CPR Cardio Pulmonary מרחב ירושלים

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1 CPR Cardio Pulmonary מרחב ירושלים Resuscitation כל הזכויות שמורות למד"א Dan Drory, MDA Paramedic and Instructor, 2011

2 Vocabulary כל הזכויות שמורות למד"א מרחב ירושלים Consciousness: הכרה (hakarah) Unconscious: מחוסר הכרה (mechoosar hakarah) CPR: החייאה (hachya ah) Breaths: נשימות (neshimot) Pulse: דופק (dofek) Compressions: עסויים (eesooeem) Adult: מבוגר (mevoogar) Child: ילד (yeled) Baby: תינוק (teenok) Vomit: קיא (key) Choking- חנק (chenek)

3 Basic Terminology כל הזכויות שמורות למד"א מרחב ירושלים Anatomy the science that research the structure of the body. Physiology the science that studies the functions of the body. Pathophysiology the science that studies the malfunctions of the body.

4 Life Definition כל הזכויות שמורות למד"א מרחב ירושלים Respiration Consuming food Secreting wastes Reproducing Reaction to stimulation Movement Aging and Death Cell Tissue Organ System Body

5 Triangle of Life Brain כל הזכויות שמורות למד"א מרחב ירושלים Heart Lungs If one of these three fail eventually all will fail

6 Time Line 4-6 minutes after a stop of blood flow to the brain, brain cells begin to die. Forever. כל הזכויות שמורות למד"א מרחב ירושלים Forever. All we hope for is that they weren t very important

7 Chain of Survival כל הזכויות שמורות למד"א מרחב ירושלים

8 Chain of Survival כל הזכויות שמורות למד"א מרחב ירושלים Spontaneous Cardiac Arrest is the leading cause of death in most parts of the world. Five vital links that can save a life are: Immediate recognition and activation of EMS Early CPR that emphasizes chest compressions. Rapid Defibrillation if indicated Effective Advanced Life Support Integrated post-cardiac care

9 If we do it right When these links are implemented in an effective way, survival rates can approach 50%. כל הזכויות שמורות למד"א מרחב ירושלים

10 CPR for every body! כל הזכויות שמורות למד"א מרחב ירושלים Adult CPR: Older than 8 years Child CPR: 1 to 8 years Infant CPR: 28 years to 1 day Paired CPR CPR with Equipment

11 CPR- for every one Safe CAB is shocking! כל הזכויות שמורות למד"א מרחב ירושלים Safety AVPU and breathing assessment Compressions with early AED operation Airway Breathing

12 Safety כל הזכויות שמורות למד"א מרחב ירושלים Look around at your environment! Make sure you, your team and your patient are safe in that order! No fire, no wire, no gas, no glass, no drugs, no thugs. Are there other people around that can help you?

$AVPU כל הזכויות שמורות למד"א מרחב ירושלים A- Alert V- Voice\Response$

13 AVPU כל הזכויות שמורות למד"א מרחב ירושלים A- Alert V- Voice\Response to Vocal Stimulus P- Pain\ Response to Painful Stimulus U- Unresponsive

14 Quickly Evaluate Breathing The Israel Experience Is the patient breathing normally? כל הזכויות שמורות למד"א מרחב ירושלים Option #1: yes Option #2: no Simple.

15 Agonal Breathing? כל הזכויות שמורות למד"א מרחב ירושלים Agonal Breathing is what happens when the brain still thinks that there is a pulse when there isn t. Another one is Gasping. Imagine a fish that has been pooled out of the water. There will be movement of breath organs ( mouth, guilds ), but what is it good for if there is no pulse? Usually, it looks as if the patient is taking deep but slow breaths. Gasps do not count as breathing!!!

16 Call for help In Israel, the emergency number for the medical services is 101 כל הזכויות שמורות למד"א מרחב ירושלים

17 Uhhh I dialed. Now what??? The Israel Experience כל הזכויות שמורות למד"א מרחב ירושלים Describe shortly why you need an EMS team. Hi, I m with an adult that is Unresponsive and he is not breathing right. They will know what that means. Give your phone number. Give the address of the place the patient is at. Don t hang up until the dispatcher does! Allow him/her to collect all necessary information.

