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Cardiopulmonary Resuscitation

Cardiopulmonary Resuscitation. American Heart Association 2011 Guidelines CPR for Health Providers. CPR for Health Care Providers. Adult Child Infant. BLS / BCLS ALS / ACLS Respiratory Arrest. Arrest, Cardiac Arrest, Code, Code Blue Ventilations. Terminology.

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Cardiopulmonary Resuscitation

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  1. Cardiopulmonary Resuscitation American Heart Association 2011 Guidelines CPR for Health Providers

  2. CPR for Health Care Providers Adult Child Infant

  3. BLS / BCLS ALS / ACLS Respiratory Arrest Arrest, Cardiac Arrest, Code, Code Blue Ventilations Terminology

  4. American Heart Association • Research • Training • Public Education

  5. Chain of Survival • Early Access • Early CPR • Early Defibrillation • Early ACLS

  6. The Myth A little CPR & everything turns out O.K.

  7. Definitions • Clinical Death = no pulse & not breathing • Biological Death = Permanent brain death (irreversible) Begins 4 - 6 minutes after arrest

  8. CABD’s of CPR • C = Circulation • A = Airway • B = Breathing • D = Defibrillation

  9. Causes of Cardiac Arrest • Heart attack- (or cardiovascular disease) • Trauma • Drowning • Drugs • Electrocution

  10. Cardiovascular Disease Can Lead To: • Heart Attack - myocardial infarction (MI) • Stroke - cerebral vascular accident or CVA (now called “brain attack”) • Aneurysm

  11. Signs of ... • Heart attack = chest pain Typical - pressure, “tightness” Vs Atypical - indigestion, jaw pain

  12. and.. • DENIAL is common • Activating EMS is the right thing to do if you have chest pain

  13. Sudden Death • Ventricular Fibrillation

  14. Ventricular Fibrillation • The most effective intervention is early defibrillation

  15. Defibrillators Manual Semiautomatic Automatic Public access is AHA goal

  16. Public Access Defibrillation -PAD • Casinos • Airports • City buildings • Senior centers • Gated communities

  17. Stroke or “Brain Attack” • hemiparesis & hemiparalysis • headache, blurred vision • aphasia (speaking problems) • one sided facial droop #1 Risk factor = hypertension Signs and Symptoms:

  18. CVD risk factors • Factors that influence the probability of cardiovascular disease.

  19. CVD risk factors that cannot be changed • Heredity • Gender • Age Race also plays a role

  20. CVD risk factors that you can change. • Smoking • High blood pressure • High cholesterol** • Lack of exercise

  21. note • Cholesterol is found in eggs, meat, & dairy products.

  22. other factors ... • Diabetes • Obesity • Excessive stress

  23. note • Having multiple risk factors poses a much greater risk than having only 1 risk factor.

  24. Pediatric safety Injury due to “accident” #1 cause of pediatric death And most are PREVENTABLE seat belts fire safety pools firearms etc...

  25. Pediatrics • Airway problems are common cause of death in infants & children. • Respiratory arrest leading to cardiac arrest.

  26. Basic principles of CPR Obviously dead Reasons to stop CPR Positioning Initial actions CABDs

  27. Obviously Dead (policy 814) • Decapitation • Incineration • Decomposition • Evisceration of heart, lung, or brain

  28. Obviously Dead (policy 814) • Post mortem lividity & rigor mortis (check apical pulse for 60 seconds) • Special situations • MVI with limited resources • entrapment (> 15 minutes extrication time) • ?

  29. Reasons to Stop CPR • Patient Revives. • Patient is turned over to rescuers of equal or greater training. • Doctor tells you to stop. • You are so exhausted you can not continue.

  30. American Heart Association • Infant 0-1 year old • Child 1year - onset of puberty • Adult Puberty on

  31. Establish unresponsiveness • Shake & Shout THIS IS THE FIRST THING YOU DO WHEN ASSESSING A UNRESPONSIVE PERSON

  32. Activate EMS • Adults • Initiate immediately and get AED • Children and infants • Witnessed – initiate immediately and get AED • Unwitnessed – 5 cycles of CPR, then initiate and get AED

  33. Position the patient • Supine • On a hard surface

  34. CABD’s of CPR • C = Circulation • A = Airway • B = Breathing • D = Defibrillation

  35. AIRWAY • Conscious Vs Unconscious • anatomical obstruction • solid obstruction • liquid obstruction

  36. AIRWAY • Open the airway. • Head tilt, chin lift : preferred method • If suspected neck injury: Modified jaw thrust.

  37. BREATHING • Mouth to mouth • Mouth to nose & mouth • Mouth to stoma • Mouth to mask

  38. BREATHING Rescue Breathing • Adult = 1 every 5-6 seconds • Child = 1 every 3-5 seconds • Infant = 1 every 3-5 seconds

  39. Adequate Ventilation • No resistance • No escape of air from around mask • Chest Rise - stop when chest begins to rise

  40. Complications of rescue breathing GASTRIC DISTENTION is caused by air entering the stomach Over-ventilating Improper head tilt (no tilt)

  41. Cricoid Pressure • Sellicks Manuever • Prevent gastric inflation/passive regurgitation • Assistance during Endotracheal Intubation

  42. CIRCULATION • Chest compressions • Proper speed • Proper depth • Proper position

  43. Speed of Compressions • Adult 100 times / min • Child 100 times / min • Infant 100 times / min

  44. Depth of Compressions • Adult 1 1/2 - 2” • Child 1 - 1 1/2” • Infant 1/2 - 1” • OR 1/3 to 1/2 the patient’s body depth.

  45. Hand Position • At the nipple line • Off the zyphoid process 2 fingers = infant 1 hand = child 2 hands = adult

  46. Ratios Compressions to ventilations Adult = 30:2 (1 and 2 rescuer) Child & infant = 30:2 (1 rescuer) 15:2 (2 rescuer) • The pause is important to allow for slow ventilations

  47. Complications of Compressions • fractured ribs • fractured sternum • lacerated lungs • lacerated liver, blood vessels, etc.,,

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