Basic Life Support: Cardiopulmonary Resuscitation (CPR). 2017 Lecture prepared by, Amer A. Hasanien RN, CNS, PhD Cardiac arrest Cardiac arrest (CA) occurs when the heart ceases to produce an effective pulse and circulate blood It includes four conditions: - Ventricular fibrillation - Pulseless ventricular tachycardia - Pulseless electrical activity - Asystole 1
Ventricular fibrillation Pulseless ventricular tachycardia 2
Pulseless electrical activity Asystole 3
Cardiopulmonary Resuscitation (CPR) a term used to describe the first aid procedures necessary to sustain life in an emergency situation. You should perform CPR when a victim is in cardiac arrest (heart stops beating). Cardiopulmonary resuscitation (CPR) provides blood flow to vital organs until effective circulation can be reestablished 2012 Pearson Education, Inc. While cardiac arrest may be a sudden event, it may also be preceded by signs and symptoms of a heart attack, including: Chest pain; heaviness or tightness that radiates to the neck, shoulders, jaw, or arms Nausea and/or vomiting Cool, pale, moist skin Weak or irregular pulse Breathing difficulty Light headedness 4
Cardiopulmonary Resuscitation (CPR) Oxygenating and circulating blood manually until defibrillation and advanced cardiac life support can be provided. Consists of three important skills Providing artificial circulation via chest compressions Opening and maintaining the airway Providing artificial ventilation through rescue breathing Defibrillation is the application of electricity to the chest of the victim whose heart has stopped. 2012 Pearson Education, Inc. 5
Building Blocks of CPR Amer A. Hasanien, RN, CNS, PhD The characteristics of the victim with cardiac arrest unresponsive either without breathing activity or with extremely abnormal breathing (gasping). Absent carotid pulse 6
Review the Adult BLS algorithm (attached). 7
Assess responsiveness Tapping on the victim shoulders Shout 8
Get the AED/Defibrillator 9
Look for no breathing or only gasping and check pulse (simultaneously). How to check carotid pulse 10
Open the airway first 11
Open the airway Provide rescue breathing: 1 breath every 5-6 seconds, or about 10-12 breaths/min. Remember open the airway first before providing rescue breathing 12
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The most common ventilation mistakes are: Failing to tip the head back far enough in adults Failing to maintain an adequate head tilt Failing to maintain an adequate seal over the mouth and/or nose, letting air escape Not giving slow, full breaths Failing to watch and listen for exhalation 16
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Chest compression technique 18
Chest Compressions If a victim s heart is not beating, deliver chest compressions to keep them alive. Chest compressions work on two principles Increase chest cavity pressure, causing the heart to pump Provide direct compression to the heart itself 2012 Pearson Education, Inc. 19
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Common chest compression mistakes are: Bending the elbows Not having the shoulders directly over the hands Placing the hands on the victim s chest improperly Letting the fingers touch the victim s chest during compressions Not compressing fast enough Not compressing deep enough Jerky rather than smooth compressions Lifting or moving the hands between compressions 23
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Universal steps for operating an AED 25
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Defibrillation Defibrillation, by literally shocking the heart, can eliminate the disorganized electrical activity and promote the resumption of a normally contracting and beating heart. 27
High Quality CPR Components 28
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Chest compression in infants (single rescuer) 30
Chest compression in infants (2 rescuers) Pulse check in infants & children 31
The keys to survival of a cardiac arrest victim are: 32
With-holding and Withdrawing CPR (Termination of Resuscitative Efforts) Related to Out-of Hospital Cardiac Arrest (OHCA) Situations where attempts to perform CPR would place the rescuer at risk of serious injury or mortal peril Obvious clinical signs of irreversible death (eg, rigor mortis, dependent lividity, decapitation, transection, or decomposition) A valid, signed, and dated advance directive indicating that resuscitation is not desired, or a valid, signed, and dated DNAR order Not required from you Amer A. Hasanien, RN, CNS, PhD Rigor mortis (rigor "stiffness", mortis "of death") Starts (3-4 h), maximum stiffness (12 h), gradually dissipates (24 h). Not required from you Amer A. Hasanien, RN, CNS, PhD 33
Dependent lividity: A purplish color assumed by the lowest-lying parts of a recently dead body due to the downward flow and pooling of blood under the influence of gravity. Not required from you Amer A. Hasanien, RN, CNS, PhD BLS termination-of resuscitation rule for adult OHCA. Not required from you 34
Terminating Resuscitative Efforts in a BLS Outof-Hospital System Rescuers who start BLS should continue resuscitation until one of the following occurs: Restoration of effective, spontaneous circulation Care is transferred to a team providing advanced life support The rescuer is unable to continue because of exhaustion, the presence of dangerous environmental hazards, or because continuation of the resuscitative efforts places others in jeopardy Reliable and valid criteria indicating irreversible death are met, criteria of obvious death are identified, or criteria for termination of resuscitation are met. Not required from you Amer A. Hasanien, RN, CNS, PhD Criteria for Not Starting CPR in Newly Born Infant IHCA Examples may include extreme prematurity (gestational age 23 weeks or birth weight 400 g), anencephaly, and some major chromosomal abnormalities such as trisomy 13. *Anencephaly is the absence of a large part of the brain and the skull. Not required from you Amer A. Hasanien, RN, CNS, PhD 35
Terminating Cardiac Arrest Resuscitative Efforts in Adult IHCA In the hospital the decision to terminate resuscitative efforts rests with the treating physician and is based on consideration of many factors, including witnessed versus unwitnessed arrest, time to CPR, initial arrest rhythm, time to defibrillation, comorbid disease, prearrest state, and whether there is ROSC at some point during the resuscitative efforts. ROSC, return of spontaneous circulation Not required from you Amer A. Hasanien, RN, CNS, PhD The National Association of EMS Physicians (NAEMSP) suggested that resuscitative efforts could be terminated in patients who do not respond to at least 20 minutes of ALS care ALS, advanced life support Amer A. Hasanien, RN, CNS, PhD 36
CPR Complications Even when performed properly, CPR may cause complications such as Fracture of ribs or sternum Separation of rib cartilage Pneumothorax Hemothroax Bruising of the lung Lacerations of the liver Even with these risks, effective CPR is necessary; the alternative may be death. Not required from you 2012 Pearson Education, Inc. Thank You Amer Hasanien RN, CNS, PhD 37