18 One hand holds the phone, what can the other do? The Israel Experience כל הזכויות שמורות למד"א מרחב ירושלים If possible check for, check for pulse Then you will be able to pass that information to the dispatcher. Ask for a Defibrillator. In a public place, try asking the security for it, they know what and where that is ( usually ) Ask for help! The compressions are fatiguing!

19 Circulation מרחב ירושלים Check for pulse 5-10 seconds o Check at the carotid artery o If there is no pulse or you are not sure if there is, perform 30 compressions כל הזכויות שמורות למד"א

20 מרחב ירושלים The Israel Experience Place 3 of your fingers on the patients crycoid cartilage when they face away from you. Apply gentle pressure Slide inward the neck with your fingers. Do you feel it? Checking pulse כל הזכויות שמורות למד"א Practice on your classmates ( 5 min )

21 Adult CPR א ב כל הזכויות שמורות למד"א מרחב ירושלים PUSH DEEP, PUSH FAST, PUSH HARD! Allow full chest recoil! Minimize interruption of chest compressions!

22 Adult Chest Compressions Key The Israel Experience כל הזכויות שמורות למד"א מרחב ירושלים Goal: 100 compressions at least per minute Go 5 cm (2.5 ) deep (1/3 chest depth) Allow full chest recoil Avoid Interruptions of compressions Perform CPR on hard surface Position your self so your arms will be at a 90 degree angle to the patient s chest Keep elbows locked, knees on floor, both hands on patient Placement of compressions is in the middle of the chest ( not the torso ) Change compressors every 2 minutes or when asked as quickly as possible. Brocken or dislocated ribs should not bother you.

23 מרחב ירושלים Airway ( after first 30 compressions ) The Israel Experience Check Airway: Open the mouth Clean secretions and visible objects ( no more than 10 seconds if you stopped compressions ) Head Tilt - Chin Lift ( in trauma Jaw thrust ) Avoid Hyperextension כל הזכויות שמורות למד"א Unconscious Conscious

24 Wait a minute! That s discussing! The Israel Experience כל הזכויות שמורות למד"א מרחב ירושלים So let s discuss You are right! You don t have to do the next step If you choose not to, resume compressions Check and Clean secretions and visible objects ( no more than 10 seconds if you stopped compressions ) every two minutes ( 200 compressions / 5 sets of 30:2 )

Mouth to Mouth Rescue Breathing The Israel Experience כל הזכויות שמורות למד"א מרחב ירושלים Seal the nose Seal the mouth Inhale normally Give 1 breath ( Exhale ) Stop with chest

25 Mouth to Mouth Rescue Breathing The Israel Experience כל הזכויות שמורות למד"א מרחב ירושלים Seal the nose Seal the mouth Inhale normally Give 1 breath ( Exhale ) Stop with chest rise You saw chest rise? Cool! Give another! No chest rise? Improve Head Tilt and try again! Only two tries! Could not get it right? Try to improve it after another 30 compressions

26 כל הזכויות שמורות למד"א מרחב ירושלים The Israel Experience Keep on going! Continue with 30 compressions followed by 2 breaths ( 30:2 ) four more times. If a defibrillator is available, operate it immediately. If you walk around with one, even before the first 30 compressions! After 5 sets of 30:2, check for pulse. No pulse? Keep on going! Ambulance arrival time in populated arias in Israel is in average - 7 minutes. Plan to use help!

27 Ok, and how do I know when to stop? The Israel Experience כל הזכויות שמורות למד"א מרחב ירושלים The sequence of CPR is based on a possibility of a return of spontaneous circulation. After you do 5 sets : about 2 minutes ( 30 compressions + 2 breaths ) X 5 You should check for pulse as you did the first time. If a pulse have returned, go to the A and B ( Give 1 breath every 5 seconds if not breathing, or maintain airway if he is. Monitor pulse )

28 Patient with a Pulse If the person has a pulse and is breathing lift legs and keep the Airway open. We need to secure their airway Keep monitoring the pulse. כל הזכויות שמורות למד"א מרחב ירושלים If the person has a pulse but is not breathing, give one breath every 5 seconds. Keep monitoring the pulse.

