C.P.R. and saving life
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1. The document discusses guidelines for performing cardiopulmonary resuscitation (CPR) in cases of cardiac or respiratory arrest. 2. It describes the causes of arrest, the basic steps of CPR including chest compressions, breathing, and use of an automated external defibrillator (AED). 3. The text provides guidance for one-person and two-person CPR, and notes some differences in performing CPR on children and infants compared to adults.
C.P.R. and saving life
- 2. When to do C. P. R.?
- 3. Causes of arrest. Cardiac arrest: Most common in adult than child. Due to stoppage of cardiac contractility or fatal arrhythmias. Many causes lead to stoppage of cardiac output and decrease blood supply to vital organs, heart, brain, myocardium, liver, kidneys, lungs. Respiratory arrest: Most common in children than adult. Many causes lead to respiratory arrest and stoppage of respiration can cause severe hypoxia and anoxia. Respiratory obstruction one of the most common reversible cause of arrest.
- 4. How to do C. P. R.? S • Safety. S • Stimulate response. S • Shout for help. S • Check pulse and Start C.P.R.
- 5. How to do C. P. R.?
- 6. Chain of survival. In adult: In child: A. E. D CALL FOR HELP C. P. R. ROSC ROSC Advanced life support Early call for help EARLY C.P.R. Prevention of arrest Advanced life support
- 7. Airway opening • Simple maneuver • Head tilt chin left • Jaw thrust:
- 8. Airway opening • Simple maneuver • Bag valve mask • Oropharyngeal and nasopharyngeal
- 9. Airway opening • Advanced airway • Endotracheal intubation • Combitube and Laryngeal mask
- 10. Airway opening • Use bag – valve – mask (B. V. M) to deliver oxygen to the victim. • After opening airway you should confirm ventilation by checking pulse oximetery in addition to Look, Listen & See. • N. B. • B. V. M. alone can deliver only 23% (room air). • Connection of oxygen source can increase oxygen delivery oxygen up to 45%. • Connection of reservoir to B. V. M. with oxygen can deliver oxygen up to 85%.
- 12. Chest compression • Chest compression is done to squeeze the heart between 2 bones, vertebral column posteriorly and sternum anteriorly. • The aim to insure blood supply to vital organs, brain, kidneys, liver, lungs, to maintain oxygenation and vitality for longer period to decrease bad prognosis after recovery. • Chest compression is the most important part to save lives.
- 13. Chest compression • High quality C.P.R. – Proper hand position: lower 1/3 of the sternum. – 1 hand is supported by the 2nd hand.
- 14. Chest compression • High quality C.P.R. – Depth is at least 5 – 6 cm. in adult child, and 3 – 5 cm in infant – Adequate chest recoil without hand off.
- 16. Breathing • Every cycle of chest compression should be followed by 2 breaths by: • Mouth to mouth. • Face mask or pocket mask. • Bag – valve – mask.
- 17. Breathing • Every breath is given over 1 sec. and give another sec. to expel air. • Chest rise is the best indicator for adequate breathing. • Avoid excessive breathing and hyperinflation of chest.
- 20. 1- Rescuer C. P. R in adult • If I see un responsive victim while I’m alone: • Call for help, ambulance with AED. • Chick pulse centrally. • If no pulse start C. P. R. • 30 successive high quality chest compressions. • Chest compression rate 100 – 120 / minute. • Compression ventilation rate 30:2/ cycle. • Every 2 minutes or 5 cycles recheck pulse again.
- 21. 1- Rescuer C. P. R in adult • Continue C. P. R. until AED arrival or the victim recover.(ROSC) • Transfer the victim after ROSC to I. C. U. To receive advanced care.
- 23. 2- Rescuer C. P. R. in adult • Divide C. P. R. work between 2 rescuers: » One of them does chest compression. » The other open the airway and give 2 breaths. • The 1st does 30 chest compressions by rate at least 100 – 120 /min. • The 2nd maintain airway open, gives 2 breathes after every 30 compressions, and act as monitoring for the effective chest compression. • Compression – ventilation rate is 30:2.
- 24. 2- Rescuer C. P. R. in adult • Switch role between two rescuers done every 2 minutes or 5 cycles. • Confirmation of pulse also done every 2 minutes or 5 cycles.
- 26. Use of AED • AED is a computerized machine that can detect heart rhythm whether shockable or not and can be charged and gives shock. • It should be available with the ambulance, or with 1st aid tools in any place crowded with people. • It has a great role in saving lives. • Once arrival of AED it should be used without waiting.
- 27. Use of AED
- 28. Use of AED • Instructions to use AED: – Turn the machine on by pressing button (ON). – Follow the instructions of the machine. – Put pads over patient bare chest one of them over the apex of the heart, the 2nd below right clavicle just right to the sternum. – Connect pads into the specific socket. – Clear away from the patient and leave the AED to analyze the rhythm and detect whether it’s shockable or not and advise if shock needed. – Start charging by pressing butting (2). – After charging shock button flash (3) and the machine is ready to deliver shock. – Say clear everybody, confirm all clear, I’m clear, then, deliver shock.
