CARDIO-PULMONARY RESUSCITATION (CPR)

1. CARDIO-PULMONARY RESUSCITATION (CPR) Module 10 Press Here for Video

2. CARDIAC PULMONARY RESUSCITATION • Introduction • Cardiac disease is the second main cause of death in Singapore. • Hence, public education and training are crucial in reducing “sudden death”

3. CARDIAC PULMONARY RESUSCITATION • CHAIN OF SURVIVAL • The concept of ‘Chain of Survival’ is the best approach to the treatment of victim with cardiac arrest

4. CARDIAC PULMONARY RESUSCITATION (Chain of Survival) • Early Access • prompt a person to call 995 before victim collapse • Early CPR • most effective when started immediately after victim collapse, chances of successful resuscitation depend on prompt bystander CPR and competent rapid response team • Early Defibrillation • is most likely to improve survival rates of cardiac arrest patients • Early Advance cardiac life support • to bring equipment to support ventilation, eg drug, defibrillator machine

5. CARDIAC PULMONARY RESUSCITATION • Heart Attack • Foreign Body Airway Obstruction • Drowning • Stroke • Drug Overdose • Suffocation • Smoke Inhalation • Electrocution • Severe Allergic Reaction

6. ONE MAN CPR • D - Danger • Look out for unsafe environment • R- Check responsiveness (Tapping the shoulder) • Are you OK? • Call ambulance 995 • A- Check airway • by head tilt chin lift (remove foreign body if visible) • B- Check breathing -- (look, listen and feel for breathing ) • up to 10 Seconds (no Breathing) • Attempt 2 ventilation • Air Blow (400 to 600mls)allow the lung deflation between each breath • C- Check Circulation • Check carotid pulse –6 to10 Seconds • No pulse start CPR

7. Determine pulselessness • Proper hand position • Run the middle finger along bottom edge of rib cage to notch at centre (tip of sternum) • Place you index finger next to your middle finger on notch. • Place the heel of one hand on the lower half of the sternum next to the index finger • Release the 2 finger and place the hand on top of the hand on the sternum so that the hand are parallel. • Straight both elbows and lock them into position

8. Tracing Landmark & Position

9. CARDIAC PULMONARY RESUSCITATION • Use your body weight to compress the victim’s chest about ( 4 to 5 cm) • Count: • 1 & 2 & 3 & 4 & 5 & 1 & 2 & 3 & 4 & 10 & 1 & 2 & 3 & 4 & 15 & 1 & 2 & 3 & 4 & 20& 1 & 2 & 3 & 4 & 25 & 1 & 2 & 3 & 4 & 30 • Chest compression rate to achieve 100 per mins • Ratio – 30 compressions : 2 breaths • Perform – 5 cycles • Check pulse • Absent – continue compression • Present – Stop compression • Check breathing • Present – Recovery position • Absent – Rescue breathing

10. Rescue Breathing • Time for rescue breathing : 1 breath every 5 second • Count: • 2 a thousand • 3 a thousand • 4 a thousand • 5 a thousand • Cycle: 12 for one min

11. Check for pulse (carotid) - 6 to 10 seconds Check for breathing - 10 seconds Time for each breath - 1 second per breath Dept of compression - 4 to 5 cm Air volume - 400 to 600 mls Compression rate - 100 per mins Ratio - 30 : 2 Cycle - 5 cycles Rescue breathing - 12 cycles Time for rescue breathing - 1 breath every 5 seconds Summary for one man CPR

12. INFANT CPR D - Danger-Look out for unsafe environment R - Check responsiveness - (call tap or gently shake the infants shoulder or tickle the sole of the foot to elicit response.) • Are you OK? • Call ambulance 995 A - Check airway-by head tilt chin lift (remove foreign body if visible) B - Check breathing -- (look,listen and feel for breathing ) • up to 10 Seconds (no Breathing) • Attempt 2 ventilation • Air Blow (30 mls)allow the • lung deflation between each breath C - Check Circulation-Check Brachial pulse • up to 10 Seconds (no Breathing) • 6 to10 Seconds • No pulse start CPR

13. Infant CPR • Proper hand position • Draw imaginary line between nipples • Place your middle and ring fingers next to the index finger • Move the 3 fingers to the centre of the sternum • Position the fingers upright • Lift up the index finger but maintain the middle and ring fingers on the sternum • Lean forward and place your cheek near the infants mouth and nose • Use your middle and ring fingers to compress the sternum about 2 cm

14. INFANT CPR • Count: • 1 & 2 & 3 & 4 & 5 & 1 & 2 & 3 & 4 & 10 & 1 & 2 & 3 & 4 & 15 & 1 & 2 & 3 & 4 & 20& 1 & 2 & 3 & 4 & 25 & 1 & 2 & 3 & 4 & 30 • Chest compression rate to achieve 100 per mins • Ratio – 30 compressions : 2 breaths • Perform – 5 cycles • Check pulse • Absent – continue compression • Present – Stop compression • Check breathing • Present – Recovery position(lateral side) • Absent – Rescue breathing

