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Agonistic breathing
in an unresponsive person; gasping, isolated breathing.
Recognizing cardiac arrest
Agonistic breathing
Sudden collapse
No heartbeat
Oxygen and the Human Body
Body does not store oxygen
Must continually supply oxygen through respiratory and circulatory systems
If process is interrupted, brain cell death occurs in minutes
Sudden Cardiac Arrest (SCA)
Electrical system of heart malfunctions, results in ventricular fibrillation
Affected person abruptly becomes unresponsive, stops breathing
Cardiopulmonary Resuscitation (CPR)
Combination of chest compressions and rescue breaths
Can restore limited blood flow and oxygen to brain
Does not address underlying problem with heart
Early Defibrillation
Most effective way to end ventricular fibrillation, and restore normal heartbeat
AEDs allow bystanders to defibrillate earlier than EMS
Chain of Survival
Most effective approach to manage sudden cardiac arrest
All links in chain must be strong for person to survive
Chest Compressions
External compressions of chest increase pressure inside chest and heart
Forces blood to move from chest to rest of body
Quality matters
Compress deeply, more than 2 inches
Compress fast, between 100 and 120 times per minute
Allow chest to fully recoil. Avoid leaning on the chest at top of each compression
Children and Infants — Chest compressions on children and infants are similar to adults except for hand positioning and the depth of the compressions
Rescue Breaths
Artificial breaths given by blowing air into the mouth to inflate the lungs
Enough oxygen in exhaled air to provide what is needed
Establishing an Airway
Airway is only path to get air containing oxygen to lungs
Tongue will likely block airway when person is unresponsive, flat on back
Head tilt-chin lift technique moves tongue and opens airway
Airway is higher priority than suspected spinal injury
Using Barrier
Devices
Use barrier device like CPR mask or overlay shield to give rescue breaths
Delivering Breaths
Each breath about 1 second in length
Only enough air to create visible rise of chest, but no more
During CPR, give 2 breaths at a time, quickly as possible within 10 seconds
Children and Infants — Rescue breaths for are performed in the same manner as for adults. Special care should be taken to not give too much air in a single breath. Provide only enough air to make the chest visibly rise, but no more
AEDs
Simple to use: voice, light, and screen instructions guide you
AED Operation
Same basic operation steps apply to all AEDs
Turn on AED
Adhere defibrillation pads to bare chest
Allow AED to analyze the heart
Deliver shock if directed by AED
Children and Infants
Cardiac arrests likely caused by initial loss of airway or breathing
Steps the same as for an adult
Most have especially designed pads or reduced energy for small body size
If specially equipped AED not available, use one configured for adults
Troubleshooting
AEDs designed to detect problems during use
If troubleshooting message occurs, follow AED voice instructions
Primary Assessment
Simple way to quickly identify if a life-threatening condition is present
Steps - unresponsive person
Check for responsiveness
If unresponsive, activate EMS and get AED if available
Assess for normal breathing
Provide Indicated Care
If not breathing or only gasping, perform CPR beginning with compressions
If breathing normally and uninjured, place person in side-lying recovery position to protect airway
Gasping
Weak, irregular gasping sounds provide no useable oxygen, not normal breathing
Treating Cardiac Arrest
Immediate high-quality CPR and rapid defibrillation can double or triple survival chance from SCA
Steps for Care
Primary assessment to determine if cardiac arrest occurred
Begin CPR with compressions; ongoing cycles of 30 compressions and 2 rescue breaths
When AED arrives, use immediately
Continue until another provider or EMS takes over, or too exhausted to continue
High-Quality CPR
Minimize interruptions
CPR is tiring; take turns performing CPR by switching every few minutes
Do Your Best
Someone in cardiac arrest will not survive without help
Nothing you can do can make the outcome worse
Compression-Only CPR
Untrained bystanders encouraged to provide compression-only CPR, which is a limited approach
As trained provider, provide both compressions and breaths
If unwilling or unable to give rescue breaths, provide uninterrupted compressions
Children and Infants
Steps for caring for cardiac arrest on a child or infant very similar to those for an adult
Multiple Providers
Working together can improve quality, minimize interruptions
Switching Providers
CPR is tiring and switching providers about every 2 minutes helps maintain CPR quality
Communicate ahead of time about how and when to switch
Take less than 5 seconds to switch
Before AED Arrives
Switch places at end of CPR cycle while rescue breaths are being given
When Attaching an AED
Continue CPR until the pads are placed and AED analysis begins
If AED Is Attached
Switch during CPR pause when AED analyzes, which is about every 2 minutes
Choking
Occurs when solid object enters narrowed part of airway, becomes stuck
Mild Blockage
Some ability to inhale; affected person can cough up object
Severe Blockage
Person cannot inhale air to create effective cough
Abdominal Thrusts
Forceful thrust beneath ribs and up into diaphragm increases pressure in chest, pops obstruction out of airway
Repeat thrusts until person can breathe normally
If person becomes unresponsive, perform CPR and look for object each time before giving rescue breaths
Considerations
Use chest thrusts if person is pregnant or obese
If alone, press abdomen quickly against rigid surface, such as back of a chair
Children and Infants
Care for choking on a child is very similar to an adult
For infants, repeating cycles of 5 back blows and 5 chest thrusts is recommended