????? Techniques of Cardiopulmanory Resucitation (CPR)

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?????Techniques of Cardiopulmanory Resucitation
(CPR)

Dr. Zhao Gang (??) The Emergency Department, the
6th peoples hospital of Shanghai, Shanghai
jiaotong University
2

?? conceptiong

• ???????????????????????
• Rescue approach and treatment for the patients
  suffering respiratory or cardiac arrest.
• ?????????????????
• Aim recovery of breath, circulation,
  consciousness
• ????????,????,????,??????,????
• Contents assessments, artificial,
  ventilation, defibrillation, chest compression,
  life support
• ????????????(a series of assessments and
  interventions)

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?????(assess and gauge)

• ???????
• Consciousness response, pupil
• ?? ????????????(?????)
• Respiration movement of chest and abdomen,
  type of respiratory movement, (agonal
  respirations)
• ??????? ??????
• Heart beat cardiac sound , pulse , ECG
  

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?????????sudden cardiac arrest (SCA)

• ???? (ventricular fibrillation)
• ????(ventricular standstill)
• ?????? (electromechanical dissociation)

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2000??????????The sequence of BLS in 2000 AHA
Guideline
?????? Basic Life Support (BLS) ?? assessment ?? EMS activation ??ABC???D????? ABCs of CPR, and the D of Defibrillation ??ABC???D????? ABCs of CPR, and the D of Defibrillation
?????? Basic Life Support (BLS) A ???? airway
?????? Basic Life Support (BLS) B ???? Breath
?????? Basic Life Support (BLS) C ???? Circulation
?????? Basic Life Support (BLS) D ?? Defibrillation

• ???????
• for training and remembering

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??????Techniques for the establishment of airway
???????? The tongue and epiglottis obstruct the
pharynx
????? Head Tilt-Chin Lift Maneuver
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??????Techniques for the establishment of airway
????? Jaw-Thrust Maneuver
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??????Techniques for the establishment of airway
?????? Foreign bodies cause airway obstruction
FBAO
????????? Subdiaphragmatic abdominal
thrust Heimlich maneuver
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??????Techniques for the establishment of airway
????? Nasopharyngeal airways
????? Oropharyngeal airways
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??????Techniques for the establishment of airway

• ?????? Esophageal-Tracheal Combitube
• ???? Laryngeal Mask Airway
• ????? Endotracheal Intubation

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???? Provide Rescue Breathing
??????? Mouth-to-nose rescue breathing
??????? Mouth-to-mouth rescue breathing
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???? Provide Rescue Breathing
???????? bag-mask ventilation
device
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???? Provide Rescue Breathing
?????? bag-mask ventilation
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???? Provide Rescue Breathing
?????? ventilation with an advanced airway

• ?????? Esophageal-Tracheal Combitube
• ???? Laryngeal Mask Airway
• ????? Endotracheal Intubation

???????? Connect with ventilator or bag
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???? Provide Rescue Breathing

• ?????????,??????????1? ?
• ???500-600ml,?????,?????????????
• ?????????CPR,??????8?10?,?????,?????????
• ??????,??????????30????2???,???????????,??????1??

• Give 2 rescue breaths, each over 1 seco- nd.
• with tidal volume of 500 to600 mL to produce
  visible chest rise, avoid rapid or forceful
  breaths.
• When an advanced airway is in place during
  2-person CPR, ventilate at a rate of 8 to 10 bpm,
  no pause in chest compressions for delivery of
  ventilations.
• without an advanced airway in place, the
  rescuer(s) should deliver cycles of 30
  compressions and 2 breaths. The rescuer delivers
  the breaths during pauses in compressions and
  delivers each breath over 1 second.

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??Circulation

• ??????(external chest compression)
• ??(defibrillation)
• ????(drug)
• 
  ????(Epinephrine)
• ??? (Dopamine)
• 
  ??????(antiarrhythmic)

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??????(external chest compression)ECC

• ????(cardiac pump)
• ????(thoracic pump)

