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New Guidelines On Cpr
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Rescue & Amblance Rescue & Amblance Trainning SectionTrainning Section
New International New International GuidelinesGuidelines on on
Cardiopulmonary Cardiopulmonary ResuscitationResuscitation
Last update dec 2005Last update dec 2005
CPR
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Chain of SurvivalChain of SurvivalChain of SurvivalChain of Survival
EarlyEarly Early Early Early Early Early Early Access Access CPR Defibrillation Advanced CPR Defibrillation Advanced Care Care
EarlyEarly Early Early Early Early Early Early Access Access CPR Defibrillation Advanced CPR Defibrillation Advanced Care Care
EarlyEarly DefibrillationDefibrillation
Valenzuela, et al. Circulation. 1997;96:33Valenzuela, et al. Circulation. 1997;96:3308-13.08-13.
For each minute that CPR & For each minute that CPR & defibrillation is delayeddefibrillation is delayed
Survival is reduced by 7 to 10%Survival is reduced by 7 to 10%
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Causes of circulation Causes of circulation arrestarrest
CardiacCardiac Ischemic heart disease Ischemic heart disease
(myocardial infarction,)(myocardial infarction,) Arrhythmias of different Arrhythmias of different
origin and characterorigin and character Electrolytic disordersElectrolytic disorders Valvular diseaseValvular disease Cardiac tamponadeCardiac tamponade Ruptured aneurysm of Ruptured aneurysm of
aortaaorta
Extra-cardiacExtra-cardiac
airway obstructionairway obstruction
acute respiratory failureacute respiratory failure
shockshock
drug overdosedrug overdose
electrocutionelectrocution
poisoningpoisoning
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The goal of CPR is to produce the best
Coronary Perfusion Pressure (CPP)
Cardiac arrest survival is dependent upon:
• Early CPR.• CPR performed properly.
Importance of CPR
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Important PointsImportant PointsImportant PointsImportant Points
RateRate
DepthDepth
ReleaseRelease
Five key aspectsto Great CPR
Five key aspectsto Great CPR
!!
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Compression
• Heard is squeezed between sternum & spine.
• intrathoracic pressure Increase to force blood out of the heard .
Decompression
• Allow complete chest recoil after each compression to maximize the vacuum in the thoracic cavity to force blood flow back to the heard
Compression-Compression-DecompressionDecompression
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Important PointsImportant PointsImportant PointsImportant Points
RateRate
DepthDepth
ReleaseRelease
Five key aspectsto Great CPR
Five key aspectsto Great CPR
!!
VentilationVentilation
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Ventilation:
Inspiration phase of no more than 1 second.
New Guidelines for Ventilation
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Important PointsImportant PointsImportant PointsImportant Points
RateRate
DepthDepth
ReleaseRelease
Five key aspectsto Great CPR
Five key aspectsto Great CPR
!!
UninterruptedUninterrupted
VentilationVentilation
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CPR “protocols” scripted to
minimize hands-off time
Important PointsImportant PointsImportant PointsImportant Points!!
Initial assessment
Reducing Pulse Checks
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Check the victim for a response ( AVPU ).
• Is person unresponsive?Is person unresponsive?• Is person unresponsive?Is person unresponsive?
Are you Are you okay?okay?
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Head tilt and chin lift
Open the airway
&
Maintain the airway open
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Look listen and feel for normal breathingLook listen and feel for normal breathing&&
LOOK FOR SIGS OF LIFELOOK FOR SIGS OF LIFE. .
Check for breathing
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push hard and push fast
If no signs of life are present
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Place the heel of one hand in the centre of the victim’s chest.
Place the heel of your other hand on top of the first hand.
press down on the sternum 4—5 cm
Land mark
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For one rescuerrescuer : After 30 compressions open the airway again using head tilt and
chin lift give two breaths while watching the chest rise .
For two rescuersFor two rescuers : Rotate compressors every 2–3 minutes to minimize fatigue.
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Main changes in adult CPRMain changes in adult CPR
The decision to start CPR is made if a victim is unresponsive The decision to start CPR is made if a victim is unresponsive
and not breathing normally.and not breathing normally.
Rescuers should place their hands on the center of the Rescuers should place their hands on the center of the
chest , rather than to spend more time using the ‘rib chest , rather than to spend more time using the ‘rib
margin’ technique.margin’ technique.
Each rescue breath is given over 1 sec rather than 2 sec Each rescue breath is given over 1 sec rather than 2 sec
The ratio of compressions to ventilations is 30\2 .The ratio of compressions to ventilations is 30\2 .
Minimize interruptions in chest compressions.
Rotate compressors every 2–3 minutes to minimize fatigue.
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Ensure the safety of rescuer and child.Ensure the safety of rescuer and child.
Check the child’s responsiveness.
open the child’s airway by tilting the head and lifting the chin.
