American Heart Association Health Care Provider CPR 2010 Curriculum 1
CPR Overview Compressions are most important part of CPR Push hard and fast Minimize interruptions CAB Assessment Circulation Airway Breathing Ventilation Avoid Hyperventilation Research over the past five years has shown that compressions seem to be the very important part of CPR. This is why you will see the increased focus on compressions and why we now will begin compressions before other steps in CPR. There has also been continued proof that hyperventilation decreases the patient s chances of survival. Below are more interesting facts about CPR and Cardiac Arrest. Sudden Cardiac Arrest EMS treats nearly 300,000 victims of out-of-hospital cardiac arrest each year in the U.S. Less than eight percent of people who suffer cardiac arrest outside the hospital survive. Sudden cardiac arrest can happen to anyone at any time. Many victims appear healthy with no known heart disease or other risk factors. Sudden cardiac arrest is not the same as a heart attack. Sudden cardiac arrest occurs when electrical impulses in the heart become rapid or chaotic, which causes the heart to suddenly stop beating. A heart attack occurs when the blood supply to part of the heart muscle is blocked. A heart attack may cause cardiac arrest. Cardiopulmonary Resuscitation (CPR) Less than one-third of out-of-hospital sudden cardiac arrest victims receive bystander CPR. Effective bystander CPR, provided immediately after sudden cardiac arrest, can double or triple a victim s chance of survival. The most effective rate for chest compressions is 100 compressions per minute the same rhythm as the beat of the BeeGee s song, Stayin Alive. 2
Adult A strong Chain of Survival can improve chances of survival and recovery for victims of heart attack, stroke and other emergencies. The Links in the Chain of Survival Recognize an emergency. Call a code or 9-1-1! Begin Cardiopulmonary Resuscitation (CPR). Use an AED Because many cardiac arrests in adults are coronary in origin, the Chain of Survival is to check the adult for responsiveness, if unresponsive, leave the adult and call 911 and then return to provide care. The reasoning for this is to get both the AED and advanced care on the way as soon as possible. Defibrillation works well in the early stages of an arrest, but it s effectiveness decreases over time. 3
Adult CPR Assessment will be done in the following order 1. Rub the patient s sternum and shout, Hey, hey are you okay? 2. Send someone to call a code or 911. If you are all alone, leave an adult and call for help. 3. Place one hand on the forehead and try to locate a pulse on the side closest to you with your other hand. 4. Assess for a pulse for five to ten seconds. 5. If there is no pulse, begin chest compressions. -place the heel of your hand in the middle of his chest. Put your other hand on top of the first with your fingers interlaced. Compress the chest at least 2 inches (4-5 cm). Allow the chest to completely recoil before the next compression. Compress the chest at a rate of at least 100 pushes per minute. Perform 30 compressions at this rate (should take you about 18 seconds). 6. If there is a second rescuer, they should prepare the airway equipment and the mask or bag for use. -After 30 compressions, open the victim's airway using the head-tilt, chin-lift method. Using the mask or bag, deliver one breath, over one second, just until you see the chest rise. Allow the breath to exhale. Deliver a second breath the same way. 7. Continue at a compression to ventilation ratio of 30:2. Try to do this five times in two minutes. 8. Switch compressors every two minutes. 9. Use the AED as soon as it arrives, remembering to not interrupt compressions until the AED is analyzing. 10. Resume CPR as soon as a shock has been delivered. 11. Continue CPR until the victim begins to breath on their own or starts to move. 12. Transfer care to the next level. 4