29 Right. What's an AED? כל הזכויות שמורות למד"א מרחב ירושלים Semi-Automated External Defibrillator A device that is capable of analyzing the most common rhythm in a Cardiac Arrest (Ventricular Fibrillation) and terminate it. After it Analyzes the rhythm and finds the VF, it charges it self and awaits your command to release the shock.

30 כל הזכויות שמורות למד"א מרחב ירושלים The Israel Experience The AED It s safe to use. It s user friendly. It even gives you instructions, in case you forget You just need to listen to it. A reminder, this should be done as soon as an AED is available

31 That s what it looks like When you open it, you will find patches ( Electrodes ). They need to be connected to the patient in the next manner: Some patients will need to get a shave before attaching the electrodes. When attaching the electrodes, press on them firmly!

32 כל הזכויות שמורות למד"א מרחב ירושלים The Israel Experience Another way to connect them is: one patch in the middle of the chest, and another between the scapulas. That method is usually used in children and infants. There are no age/weight restrictions. Chances of survival when an AED is not being used during VF drop 7-10% every minute! An excellent CPR has a high potential of prolonging the life expectancy of the heart and the brain, but only an AED can terminate the VF! More so, without a proper perfusion that is build with the CPR, the AED s potential is poor. Those to are tightly connected, and evenly important!

33 AED Safety כל הזכויות שמורות למד"א מרחב ירושלים Connect only to a patient that is unresponsive and breaths abnormaly DO NOT use on wet surfice DO NOT use in surroundings of a sparkle inflammable gases or fluids. When the AED is Analyzing, DO NOT touch the patient DO NOT touch the patient from the beginning of Analyze until the end of shock delivery. Resume CPR immediately after. Check for pulse after 2 minutes.

34 Lifepack 500 built-in protocol: The Israel Experience Connect Electrodes Start CPR! Right arrow Analyzing Rhythm, stay clear of the patient כל הזכויות שמורות למד"א מרחב ירושלים Shock not Advised, Check for pulse, If there is no pulse, start CPR. OR Shock Advised, Charging, Signal when ready and await for your consent. You should say loudly: Stand Clear! and push the red button after you made sure that they did. Resume CPR immediately after the shock is delivered! The AED will start a count down from two minutes and will notify you when you should press Analyze again. During those two minutes you do the 30:2 like a crazy monkey.

35 Complications during CPR Death Vomit Use Suction or turn the head to the side if C spine is uncompromised. After cleaning, start again from C כל הזכויות שמורות למד"א מרחב ירושלים No chest rise Re-tilt head, and try again ( Once ). If it still doesn t go in there might be a foreign object in the A.W. Chest Compressions will push that out. Air escapes Maintain good seal and re-tilt the head Abdomen rises Re-tilt head and maintain good seal Laryngospasm

36 CPR for Two כל הזכויות שמורות למד"א מרחב ירושלים In paired CPR, the idea is to decrease the amount of time between each step. In such, partners work together to cover all steps of CPR simultaneously. For example, after AVPU, while one partner checks breathing, the other can start making the 101 call. This eliminates any delay in getting BLS/ALS to the scene. Both partners need to communicate with each other in order to ensure nothing gets forgotten.

37 Vocabulary Pause כל הזכויות שמורות למד"א מרחב ירושלים Consciousness: הכרה (hakarah) Unconscious: מחוסר הכרה (mechoosar hakarah) CPR: החייאה (hachya ah) Breaths: נשימות (neshimot) Pulse: דופק (dofek) Compressions: עסויים (eesooeem) Adult: מבוגר (mevoogar) Child: ילד (yeled) Baby: תינוק (teenok) Vomit: קיא (key) Choking- חנק (chenek)

38 Child CPR כל הזכויות שמורות למד"א מרחב ירושלים Similar to an adult CPR when you are alone, but: Asphyxial Arrest is more common then VF in children and infants. If you are curtain that the cardiac arrest was caused by an asphyxia and you are alone, commence 2 minutes of CPR ( 30:2 ) and only then call for help. In a witnessed arrest call for help immediately When in doubt, CALL FIRST! Use of 1 or 2 hands for compressions Breaths are every 4 seconds for a patient with pulse, monitor pulse ( for no longer then 10 seconds ) and airway.