Keeping the airway open, look, listen and feel for normal breathing
(NOMORE THAN 10 SEC)
If the child is not breathing
Give two initial rescue breaths
The rescuer should provide 5 cycles (a cycle is 30 compressions and 2
breaths) of CPR (about 2 minutes) before
CALL 999 and get an AED
start chest compressions (2.5 to 4 cm).
One year of age up to 8
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To perform chest compression in children over1 year of age, Position yourself vertically above the victim’s chest
with your arm straight, compress the lower third of the sternum. (avoid compressing the upper abdomen),
place the heel of one hand over the lower third of the sternum ( NIPPLE LINE LEVEL)
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Ensure the safety of rescuer and infant .Ensure the safety of rescuer and infant .
Check the LOC.
open the infant’s airway by tilting on the patient’s ear-side angle of the jaw & tiding the head back ( do not hyperextend the neck )
Keeping the airway open, look, listen and feel for normal breathing (NOMORE THAN 10 SEC)
If the infant is not breathing
Give two initial rescue breaths
The rescuer should provide 5 cycles (a cycle is 30 compressions
and 2 breaths) of CPR (about 2 minutes)
CALL 999 and start chest compressions (1 to 2.5 cm)(100\min).
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Just below nipple line
Compress the sternumwith two fingers
(One rescuer) 30\2
Just below nipple line
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Patient Symptoms when Patient Symptoms when inin
Ventricular Fibrillation Ventricular Fibrillation
Patient Symptoms when Patient Symptoms when inin
Ventricular Fibrillation Ventricular Fibrillation UnconsciousUnconscious No BreathingNo Breathing No Signs ol life No Signs ol life
Resulting in…Resulting in…
UnconsciousUnconscious No BreathingNo Breathing No Signs ol life No Signs ol life
Resulting in…Resulting in…
No Oxygen to the Brain or Body OrgansNo Oxygen to the Brain or Body OrgansNo Oxygen to the Brain or Body OrgansNo Oxygen to the Brain or Body Organs
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What does a defibrillator doWhat does a defibrillator do? ?
The AED is programmed to analyze The AED is programmed to analyze the heart’s electrical activity, and the heart’s electrical activity, and decide whether the electrical shock decide whether the electrical shock would help. It then builds up an would help. It then builds up an electric charge and deliver to the electric charge and deliver to the patient when you push the button. patient when you push the button.
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AED Don'tsAED Don'ts
Don’t use the AED to monitor PTs Don’t use the AED to monitor PTs who are awake or have a pulse who are awake or have a pulse
Don’t attach the AED to PTs in Don’t attach the AED to PTs in anticipation of arrest.anticipation of arrest.
Don’t defibrillate the PTs when both Don’t defibrillate the PTs when both the PT and the defibrillator are in the PT and the defibrillator are in contact with metal or water .contact with metal or water .
Don’t analyze with the AED while Don’t analyze with the AED while chest compression are in progress.chest compression are in progress.
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Electrode placementElectrode placement
Remove electrodes from package (check Remove electrodes from package (check expiry date).expiry date).
Apply to PT :superior right chest Apply to PT :superior right chest
left lower lateral side of chestleft lower lateral side of chestWet PTs should be toweled dry.Wet PTs should be toweled dry.Hairy chest may need shaving.Hairy chest may need shaving.Can be use with pacemaker, electrode on Can be use with pacemaker, electrode on
right side should be beneath pacemaker. right side should be beneath pacemaker.
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• CPRCPR (only)(only) ……………………… ……………………… 0-2%0-2%
• EMS/EREMS/ER …………………… …………………… 5-15%5-15%
• CPRCPR++AEDAED…….. …….. 3030--75%75%
• CPRCPR (only)(only) ……………………… ……………………… 0-2%0-2%
• EMS/EREMS/ER …………………… …………………… 5-15%5-15%
• CPRCPR++AEDAED…….. …….. 3030--75%75%
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• Don’t Touch Patient During Don’t Touch Patient During AnalysisAnalysis•Except for pulse check. Except for pulse check.
• Don’t Touch Patient During Don’t Touch Patient During AnalysisAnalysis•Except for pulse check. Except for pulse check. Start chest compressions for 2 minutes Start chest compressions for 2 minutes
immediately after defibrillation. Without pulse immediately after defibrillation. Without pulse checkcheck
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AED ChangesAED Changes
Immediately Immediately resume CPR for 2 resume CPR for 2 minutesminutes, no rhythm, breathing or , no rhythm, breathing or pulse check(pulse check(Compressions do not Compressions do not cause harm if there is a rhythm ).cause harm if there is a rhythm ).
With past guideline AED’s there was a hands off delay of 29-37 seconds between first shock and first compression.
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AED AED AlgorithmAlgorithm
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