CARDIOPULMONARY RESUSCITATION

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CARDIOPULMONARY RESUSCITATION

• CPR

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Cardiopulmonary Resuscitation (CPR)

• CPR is a proven technique to administer basic
  life support to a patient whose heart has stopped
  beating.
• CPR consists of artificial respiration which
  supplies oxygen to the blood and heart
  compressions which supply blood to the body.

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Automated External Defibrillator (AED)

• Device that generates an electric shock
• AED analyses the patients heart rhythm and
  indicates if an electric shock would be
  beneficial
• While in an abnormal rhythm, the heart does not
  effectively pump blood throughout the body
• CPR and early defibrillation give the best chance
  of survival

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Pulse Check in CPR

• Carotid Artery - Adult/Child
• Brachial Artery- Infant
• Pulse check is only taught to trained responders
• If the patient is unresponsive and not
  breathing, and you dont find a pulse after 10
  sec, you must conclude the patient is in cardiac
  arrest. You should immediately begin CPR and AED
  without further delay.

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Landmarking-Adult

• With the hand closest to the head, place the heel
  of that hand on the sternum in the centre of the
  chest. Make sure it is not on the xiphoid
  process.
• Place the heel of the other hand on top of the
  first hand.
• Interlace the fingers to keep them off the
  chest.
• Landmark every time you remove your
• hands from an adult patients chest.

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Landmarking-Child

• Place the heel of one hand on the sternum in the
  centre of the chest. Make sure it is not on the
  xiphoid process.
• Only the heel of the hand should be in contact
  with the chest.
• For the child, you administer cardiac
  compressions with one or two hands - as needed
• Subsequent landmarking is
• done visually.

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Landmarking-Infant

• Place two fingers in the middle of the infant's
  chest between the nipples
• Slide your fingers to just below the nipple line
• Administer chest compressions with the two fingers

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Depth of Compressions

• Adult, Child and Infant
• Compress the chest down one third to one half
  its depth

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Cardiac Compression and Ventilation Ratios
Groups (yr.) Single Rescuer CPR Two Rescuer CPR Compression Rates
Adult (gt8 yrs) 30 comp. 2 ventilations 30 comp. 2 ventilations 100 per minute
Child (1-8 yrs) 30 comp. 2 ventilations 30 comp. 2 ventilations 100 per minute
Infant (lt1 yrs) 30 comp. 2 ventilations 30 comp. 2 ventilations 100 per minute
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One Rescuer CPR, Adult

• Scene survey
• Establish unresponsiveness
• Activate EMS
• Open airway
• Check for breathing
• If absent, check pulse
• If absent, landmark
• 30 compressions 2 breaths
• 100 compressions per minute
• repeat 5 sets of 302, reassess

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Two Rescuer CPR - Adult or Child

• Survey the scene
• Rescuer 1 is performing CPR
• Rescuer 2 will identify him/her self checks
  that EMS has been activated
• Rescuer 1 complete 302 cycle then reassess
  vitals - no more than 10 sec.
• Rescuer 2 co-operates with Rescuer 1 with
  reassessment
• if no visible signs
• One rescuer now performs chest compressions
• The other now administer rescue breaths
• Rescuer 1 and 2 will change positions with little
  interruption every few minutes

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One Rescuer CPR - Child
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One Rescuer CPR - Infant
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Do Not Resuscitate (DNR)

• Decapitated
• In Rigor Mortis
• Incinerated
• Eviscerated
• Decayed
• Prolonged submersion (days of decomposition)
• Ordered not to by a physician or police officer

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Key Points

• Use an even squeezing motion when doing the
  compressions
• CPR should never be interrupted for more than 10
  seconds
• Always release pressure between compressions
• Maintain contact with the skin at all times
• For adults/child
• interlace fingers of both hands or extend them
  straight out to give a straight, downward
  pressure on the sternum

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Key Points

• Expect some damage to the patients chest while
  doing CPR.
• Injuries to the chest area can be
  life-threatening if they result in damage to
  either the heart or lungs, or cause severe
  internal bleeding.
• Responders may require CISM support after
  performing CPR

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Chain of Survival

• Healthy Choices
• Recognition of Warning Signs
• Early Access to the Emergency Medical Services
  (EMS) System
• Early CPR
• Early Defibrillation
• Early Advanced Care
• Early Rehabilitation

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Health Care Provider Level (HCP)

• EMS activation if the patient is suffering
  respiratory arrest, if alone the HCP should do 5
  cycles of CPR before calling EMS
• HCP would do two breaths before compressions are
  started
• Two rescuer CPR on children or infants will be
  done at rate of 152 when using a BVM

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Health Care Provider Level (HCP)

• Aged guidelines are
• Infant up to one year of age
• Child 1 yr to puberty
• Adult after puberty
• Infant compressions may be delivered using the
  two thumbs with hands encircling the chest