15. Rescue Breathing Time for rescue breathing : 1 breath every 3 second Count: 2 a thousand 3 a thousand Cycle: 20 for one min

16. Summary Infant CPR • Check for pulse (brachial) - 6 to 10 seconds • Check for breathing - Up to 10 seconds • Time for each breath - 1 second per breath • Depth of compression - 2 cm • Air volume - 30 mls • Compression rate - 100 per mins • Ratio - 30 : 2 • Cycle - 5 cycles • Rescue breathing - 20 cycles • Time for rescue breathing - 1 breath every 3 seconds • Count - 2 a thousand, 3 athousand

17. Infant : conscious to unconscious choking • Assess for sign of complete airway obstruction ( choking) • Support the infants head and body between your hands and forearms using the sandwich manoeuvre • Hold the infants face down and rest your forearm on your thigh • Keep the head lower than the trunk • Deliver 5 back blows forcefully between the shoulder blades with the heel of your other hand • Support the infants head and body between your hands and forearms after delivering the 5 back blows • Turns the infant over on his/her back resting on your thigh • Keep the head lower than the trunk • Deliver 5 chest thrusts over the lower half of the sternum by counting 1,2,3,4,5

18. Infant : conscious to unconscious choking • Reassessment • Check if foreign body is expelled after every set of 5 back blows and 5 chest thrusts and remove if it is visible. If the airway remains obstructed and the infant is conscious, repeat the sequence of 5 back blows and 5 chest thrusts until the foreign body is expelled or the infant becomes unconscious.

19. Infant unconscious choking • When infant becomes unconscious . • Position infant on a firm , flat surface • Call the ambulance 995

20. Infant unconscious choking A - Check airway - by head tilt chin lift (remove foreign body if visible) B - Check breathing • (look,listen and feel for breathing up to 10 Seconds • No Breathing – Attempt ventilation(1st attempt) • If airway is blocked, reposition the infant’s head and re-attempt to ventilate ( 2nd attempt) • If airway is still blocked, relieved obstruction by performing 30 chest compression ( The landmark and technique for chest compression is the same as for infant CPR) REPEAT THE STEP UNTIL ABLE TO GIVE 2 SUCCESSFUL VENTILATIONS C - Check circulation: • Absent – continue compression • Present – Stop compression Check breathing • Present – Recovery position(lateral side) • Absent – Rescue breathing

21. Adult Obstruction • Conscious Victim • Ask “Are you choking" I can help) • Determine if victim can • Speak • Breath • Cough • Stand behind the victim • Put your arms around the casualty's abdomen and locate for the navel • 2 finger above navel perform inward upward thrust • Make a fist with one hand • Place thumb side of the fist against the abdomen above 2 fingers spacing • Release the 2 fingers spacing but maintaining the fist against the abdomen • Give 5 successive inward-upward thrust • Check if foreign body is expelled after every set of 5 abdominal thrust • Every thrusts until the foreign body is dislodged or the casualty becomes unconscious

22. Position (Pregnancy & Obese) • Stand behind the person, position one foot between the casualty's legs • Locate landmarks: • Place arms under the casualty’s armpits to encircle the chest • Make a fist with one hand • Place thumb side of fist on the middle of the person’s breaths bone • Grasp the fist with the other hand and give successive quick backward thrust • Check if foreign body is expelled after every set of 5 chest thrusts • Repeat thrust until the foreign body is dislodged or the person becomes unconscious

23. ADULT UNCONSCIOUS CHOKING • Unconscious Victim • Position the victim –lie on flat surface • Establish unresponsiveness • Activate EMS - Call 995 • Check for : • Airway • Breathing • If the breathing is absent, attempt to ventilate ( 1st attempt) • If airway is blocked, re-position the casualty’s head and re-attempt to ventilate ( 2nd attempt) • If airway is blocked , relieve obstruction by • Performing 30 compression (position & landmark as CPR) • Repeat Step until able to give 2 successful ventilators • Check for : Circulation –pulse • Absent – Start CPR • Present – Stop compression • Check breathing • Present – Recovery position • Absent – Rescue breathing • Reassessment - Recovery position

24. Step 2 – Recovery Position Step 1 – Recovery Position Step 3 – Recovery Position Step 4 – Recovery Position

25. Remember • CPR can SAVE LIVES. • Do it WELL. • Do it RIGHT. • And the patient gets a chance at life

26. The end Module 10 Cardio-Pulmonary Resuscitation For training purpose only Not for sale