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Cardio-Pulmonary Resuscitation (CPR)

AMERICAN HEART ASSOCIATION
HEALTHCARE PROVIDER
CARDIO-PULMONARY RESUSCITATION

In detail at “www.americanheart.ore – CPR-ECC- 2010 CPR Guidelines” All course manuals are to be obtained on your own – http://aha.channing-bete.com -1- 800-611-6083

Discussion & Demonstration Highlights

CPR-Definition

  • Cardio – referring to the heart
  • Pulmonary – referring to breathing, ventilation
  • Resuscitation – replacing missing functions

Possible Clinical Scenarios

  • Conscious, healthy
  • Conscious, – ill or injured
    • Injured -“B’s”
      breaks, bites, burns, bruises, boils, bumps, (a)brasions, brains
      Stroke
      Signs — facial droop, slurred speech, “drifting arm”
    • Heart attack
      Signs – hypo-ventilating, diaphoretic, cyanotic, grimace
      Symptoms – radiating pain, Hx, nausea, in-coherent, dizzy
      Treatment – nitro, 2×81 mg aspirin, activate 911
  • Unconscious – breathing & pulse
    • Stroke
    • Diabetic reaction
    • Injured – shock
  • Unconscious – no breathing, pulse
  • PEA -ventricular fibrillation (3-5 minutes)
  • Cardiac arrest

CPR Indications
CPR is only indicated in cardiac arrest or ventricular fibrillation. For every minute that passes from sudden cardiac arrest (SCA) and fibrillation, survival rates decrease 7-10 % without CPR. However if CPR is available, the rates decline less quickly at an average of 3 -4 % per minute. (CPR can double or triple survival rates – defibrillation increases survival even more).

Scene Assessment
AHA recommendation is to maintain your safety in any emergency situation whether it is in a healthcare facility or community setting

Victim Assessment
Assess victims responsiveness for 5-10 seconds- try establish response, and at the same time- look for agonal or absence of breathing

Activation of EMS System & get the Defibrillator

  • 911 are the universal emergency phone number throughout the United States Most fire and police facilities have caller identification for single landline phones. If you are calling from a facility that has many phone lines, you will need to dial “9”, then 911. You will need to give the dispatcher very specific directions to the exact location of the emergency.
  • If you are calling with a cell phone in Massachusetts, the call will go to the state police – they will then “patch” you to the town or city you are calling from.
  • Digital phone service is still random depending on the Phone Company and/or town or city. You should investigate the recommended emergency procedure for each situation.
  • If there is no response from the victim, and you are alone,
    • In an un-witnessed arrest, use your cell phone immediately, or if no cell phone, perform CPR for 2 minutes and then go for help
    • In a witnessed arrest, for arrest, go for help immediately, and them return and perform CPR
    • In an un-witnessed or witnessed arrest there is a second person, send them immediately for help, provide one person CPR. When the second person returns provide two person CPR

Circulation

Initiating CPR – PUSH HARD & FAST – MINIMUM OF TWO INCHES !
“HIGH QUALITY COMPRESSIONS”

  • If victim is exhibiting agonal breathing or no breathing,
  • Check the carotid artery pulse for at least ten seconds – if no pulse
  • Remove all clothing from chest
  • Assure victim is on firm surface (floor, bed board, deflated mattress)
  • Avoid pushing on xiphoid or rib insertion
  • Line middle finger with chest line
  • Place hand (same as side of victim your are working on), line yourself over
    mid chest of victim o Place second hand on first hand – lock elbow, rest all your body weight on
    victim – push at least 2 inches at a minimum rate of 100 times per minute
  • *Thoracic Pump Effect – Compressions at a rate of 100/mimite can facilitate alternating “positive” and “negative” pressures in the mediastinum
  • Perform 30 compressions (within 18 seconds) provide two breaths, repeat five times (two minutes)

Airway
Open the airway – hyper-extend the head & neck, using the head tilt chin lift
method — this will move the tongue away from the opening of the trachea o if suspect neck injury – Use the j aw thrust method

Breathing

  • Use a barrier device, or if your choose, block nostrils with fingers, seal the victim’s mouth with yours – blow in until chest moves – then stop immediately, repeat with a second breath. Over ventilation could cause vomiting and aspiration.
  • It is recommended that you not use the mouth to mouth method without a
    barrier device o Use a disposable mouth shield, pocket mask, or AMBU bag for ventilation.

Equipment & Supplies
Google with key word(s) – “CPR supplies, or CPR barrier devices, or CPR Personal Protection Equipment”

Periodic Assessment
Assess for breathing and circulation repeat if indicated. Prepare for ACLS intervention

Two Person CPR -Use of AMBU
Definition: Airway Management Breathing Unit
Indications: To ventilate and oxygenate patients

Use the “C & E” hand method with the pocket mask and AMBU

  • Lateral – from the side -place same (your) hand on top of mask, as the side vour are on working on the victim
  • Cephalic – over head
  • Good Samaritan Act

Physicians, Registered Nurses, and Workplace/job description

  • Community action – Not mandatory
  • DNR – “Do Not Resuscitate”
  • Right of refusal – conscious victim

MASSACHUSETTS – Regular Session – Effective 12/25/77 – Chapter 555, Laws 1977, House Bill No. 1650
AN ACT EXEMPTING FROM CIVIL LIABILITY CERTAIN TRAINED INDIVIDUALS FOR RENDERING EMERGENCY CARDIOPULMONARY RESUSCITATION.

