Cpr Aed
- 1. Cardiopulmonary Resuscitation and the Automatic External Defibrillator Gram McGregor, 1Lt, CCAT Nurse Jeff Pintler, SSgt, Combat Medic 141 Medical Group, Washington Air Guard
- 2. Cardiopulmonary Resuscitation (CPR)* Establish Unresponsiveness Send someone to call emergency services as able If alone, leave the victim to call emergency services as able * per American Heart Association guidelines
- 3. CPR cont. Airway Head tilt-chin lift Breathing-Look listen and feel Give two slow breaths Circulation-check for a pulse or other signs of circulation Start chest compressions
- 4. Performing a pulse check Maintain head tilt Place 2 or 3 fingers on the Adam’s apple. Slide fingers into groove between Adam’s apple and the muscle, pull fingers towards you Feel for pulse at this position no more then 10 seconds If no pulse, start chest compressions
- 5. Performing chest compressions Find position on lower half of sternum right between nipples/middle of chest. Place heel of one hand on this position Place heel of second hand on top of first Position body directly over hands Begin chest compressions
- 6. By the numbers* Rate: 100 compressions a minute One or two rescuer: 15 compressions, then 2 slow breaths Recheck pulse and respirations every 4 cycles or roughly one minute Continue until exhausted or relieved by higher level of medical care provider *per American Heart Association guidelines
- 7. Choking-Foreign Body Airway Obstruction If conscious, confirm problem by asking patient Universal sign Contraindications Ability of patient to talk Ability of patient to forcefully cough Ability of patient to continue to move air Continue to monitor patient
- 8. Conscious-Heimlich Maneuver If patient conscious and standing but unable to talk Make fist with one hand Place thumb side of fist on patient’s abdomen Grasp fist with other hand and provide quick upward thrusts Repeat until object expelled or the victim becomes unconscious
- 9. Unconscious-Abdominal thrusts For unconscious patients Place on back Grasp jaw and lift the jaw and tongue with one hand Perform a finger sweep with the index finger of other hand Attempt slow rescue breathing If chest fails to rise, reposition head and reattempt rescue breaths
- 10. Unconscious-Abdominal thrusts continued Straddle the patient Place heel of one hand on abdomen just above the navel Place the heel of the other hand on top of the first and provide up to 5 quick abdominal thrusts Recovery position
- 11. Automatic External Defibrillator A shocking lecture
- 12. Rationale Most frequent initial rhythm in adult cardiac arrest: ventricular fibrillation
- 13. Rationale Most effective treatment for VF: defibrillation
- 14. Rationale Increased VF time = Decreased survival probability 1 minute of VF = ~10% decrease in chance of survival
- 15. Rationale BLS cannot convert VF to normal sinus rhythm BLS only increases time available to defibrillate
- 16. Principle of Early Defibrillation All personnel who respond to cardiac arrests must be trained to operate, equipped with, and permitted to operate a defibrillator
- 17. AED Definition Computerized defibrillator that can: Analyze the heart rhythm of a person in cardiac arrest Recognize a shockable rhythm Advise the operator whether the rhythm should be shocked Indicated in patients with sign of cardiac arrest such as unresponsive, not breathing and no pulse or other signs of circulation
- 18. AED Types Fully Automatic Semi- Automatic
- 19. Operational Steps Assess scene, patient Confirm cardiac arrest Turn on power Attach AED to patient’s chest Initiate rhythm analysis Deliver shock if indicated
- 20. Standard Procedures Assess scene for safety Water Explosive atmosphere Patient on conductive surfaces
- 21. Standard Procedures Do NOT use AED if patient is: < 8 years old Weighs < 55 pounds
- 22. Standard Procedures Assess patient ABCs Presence of transdermal medication patches (nitro patches) Confirm arrest Unresponsive Apneic Pulseless
- 23. Standard Procedures Start CPR Attach defibrillator Do NOT waste time setting up O 2 , suction, IVs, etc. Place pads on patient as on picture on packaging
- 24. Standard Procedures Stop CPR, analyze rhythm Avoid patient contact during analysis If machine says “shock,” “Clear” patient Deliver shock Immediately reanalyze
- 25. Persistent VF 3 “stacked” shocks, no pulse checks in between If unsuccessful, 1 minute of CPR Then if no pulse present, 3 more “stacked” shocks
- 26. Persistent VF Always shock in sets of 3 Whenever chest is touched after initial assessment, it should be to perform CPR for 1 minute Continue to shock until “no shock indicated” message received
- 27. Post-Resuscitation Care Continue to support airway, ventilation Supplemental O 2 Clear airway if vomiting occurs Monitor vitals Stabilize, transport, meet emergency team
- 28. Skill Maintenance Practice Drill at least monthly Rotate responsibility for checking machine
- 30. Summary Shock Early and Shock Often!
- 31. Questions? Hands On Practice
- 32. Reference Cummins, R.O. (2001) Advanced cardiac life support provider manual.