39 Child CPR Team Resuscitation The Israel Experience כל הזכויות שמורות למד"א מרחב ירושלים Recognize the need in CPR One care taker starts CPR The other activates 101 and fetches the AED if available Upon the return of the second, commence CPR with a ratio of 15:2. Connect and activate the AED as soon as available.

40 Child Chest Compressions Key The Israel Experience כל הזכויות שמורות למד"א מרחב ירושלים Goal: 100 compressions at least per minute Go 4 cm (1.5 ) deep (1/3 chest depth) Allow full chest recoil Avoid Interruptions of compressions Perform CPR on hard surface Position your self so your arms will be at a 90 degree angle to the patient s chest Keep elbows locked, knees on floor, one or both hands on patient Placement of compressions is in the middle of the chest (not the torso) Change compressors every 2 minutes or when asked as quickly as possible. Brocken or dislocated ribs should not bother you.

41 Infant CPR Similar to a child CPR as well, but few changes: כל הזכויות שמורות למד"א מרחב ירושלים in AVPU assessment: Verbal: make a familiar sound to the baby Pain: press your thumbs on the soles of the feet.

42 Infant CPR Assessment of breathing: כל הזכויות שמורות למד"א מרחב ירושלים

then 60 bpm ( 0 included ), Start CPR Alone: 30:2, in a

43 Infant CPR Pulse check: locate the brachial artery Check for pulse for 10 seconds only If pulse is slower then 60 bpm ( 0 included ), Start CPR Alone: 30:2, in a team 15:2 Connect and activate the AED as soon as available.

44 Asphyxial Arrest is more common than VF in children and infants. If you are curtain that the cardiac arrest was caused by an asphyxia and you are alone, commence 2 minutes of CPR ( 30:2 ) and only then call for help. In a witnessed arrest call for help immediately When in doubt, CALL FIRST! Use 2 thumbs on a finger below nipple line for compressions After first set of compression extent the head ( head tilt chin lift ), beware of hyperextension! Supply breaths are every 3 seconds for a patient with pulse above 60 bpm, monitor pulse ( for no longer then 10 seconds, every 2 minutes ) and airway. Lost the pulse Start CPR

45 Infant CPR Team Resuscitation The Israel Experience כל הזכויות שמורות למד"א מרחב ירושלים Recognize the need in CPR One care taker starts CPR The other activates 101 and fetches the AED if available Upon the return of the second, commence CPR with a ratio of 15:2. Connect and activate the AED as soon as available.

46 Infant Chest Compressions Key The Israel Experience כל הזכויות שמורות למד"א מרחב ירושלים Goal: 100 compressions at least per minute Go 3 cm (1.2 ) deep (1/3 chest depth) Allow full chest recoil Avoid Interruptions of compressions Perform CPR on hard surface Use 2 thumbs on a finger below nipple line for compressions Change compressors every 2 minutes or when asked as quickly as possible. Brocken or dislocated ribs should not bother you. They should bother the parents. If they do, you did good enough!

47 Finally, the conclusion But first - כל הזכויות שמורות למד"א מרחב ירושלים

48 Age Call for help Indication for CPR Placement of hands Depth of compressions Rhythm Adult >8y Child >1y,<8y Immediately Unresponsive, Abnormal or non excitant breathing, No definite pulse in the carotid for no more then 10 sec Middle of the chest One third of chest depth At least 100 per minute Infant >28 d,<1y Unresponsive, Discolored, Pulse below 60 in the brachial artery for no more then 10 sec finger below nipple line

49 Compressions done by Two hands Two hands/one hand Two thumbs Lone rescuer CPR ratio 30:2 Team CPR ratio 30:2 15:2 15:2 Airway opening Head tilt Chin lift ( beware of hyperextension ) Form of Mouth to Mouth Mouth to mouth Depends on the size Mouth to nose and mouth Rhythm of Rescue Breaths 1 each 5 sec 1 each 4 sec 1 each 3 sec

https://youtu.be/5r7havfzxek

CPR https://youtu.be/5r7havfzxek CPR Saves Lives Cardiopulmonary Resuscitation or CPR and defibrillation within 3-5 minutes can save over 50% of cardiac arrest victims CPR followed by AED saves thousands