Version Effective date Changes Prepared By CPR + AED

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1 Version Effective date Changes Prepared By Ver rd June 2017 First Issue Muhammad Fauzy, Principal Trainer CPR + AED 218E Changi Road, PKMS Building #03-05A Singapore Tel: Fax: info@ahleensg.com Website:

2 Content Page Topic Page 1 The Principles of Resuscitation 3 2 The Procedure for CPR 5 3 Automated External Defibrillation 6 4 Acknowledgements 9 2

3 CARDIO PULMONARY RESUSCITATION (CPR) AND AUTOMATED EXTERNAL DEFIBRILLATION (AED) LEARNING OBJECTIVES 1.1 List the principles of resuscitation The Chain of Survival The Heart Common Heart Rhythms The importance of Early Defibrillation 1.2 List the procedure for cpr 1.3 Automated External Defibrillator Safety Precautions Chest Preparation Operate AED Analyse Documentation & Housekeeping Procedure for AED 1.1 LIST THE PRINCIPLES OF RESUSCITATION Cardio Pulmonary Resuscitation (CPR) is the life-saving technique for treatment of cardiac arrest (sudden death). OBJECTIVE To provide oxygen to the heart, brain and other vital organs. SPEED IS IMPORTANT SURVIVAL RATE 0% 10% 20% 30% CPR begun in > 4 minutes CPR begun in 4 minutes 3

4 THE CHAIN OF SURVIVAL 1. Early Access Recognise the symptoms and signs of life-threatening conditions that warrant a call to ambulance Early CPR An intervention to provide oxygen to the heart, brain and other vital organs. No oxygen reaches the brain for 4 minutes, leads to brain dead. 3. Early Defibrillation The external electric shock defibrillation will restore regular heart rhythm. It improves survival rates for out-of-hospital cardiac arrest casualty. 4. Early Advance Cardiac Life Support Medical care includes supporting ventilation, establishing intravenous access and preparing the casualty for transport to hospital. Note: The first three links are crucial. Prompt action will minimise fatality and complications to the casualty. THE HEART The heart is a muscular organ which pumps blood to all parts of our body. It lies between the lungs, in the middle of our chest and at the lower half of the breastbone. (Sternum) When the heart stops pumping and hence circulation ceases, is known as clinical death. COMMON HEART RHYTHM Normal Sinus Rhythm (Non-Shockable Rhythm): The heart beat is triggered by natural electrical signals Ventricular Fibrillation (VF) (Shockable Rhythm): The heart s electrical activity is chaotic, cannot pump blood Asystole (Non-Shockable Rhythm): A flat line or a dead heart 4

5 THE IMPORTANCE OF EARLY DEFIBRILLATION 1. Ventricular Fibrillation (VF) if untreated, leads to asystole and death. 2. Defibrillation is treatment for VF. Increases 10% of the survival rate, death rate increases 7 10% for every minute without defibrillation. 3. VF degenerates to asystole within 8 10 mins. Minimal survival once asystole. 1.2 LIST THE PROCEDURE FOR CPR ACRONYM: D R S A B C 5

6 1.3 AUTOMATED EXTERNAL DEFIBRILLATOR The AED machine is able to detect, analyse and interpret the heart rhythm of the victim. It prompts the operator through a voice prompt or text message to whether or not defibrillation is required. Shockable rhythm is Ventricular Fibrillation (VF). Non-Shockable rhythm is Asystole or Normal Sinus Rhythm (NSR) AED Increases 10% of the survival rate from sudden cardiac arrest caused by VF. ONLY use the AED machine if the victim is: 1. Unconscious 2. Not breathing. SAFETY PRECAUTIONS Ensure casualty safety Water immersion remove casualty to a dry area Metal surface place blankets between casualty and the metal contact, or remove casualty to a safe place Flammable gas remove casualty to a safe place Ensure no other person is in contact with casualty just prior to shocking (defibrillation) Avoid oxygen / flammable gas in close proximity with the defibrillator s paddles CHEST PREPARATION Items Gloves Scissor Jewelry Hairy chest Wet chest Medication patches Pacemaker Action Wear Gloves Cut casualty s clothes (last resort) and expose casualty s chest. Moved to the side Shaved Wiped Removed Placed pad : 4 fingers breath away 6

7 OPERATE AED 1. Place electrodes pads: one pad below right clavicle (collar bone) and one below to the left of the nipple Note: 1. female: do not place over the breast (cover the chest to protect modesty) 2. pads are firmly attached as good contact increases shock efficiency 2. On AED machine 3. Plug in the connector to the AED machine ANALYZE Machine Prompt Analyzing heart rhythm, do not touch the patient Shock advised, charging, stay clear of patient Deliver shock now, press the orange button now Shock delivered, continue CPR After 1 minute, Analyzing heart rhythm, do not touch the patient No shock advised Action Providers say Stay clear Providers say Continue CPR Providers say Stay clear, AED provider presses the shock button CPR Provider performs 30 compressions, AED provider gives 2 breaths Providers say Stay clear check breathing, If breathing present and no injury place casualty recovery position and monitor vital signs every 5 minutes. If Breathing absent, continue CPR. DOCUMENTATION & HOUSEKEEPING AED provider to document and record all incidents Name of casualty, AED provider and CPR provider. The time of collapse and the time AED was put on. The number of shocks and the timing of each shock. The time of ambulance arrival and transported to which hospital. The housekeeping includes: Replace Gloves Replace Towel Replace Shaver Replace AED pad Sterilise Scissors Battery check if necessary 7

8 PROCEDURE FOR AED Check for Danger (Protect yourself and casualty) Chest Preparation Operate AED Analyse YES Breathing Present? NO NO Shock advised? YES Recovery Position & Monitor vital signs every 5 mins (AED remains connected) CPR for 1 Min Press Shock button 8

9 ACKNOWLEDGEMENTS This first aid note is compiled by AHLEEN PTE. LTD. We acknowledge with gratitude the following reference sources. 1. A Manual for Providers CPR+ AED, Rev 6/2016 (National Resuscitation Council Singapore NRC) 2. Basic Cardiac Life Support Course Provider Manual, 2017 edition (National Resuscitation Council Singapore NRC) 3. The Singapore National First Aid Council (NFAC). 4. The Singapore National Resuscitation Council (NRC). 9