Be in enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

Chapter 112 of the General Laws is hereby amended by inserting after section 12U, inserted by chapter 397 of the acts of 1977, the following section:-
Section 12V. Any person who is currently certified by the American National Red Cross or the American Heart Association in cardiopulmonary resuscitation, or any person who has successfully met the training requirements of a course in basic emergency care of the un-witnessed cardiac arrest, conducted according to the standards established by the American Heart Association, who in good faith and without compensation renders emergency cardiopulmonary resuscitation in accordance with his training, other than in the course of his regular professional or business activity, to any person who apparently requires cardiopulmonary resuscitation, shall not be liable for acts of omissions, other than gross negligence or willful or wanton misconduct, resulting from rendering of such emergency cardiopulmonary resuscitation. (Approved —1977)

Mass. Gen. Laws chapt 111C § 14 and 112 § 12V (1998) provides that any person who is trained according to the standards and guidelines of the American Heart Association or the American National Red Cross in cardiopulmonary resuscitation (CPR) or the use of semi-automatic or automatic external defibrillators or any person who has successfully met the training requirements of a course in basic cardiac life support, conducted according to the standards established by the American Heart Association, who in good faith and without compensation renders emergency cardiopulmonary resuscitation or defibrillation in accordance with his training, other than in the course of his regular professional or business activity, to any person who apparently, requires cardiopulmonary resuscitation or defibrillation, shall not be liable for acts or omissions, other than gross negligence or willful or wanton misconduct, resulting from the rendering of such emergency cardiopulmonary resuscitation or defibrillation.

Demonstration & Practices

ADULT (8 ws.& up) CHILD (1 vr. To 8yrs) INFANT (one month —one year)
ASSESS
RESPONSIVENESS
Determine agonal or ineffective breathing
ASSESS RESPONSIVENESS ASSESS RESPONSIVENESS
CALL 911 CALL 911 CALL 911 AFTER ABC’S After two minutes
CIRCULATION -COMPRESS A T LEAST 2 INCHES -30 TIMES THEN TWO BREA THS -Same for two person 30:2 Five cycles CIRCULATION-COMPRESS 2 INCHES -30 TIMES THEN TWO BREATHS -Two person -15:2 ratio 10 cycles CIRCULATION COMPRESS
1 /1/2 INCHES -30 TIMES THEN TWO BREATHS -Two person —15:2 ratio 10 cycles
Compression rate 100/min. Compression rate 100/min. Compression rate 100/min.
2 INCHES Approximately 2 INCHES \XA INCHES

RESCUE BREATH – 5 SEC
RESCUE BREATH – 3 SEC
RESCUE BREATH – 3 SEC

** neonate – new birth – four weeks – remain – “A-B-C” sequence
FOREIGN BODY AIRWAY OBSTRUCTION

Conscious Adult Conscious Child Conscious Infant
“Abdominal shrug” (Heimlich maneuver) “Abdominal shrug” (Heimlich maneuver) Back blows
No back blows No back blows Chest thrust (two fingers)
No finger sweep No finger sweep No finger sweep
** If unconscious, perform CPR – 30 & 2 x 5 – check airway, attempt breaths, repeat if necessary ** If unconscious, perform CPR check airway, attempt breaths, repeat if’ necessary ** If unconscious, perform CPR check airway, attempt breaths, repeat if necessary
Unconscious – perform A-B-C Unconscious – perform A-B-C Unconscious –
perform A-B-C

AED FACTS SHEET
Ventricular Fibrillation – An abnormal irregular heart rhythm whereby there are very rapid uncoordinated fluttering contractions of the lower chambers (ventricles) of the heart.
Biphasic Defibrillator – emits a positive and negative charge. Found to be more effective than a Monophasic defibrillator.
Monophasic Defibrillator — emits only a positive charge.
Automated External Defibrillator (AED) – Analyzes heart pattern automatically. “Orange button” needed to be pushed by rescue in order to initiate a shock to defibrillate victim/patient This is the common model used in community and health care settings. Strength of shock -120-200 joules. One shock only!|V» provide CPR for two minutes before next assessment.
Semi-Automated External Defibrillator used by Emergency Medical Technician (EMT). Manual Defibrillator – used by Paramedics and critical care personnel in hospital setting.
The machines are defibrillators.
Defibrillators only shock when the patient/client are in fibrillation.
Defibrillators don’t shock when the patient/victim aren’t in fibrillation.

That could be a “pumping” rhythm or could be asystole (cardiac arrest) AED:
Continue CPR until AED arrives, the second it arrives open and turn on: Always turn unit on first, then follow prompts-apply pads, plug in.
Only need to wipe off wet area or shave area where pads are placed.
Do not touch victim/patient during shock.
Once pads are attached do not remove until EMS arrives.
Child pads are preferred with children and infants; If none use adult pads for all.
Stop CPR when prompted, allow shock, continue CPR for two minutes, stop when prompted to analyze again.
Charge ranges from 120 -2 00 joules of electricity. Adult pads may be used with adults and children -child pads not effective on adults.
In Massachusetts, health & fitness clubs and health care facilities with patients over night must have an AED. Federal law requires all airplanes carry an AED.

Original Good Samaritan law (1977) revised In 1998 adding AED for CPR certified rescuers.
Five year battery supply for shock; nine volt battery indicator light indicating charge for the five year battery.

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