly 250,000 people die each year in the U.S. of coronary heart disease in out-of-hospital setting.

• More than 70% of out-of-hospital cardiac arrest patients have V-fib. – Rapid, disorganized, and ineffective vibration of

the heart– Electric shock can defibrillate.

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Defibrillation

An automated external defibrillator. (2 of 3)

Defibrillation

• Patients in cardiac arrest have greatest chance for survival when early defibrillation is available.

• AEDs identify V-fib and advise rescuers to deliver shock if needed.

• Learn how to use your specific AED. • Get required training and practice!

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CPR Training

• First responders should complete CPR course through recognized agency.

• Update your skills through recertification courses. • Schedule periodic reviews of CPR theory and practice

for all first responders.

Legal Implications of CPR

• Start CPR on all patients unless obviously dead. • Physician at the hospital will determine whether you

should stop. • Check your department’s protocols and state

regulations.