- 29. Use of AED • Instructions to use AED: – Start C. P. R. again without waiting anything. – Do not stop C. P. R. until the machine re analyze again after 2 minutes. – Switching between 2 rescuers is done at analyzing pause
- 30. Use of AED • Instructions to use AED: – If the victim on watery or metal surface you should move him away for your safety. – If there is sweeting or water on victim’s chest you should dry it before applying the pads. – If the victim has excessive long chest hair apply the paddles to chest firmly then rapidly remove them then reapply it again to have good electrical conduction. – If the victim has a pace – maker turn it off before applying pads. – If there is nitroglycerin patch remove it and clean its site before giving electrical shock.
- 31. Use of AED
- 33. Changes for child • Child is: age group 1 year old to age of puberty. • The most common cause of sudden death in children is hypoxia. • If you find unresponsive child with carotid pulsation not felt you should start C. P. R. first for 2 minutes then if he is not came back to life you should call for help, then, Continue chest compression and C. P. R. • In 1 – rescuer C. P. R. in child compression – ventilation rate is also 30:2 as adult. • In 2 – rescuers C. P. R. compression – ventilation ratio become 15:2.
- 34. Changes for child • Switch role and rechecking of pulse becomes every 10 cycles (15:2). • You can use 1 or 2 hands in chest compression according to body weight of the child, to reach adequate depth.
- 35. Changes in infant • Infant is: age group from 1 month– 12 months. • Feeling the pulse over brachial artery. • In 1 – rescuer C. P. R. in infant compression – ventilation rate is also 30:2. • You should use both index and middle fingers of one hand over lower ½ of sternum below imaginary line between the two nipples
- 36. Changes in infant • In 2 – rescuers C. P. R. compression – ventilation rate become 15:2. • Switch role and rechecking of pulse becomes every 10 cycles (15:2). • Use both thumbs of both hands beside each other over lower ½ of sternum, and encircle the rest of fingers of both hands around infant chest, and start C. P. R. • Opening the airway in infants is by putting the head in neutral position, because of large occiput of the infant, hyper extension of the neck may obstruct airway.
- 37. Use of AED in child and infant • Manual defibrillator is preferred than AED, but, if you have no choice use pediatric pads (small sized pads). • If pediatric pads not available you may use adult pads instead, but, put one of the pads over apex of the heart, and the other on the back, put the heart between two paddles.
- 38. Chocking • Chocking happened when hard or soft objects entrapped into throat of patient during eating or swallowing. • It leads to partial or complete airway obstruction and may be lethal. • If the victim can cough encourage him to cough.
- 39. Chocking • Management in adult: – Do Heilmlich’s maneuver: • Stop behind the victim to support him. • Put fest of one hand above the umbilicus and below the sternum with both hands do backward upward abdominal pressure on the abdomen helping the victim to expel that foreign body out. • You may do 5 back slaps. • Continue doing this maneuver until expelling this object or become unresponsive. • If becomes unresponsive, lie him flat, then start C. P. R. , but before giving breath look into the mouth if that object easily removed remove it before giving breath.
- 40. Chocking
- 41. Chocking • Management in infant: – Do 5 back slaps followed by 5 anterior chest compressions until the object expelled. – If becomes unresponsive lie him flat and start C. P. R. consider removal of the object before giving breaths.
- 42. Chocking
- 43. • Special cases: – Children or short victims. – Pregnant women. – Obese. – I am alone. Chocking
- 44. Advanced breathing • In case you can get endotracheal intubation or any advanced airway, now you have secured airway, so chest compression and ventilation become independently. • Chest compression rate becomes continuously without stop, by rate 100 – 120 /min. for 2 minutes, • Respiratory rate becomes one breath every 5 – 6 sec. in adult, and one breath every 3 sec. in infant.
- 45. Advanced cardiac life support • C. P. R. with monitor and drugs: • We will have better results if we have well trained heart savers with good equipment, as this equipment will help us to diagnose the cause of cardiac arrest according to reading cardiac rhythm. • Arrange ACLS team from well- trained personals (team leader – chest compression – airway – drugs – monitoring – defibrillator – recorder) you can manage situation according to number of available persons.
- 46. Advanced cardiac life support • Rhythm on the monitor may be: Non – shockable rhythm: • Asystole: wavy line, or only p- waves. • Pulseless electrical activity (PEA): non – arrest rhythm without pulse.
- 47. Advanced cardiac life support • Rhythm on the monitor may be: Shockable rhythm: • Ventilicular fibrillation (V.F.): coarse bizarre shape ventilicular waves. • Ventilicular tachycardia without pulse (pulseless V. Tach.)
- 48. Advanced cardiac life support
- 49. Advanced cardiac life support