Pump the blood to the organs
????(position of compression)
?????,????? The lower half of the sternum between
nipples
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??????(external chest compression)ECC techniques
Place the heel of one hand on the lower half of
the sternm and the other hand on top of the first
,so that the hands are parallel. Be sure the long
axis of the heel of your hand is placed on the
long axis of the sternm your hand may be either
extended or interlaced but should be kept off the
chest.
????????????,????????,??????????????????????????,?
??????
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??????(external chest compression)ECC techniques
Lock the elbows in position, with the
arms straightened. Position your shoulders
directly over your hands so that the thrust for
each chest compression is straight down on the
sternum. Release the pressure completely and
allow the chest to return to its normal position
after each compression. Keep your hands in
contact with the victims sternum to maintain
proper hand position.
??????,????? ??????????????????????????? ?????????
????,?????????? ?????????????????
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??????(external chest compression)ECC techniques

• ????100?/??
• ????4-5cm
• ??-????302
• ???????11
• ?2???????
• ?????,?????10?

• Compression rate 100/min
• Depress the sternum 4 to 5cm
• Compression-ventilation ratio 302
• Compression /relaxation time 11
• Switch the compressor every 2 min.
• Minimize interruption of chest compression,
  limit interruption to no more than 10 seconds.

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??(fibrillation treatment)defibrillation

• SCA ??????????????????(VF)?
• ?????? VF ???????
• ???????,????????????
• ??? VF ????????????

• the most frequent initial rhythm in witnessed SCA
  is ventricular fibrillation (VF)
• the treatment for VF is electrical
  defibrillation,
• the probability of successful defibrillation
  diminishes rapidly over time,
• VF tends to deteriorate to asystole within a few
  minutes.

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?????????electrical defibrillation and
defibrillator
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????manual defibrillation
????
Electrode Placement
??????????????,???????????????????
The right (sternal) chest pad is placed on the
victims right infraclavicular chest , the apical
(left) pad is placed on the victims
inferior-lateral left chest, lateral to the left
breast.
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???????? Shock Energies

• ??????? 360J
• Monophasic Waveform Defibrillators
• ???????150J-200J
• Biphasic Waveform Defibrillators

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????steps to operate defibrillator

1. ????
2. ?????
3. ????
4. ?????????

1. Power on
2. Attach electrode pads
3. Select energy
4. Clear the victim and press the shock button

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??????? Defibrillation Plus CPR

• ?????
• A Critical Combination
• ????????????(SCA)??????
• Early defibrillation is critical to survival from
  SCA

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• ?????(Chain of Survival)

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???(Chain of Survival)

• ?????????????(EMS)???????????120
• ????????CPR
• ????????
• ????????????????????

• Early recognition of the emergency and activation
  of the emergency medical services (EMS) or local
  emergency response system phone 120
• Early bystander CPR
• Early delivery of a shock with a defibrillator
• Early advanced life support followed by
  postresuscitation care delivered by healthcare
  providers.

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???? the sooner the better
30

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BLS??(algorithm)
BLS algorithm
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??CPR????

• ??????????????
• ???????120,???????????????
• ??????????,?????????,??????????,?????
• ???????????????????(????,??????)
• ?????????????????????????(???????????,????10?)
• ?????????,??????????,?????,????????(?????????1?,?
  ??????????,????????????)
• ?????????????????,????????????(?????????????,????
  ?????????,??????,???????????)??100?/?,??????????(
  ???????????)????????,????,??4?5????????30?2
• ???????5???????????????(????????????????????,????
  ???????)
• ??????????,?360J??,??????????????,???????(??????
  ?????????????)
• ???????5????????,??????????(?????????????-????-?
  ???????????,??????)

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Sequence of CPR
Step 1
Step 2
Step 3
Step 4
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One rescuer CPR

• Compression rate 100/min
• Depress the sternum 4 to 5cm
• Compression-ventilation ratio 302
• Compression /relaxation time 11
• Switch the compressor every 2 min.
• Minimize interruption of chest compression,
  limit interruption to no more than 10 seconds.

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Two rescuer CPR

• Give 2 rescue breaths, each over 1 seco- nd.
• with tidal volume of 500 to600 mL to produce
  visible chest rise, avoid rapid or forceful
  breaths.
• When an advanced airway is in place during
  2-person CPR, ventilate at a rate of 8 to 10 bpm,
  no pause in chest compressions for delivery of
  ventilations.
• without an advanced airway in place, the
  rescuer(s) should deliver cycles of 30
  compressions and 2 breaths. The rescuer delivers
  the breaths during pauses in compressions and
  delivers each breath over 1 second.

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Master the important technique
Thank you !