AED Use the Automated External Defibrillator (AED) to Treat Ventricular Fibrillation. Many sudden cardiac arrest victims are in ventricular fibrillation (VF). VF is an abnormal, chaotic heart rhythm that prevents the heart from pumping blood. You must defibrillate a victim immediately to stop VF and allow a normal heart rhythm to resume. The sooner you provide defibrillation with the AED, the better the victim's chances of survival. Several studies have documented the effects of time to defibrillation and the effects of bystander CPR on survival from SCA. For every minute that passes between collapse and defibrillation, survival rates from witnessed VF SCA decrease 7 to 10 percent if no CPR is provided. When bystander CPR is provided, the decrease in survival rates is more gradual and averages 3 to 4 percent per minute from collapse to defibrillation. CPR can double or triple survival from witnessed SCA at most intervals to defibrillation. There are many different types of AEDs on the market, but all work in a similar fashion. 1. Open the cover if needed and turn the AED on. 2. Place the patches on the victims bare skin as shown on the patches. 3. Follow the prompts of the AED. 4. Make sure that no one is touching the patient while the AED analyzes. Interruption may cause the patient to not receive the badly needed shock. 5. If a shock is indicted, clear the patient both visually and by sweeping your hand the length of the patient's body. When the machine indicates readiness, deliver the shock. 6. Continue CPR and AED use until patient becomes responsive or more help arrives. 7. Begin compressions as soon as the shock has been delivered and it is safe to touch the patient. The adult AED patches can be used on any patient in cardiac arrest. Due to the patient's size, you may have to use a front and back placement to make the patches fit. If pediatric patches are available, use them only on pediatric patients. The energy used in pediatric patches does not have enough energy to convert an adult in cardiac arrest. Some common concerns when using an AED include the following: If your patient is wet, they may need to have their chest dried before the patches will stick well. Dry their chest quickly, as it does not need to be totally dry for the patches to stick. Do not defibrillate it standing water as the energy may travel. Move the patient to a dry area and then deliver the shock. It is fine to defibrillate on ice. Medication patches should be removed with a gloved hand. The area where the patch was should be wiped with a towel. If a patient has a pacemaker or internal defibrillator, you may use an AED on them if they are in cardiac arrest. Try to avoid placing the patches directly over the implanted device. 5
Child and Infant Chain of Survival Because the causes of pediatric cardiac arrest are commonly traumatic in origin, the Chain of Survival for children starts with prevention, followed by early CPR and early 911. The last link in the Pediatric Chain of Survival is early advanced care. The order of care for pediatric patients is check for responsiveness, provide two minutes of care if you are all alone and then leave the child to call 911. Many of these steps may often be done simultaneously. 6
Child CPR Assessment of a child who you suspect to be in cardiac arrest should be done in the following order 1. Rub the patient s sternum and shout, Hey, hey are you okay? 2. Send someone to call a code or 911. If you are all alone, you will need to provide two minutes of care or five cycles of CPR before leaving the child. 3. Place one hand on the forehead and try to locate a pulse on the side closest to you with your other hand. 4. Assess for a pulse for five to ten seconds. 5. If there is no pulse, begin chest compressions. -You may use one or two hands to perform compressions. Place the heel of your hand in the middle of his chest. Put your other hand on top of the first with your fingers interlaced. Compress the chest one third to one half of the depth of the child s chest. Allow the chest to completely recoil before the next compression. Compress the chest at a rate of at least 100 pushes per minute. Perform 30 compressions at this rate (should take you about 18 seconds) if you are all alone, or 15 compressions if there are two or more rescuers. 6. If there is a second rescuer, they should prepare the airway equipment and the mask or bag for use. -After 30 compressions, open the victim's airway using the head-tilt, chin-lift method. Using the mask or bag, deliver one breath, over one second, just until you see the chest rise. Allow the breath to exhale. Deliver a second breath the same way. 7. Continue at a compression to ventilation ratio of 30:2 for one rescuer and 15:2 for two rescuers. 8. If after 2 minutes you are still alone, leave the child to call 911. 9. Switch compressors every two minutes if possible. 10. Use the AED as soon as it arrives, remembering to not interrupt compressions until the AED is analyzing. 11. Resume CPR as soon as a shock has been delivered. 12. Continue CPR until the victim begins to breath on their own or starts to move. 13. Transfer care to the next level. 7
