CPR +

Abbreviations:

AED- automated external defibrillator

AHA- american heart association

ALS- advanced life support

AP- anteroposterior

BLS- basic life support

CCF- chest compression fraction

CPR- cardiopulmonary resuscitation

ECG- electrocardiogram

ED- emergency department

EMS- emergency medical services \

FBAO- foreign body airway obstruction

LUD- lateral uterine displacement

PAD- public access defibrillation

PALS- pediatric advanced life support

PPE- personal protective equipment

pVT- pulseless ventricular tachycardia

ROSC- return of spontaneous circulation

T-CPR- telecommunicator - assisted cardiopulmonary resuscitation

TIA- transit ischemic attack

Notes:

  • Main concepts of CPR
  • Chest compressions
  • Breaths
  • airway

Critical concepts for high quality CPR:

-if you recognize cardiac arrest in someone, start chest compressions within 10 seconds.

Chest compressions:

  • chest compression on adults should be at least 2 inches (5cm) but no more than 2.4 inches (6cm)
  • children: approximately 2 inches (5cm) or at least ⅓ the AP diameter of the chest
  • infants: approximately 1 ½ inches (4cm) or at least ⅓ the AP diameter of the chest

Keep in mind:

  • Push hard, push fast
  • Allow complete chest recoil after each compression
  • Avoid leaning on the chest between compressions
  • Minimize interruptions in compressions (less than 10 seconds)
  • Deliver each breath over 1 second, enough to make the chest rise

The chain of survival:

The chain of survival - the actions that must take place to give the person in cardiac arrest the best chance of survival.

Adult/children chain of survival:

  1. Recognition and emergency activation
  2. High quality CPR
  3. Defibrillation
  4. Advanced resuscitation
  5. Post cardiac arrest care
  6. Recovery and survivorship

Newborn chain of survival:

  1. Prevention
  2. Recognition and emergency activation
  3. Initial steps
  4. Ventilation
  5. Advanced resuscitation
  6. Postnatal care
  7. Recovery

Recognition and emergency activation:

  1. Check surroundings and ensure that it is safe
  2. Check for responsiveness (tap the their shoulder and ask if they are okay)
  • For infants, tap on their heel
  1. If there is no response activate the emergency response system (shout for help, call 911, or local emergency response)
  2. To minimize delay in cpr asses breathing at the same time as you check their pulse (to check their pulse look at their chest for at least 5-10 seconds)

Advanced resuscitation:

  • Advanced resuscitation must be done by medically trained professionals
  • Ex. obtaining vascular access, giving medications, placing an advanced airway and obtaining a 12-lead electrocardiogram(ECG) or starting advanced cardiac monitoring.

Adult 1-rescuer BLS sequence:

  1. Verify scene safety
  2. Check responsiveness
  3. Look for breathing and check pulse, is it normal or abnormal?
  • If breathing is normal, monitor until help arrives
  • If abnormal provide 1 breath every 6 seconds or 10 breathes per minute
  • Check pulse every 2 mins
  • If you think it's an opioid overdose administer an opioid antagonist (naloxone if available )
  1. If the person is not breathing, start CPR
  • Perform cycles of 30 compressions and 2 breaths (The compression rates should be at a rate of 100 to 120/min)
  • Use AED/defibrillator as soon as it is available
  • Opioid overdose, use naloxone
  1. AED arrives, follow prompt
  • If its shockable, give one shock and resume cpr for 2 min(continue till the person moves or professionals take over or prompted by the AED/Defibrillator to allow for a rhythm check)
  • No, not shockable then resume CPR for 2 minutes until prompted by the AED/Defibrillator to allow for a rhythm check

Cpr for a pregnant person:

  • Perform high quality CPR like you would do with anyone
  • For a visible pregnant person perform manual LUD if another rescuer is present (manually moving the uterus to the persons left to relieve the pressure on the large blood vessels)
  • If the person is revived lay them on their left side

Opening the airway:

Two methods for opening the airways are:

  • Head tilt-chin lift
  • Jaw thrust (use this if you suspect a head or neck injury)

Head tilt-chin lift:

  1. Place one hand on the person's forehead and push with your palm to tilt the head back
  2. Place the fingers of the other hand under the bony part of the lower jaw, near the chin.
  3. Lift the jaw to bring the chin forward.

*avoid pressing deeply into the soft tissue under the chin because this might block the airway and, do not close the person's mouth completely

Jaw Thrust:

  1. Position yourself at the person's head.
  2. Place one hand on each side of the person's head. You may rest your elbows on the surface where the person is lying.
  3. Place your fingers under the angle of the person's lower jaw and lift with both hands, displacing the jaw forward
  4. If the person's lips close, push the lower lip with your thumbs to open the lips.
  • If the jaw thrust does not open the airway, use the head tilt–chin lift

Bag mask devices:

  • Use a bagmask if available to, to provide positive pressure ventilation
  • Bag mask ventilation is more effective when there's 2 rescuers

For a single rescuer:

  1. Position yourself directly above the head
  2. Place the mask on the person's face, using the bridge of the nose as a guide. Use E-C clamp technique to hold the mask in place while you lift the jaw to hold the airway open
  • Use the thumb and index finger of one hand to make a “C” on the side of the mask, pressing the edges of the mask to the face
  • Use the remaining fingers to lift angles of the jaw. Open the airway and press the face to the mask
  1. Squeeze the bag to give ventilation while watching for chest rise. Deliver each ventilation over 1 second, with or without the use of supplemental oxygen.

For 2 or more rescuers:

  • Rescuer 1 positioned directly above the person, opens the airway and positions the bag mask device.(careful not to press too hard)
  • Rescuer 2 positioned at the person's side, squeezes the bag, delivering the ventilation.

Ventilation for a person with a stoma or tracheostomy tube:

  • When ventilating a person with a stoma or tracheostomy tube, position the mask over the stoma or tube and use the previously described techniques.
  • A pediatric mask may be more effective than an adult mask
  • If the chest doesn't rise, you can connect the bag mask device directly to the tracheostomy tube. If the chest still doesn't rise, you will need to close the person's mouth while providing breaths over the stoma or tracheostomy tube.

Using the AED:

  1. Power the AED if needed
  2. Follow the AED prompt
  3. Apply pads to a person's bare chest (use adult pads for pt. 8 yrs or older.)
  4. Plug in pad connecters if needed
  5. DO NOT TOUCH the pt. while the AED is reading the hearts rhythm
  6. If the person does not need to be shock resume CPR immediately starting with chest compressions.
  7. If they do need to be shocked, clear the pt. (loudly state “everybody clear”)
  • Look to be sure that no one is in contact with the pt.
  1. AED prompts “deliver shock now.”Press the shock button
  2. AED prompts “shock delivered. Start CPR”
  • resume CPR immediately starting with chest compressions.
  1. After about 5 cycles or 2 minutes of CPR, the AED will prompt you to repeat steps 3 and 4.

-place one pad under the clavicle and the other on the left side of the chest

-left side between the person's sternum and left nipple and the other pad on the left side of the person's back, next to the spine.

Elements of effective high-performance teams

3 components

  • Roles and responsibilities
  • Communication
  • Debriefing
  • Rescuers should clearly define roles as soon as possible and delegate tasks according to each team members skill level

Hairy chest with an AED

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