New Guidelines On Cpr

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

Trainning SectionTrainning SectionRescue & Amblance Rescue & Amblance

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%


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


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


Important PointsImportant PointsImportant PointsImportant Points

RateRate

DepthDepth

ReleaseRelease

Five key aspectsto Great CPR


!!


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



RateRate

DepthDepth

ReleaseRelease



!!

VentilationVentilation


Ventilation:

Inspiration phase of no more than 1 second.

New Guidelines for Ventilation



RateRate

DepthDepth

ReleaseRelease



!!

UninterruptedUninterrupted

VentilationVentilation


CPR “protocols” scripted to

minimize hands-off time

Important PointsImportant PointsImportant PointsImportant Points!!

Initial assessment

Reducing Pulse Checks



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?


Head tilt and chin lift

Open the airway

&

Maintain the airway open


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


push hard and push fast

If no signs of life are present


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


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.


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.



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


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)



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).


Just below nipple line

Compress the sternumwith two fingers

(One rescuer) 30\2

Just below nipple line


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


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.


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.


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.


• 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%


• 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


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.


AED AED AlgorithmAlgorithm


Technology

New Guidelines On Cpr