Infant CPR A. Two thumbs technique for two rescuers B. Single rescuer finger placement Assessment of a infant who you suspect to be in cardiac arrest should be done in the following order; 1. Tap the infant s foot and shout, Baby, baby are you okay? 2. Send someone to call a code or 911. If you are all alone outside of the hospital, you will need to provide two minutes of care or five cycles of CPR before leaving the infant. 3. Try to locate a brachial pulse on the inside of the upper arm with two fingers of one hand. 4. Assess for a pulse for five to ten seconds. 5. If there is no pulse, begin chest compressions. -Place 2 fingers on the breastbone -- just below the nipples. Make sure not to press at the very end of the breastbone. Press down on the infant's chest so that it compresses about 1/3 to 1/2 the depth of the chest. Give 30 chest compressions. Each time, let the chest rise completely. These compressions should be FAST and hard with no pausing. Count the 30 compressions quickly. This is the preferred technique for one rescuer infant CPR -If there is a second rescuer, they should prepare the airway equipment and the mask or bag for use. -After 30 compressions for one rescuer or 15 compressions for two rescuers, open the victim's airway using the head-tilt, chin-lift method. With an infant, open the airway only to a sniffing position. Using the mask or bag, deliver one breath, over one second, just until you see the chest rise. Allow the breath to exhale. Deliver a second breath the same way. 1. Continue at a compression to ventilation ratio of 30:2 for one rescuer and 15:2 for two rescuers. 2. If after 2 minutes you are still alone, outside of the hospital, leave the infant to call 911. 3. Switch compressors every two minutes if possible. 4. Use the AED as soon as it arrives, remembering to not interrupt compressions until the AED is analyzing. 5. Resume CPR as soon as a shock has been delivered. 6. Continue CPR until the victim begins to breath on their own or starts to move. 7. Transfer care to the next level. 8
Choking Adult and Child Heimlich maneuver for an adult or child older than age 1 A person who is choking cannot talk, cough, or breathe, and may turn blue or dusky. The Heimlich maneuver can help dislodge the food or object. WARNING: Do not begin the choking rescue procedure unless you are certain that the person is choking. Stand behind the person and wrap your arms around his or her waist. If the person is standing, place one of your feet between his or her legs so you can support the person's body if he or she loses consciousness. Make a fist with one hand. Place the thumb side of your fist against the person's abdomen, just above the navel but well below the sternum. See picture A below. Grasp your fist with the other hand. Give a quick upward thrust into the abdomen. This may cause the object to pop out. Use less force for a child. Repeat thrusts until the object pops out or the person loses consciousness. 9
Choking Infant If you suspect that an infant is choking, quickly assess the infant If the baby can't cough or cry, then he or she is probably choking. Have someone else call 911, and go to step 3. If no one is available to call 911, go to step 3 and try to help the baby for 2 minutes before stopping to call 911 yourself. If you think the baby is having an allergic reaction rather than choking on something, call 911 immediately. If the baby is able to cough or cry, then he or she is able to breathe. Call 911 and watch the baby closely. If the baby suddenly stops coughing or crying and can't seem to breathe, go to step 3. Give 5 blows to the back Lay the baby face-down on your arm. Hold the baby's head with your hand to keep his or her neck straight. The baby's legs should be straddling your arm near the elbow. Lean the baby down at an angle. The infant's head should be lower than his or her waist. With the heal of your other hand, strike the baby between the shoulder blades 5 times. Give 5 chest thrusts Roll the baby from one arm to the other so that he or she is now laying face up. Keep the head cradled in your hand and the legs straddling your arm. Hold the baby at an angle with his or her head low and give 5 chest thrusts. Use two fingers on the breast bone right between the nipples. Push down about an inch 5 times. Repeat back blows and chest thrusts until the child can cough, cry or breathe. If the infant goes unresponsive, lay the infant on a hard flat surface and begin the steps of CPR. When you reach the step of giving a breath, look in the mouth before giving a breath. Sweep only if you see an object. When the infant goes unresponsive, the infant may relax and the object move down the esophagus. 10
Summary Agonial breathing Modified jaw thrust Pain associated with cardiac arrest 11