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CPRCPRCardiopulmonary ResuscitationCardiopulmonary Resuscitation

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Definition of CardiopulmonaryDefinition of Cardiopulmonary

resuscitationresuscitation Cardiopulmonaryresuscitation:Cardiopulmonaryresuscitation: TheThe

emergency substitution ofheart and lungemergency substitution ofheart and lung

action to restore life to someone whoaction to restore life to someone whoappears dead.appears dead.

The two main components ofThe two main components ofcardiopulmonary resuscitation (CPR) are:cardiopulmonary resuscitation (CPR) are:1.1. chest compressionchest compression to make the heartto make the heartpump.pump.

2. mouth2. mouth--toto--mouthmouthventilationventilation to breathto breath

for the victim.for the victim.

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In the event of an earlyIn the event of an early heart attackheart attack, death, death

can often be avoided if a bystander startscan often be avoided if a bystander startsCPR promptly (withinCPR promptly (within 5 minutes5 minutes of the onsetof the onsetof ventricular fibrillation).of ventricular fibrillation).

When paramedics arrive, medications and/orW

hen paramedics arrive, medications and/orelectrical shock (cardioversion) to the heartelectrical shock (cardioversion) to the heart

can be administered to convert ventricularcan be administered to convert ventricularfibrillation to a normal heart rhythm.fibrillation to a normal heart rhythm.

Therefore, prompt CPR and rapid paramedicTherefore, prompt CPR and rapid paramedicresponse can improve the chances ofresponse can improve the chances ofsurvival from a heart attack.survival from a heart attack.

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What is a heart attack?What is a heart attack?A heart attack (also known as a myocardial infarction) isA heart attack (also known as a myocardial infarction) is

the death of heart muscle from the sudden blockage ofthe death of heart muscle from the sudden blockage ofa coronaryartery bya blood clot. Coronaryarteries area coronaryartery bya blood clot. Coronaryarteries areblood vessels that supply the heart muscle with bloodblood vessels that supply the heart muscle with bloodand oxygen.and oxygen.

Blockage of a coronaryarterydeprives the heart muscleBlockage of a coronaryarterydeprives the heart muscleof bloodand oxygen, causing injury to the heartof bloodand oxygen, causing injury to the heartmuscle.muscle.

Injury to the heart muscle causes chest pain andInjury to the heart muscle causes chest pain and

pressure.pressure.

If blood flow is not restored withinIf blood flow is not restored within 20 to 40 minutes20 to 40 minutes,,irreversible death of the heart muscle will begin toirreversible death of the heart muscle will begin tooccur. Muscle continues to die foroccur. Muscle continues to die for66--8 hours8 hours at whichat whichtime the heart attack usually is "complete." The deadtime the heart attack usually is "complete." The deadheart muscle is replaced by scar tissue.heart muscle is replaced by scar tissue.

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POINTS OFCPR:POINTS OFCPR:

Artificial ventilation

+

External Chest Compressions

To oxygenate andcirculate

blood when thepatient is in arrest

Depressing the sternumcauses enough blood toflow to sustain life fora

short period of time

nly effective for a short period oftime:

1. Cannot sustain life indefinitely2. Must be started as early as possible3. Effectiveness decreases the longer

you doing CPR4. Some cases defibrillated needed

5. CPR increases the amount of timethat defibrillation will be effective

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CPR produce a pumping activity only 25CPR produce a pumping activity only 25--39% as effective as the action of a normal39% as effective as the action of a normalheart.heart.

Thus, 90Thus, 90-- 100% oxygen should be100% oxygen should bedelivered to all patients who havedelivered to all patients who havesustained a cardiac arrest, as soon assustained a cardiac arrest, as soon aspossible.possible.

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CPR InterruptionCPR Interruption

CPR should not be interrupted forCPR should not be interrupted formore thanmore than 5 seconds.5 seconds.

Unless, it is necessary to move theUnless, it is necessary to move thepatients up ordown a stairway.patients up ordown a stairway.

Such interruptions should not exceedSuch interruptions should not exceed

15 seconds!15 seconds!

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CPRComplicationsCPRComplications

FracturedribsFracturedribs

Fractured sternumFractured sternum

Lacerations of the liver, spleen, lungLacerations of the liver, spleen, lungor heartor heart

Damage to the pleuraresulting fromDamage to the pleuraresulting from

broken ribsbroken ribs

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Beginningand TerminatingCPRBeginningand TerminatingCPR

CPR is not indicated fora patientCPR is not indicated fora patient

known to be in the terminal stages ofknown to be in the terminal stages ofan incurable condition, if sign DNRan incurable condition, if sign DNR

orders are present.orders are present.

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Once started, CPR should be terminatedOnce started, CPR should be terminated

only when one of the following occurs:only when one of the following occurs:1.1. The patients heart resume normal beatingThe patients heart resume normal beating

2.2. A physician/ other properly trained personA physician/ other properly trained person

assumes responsibility for the patientassumes responsibility for the patient3.3. The rescuer is exhausted and unable toThe rescuer is exhausted and unable to

continuecontinue

4.4. The patient is pronounced dead by theThe patient is pronounced dead by thephysician, coroner or other individual withphysician, coroner or other individual withthe legal authority to do so.the legal authority to do so.

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AEDAED

AEDs, or automated external defibrillators, areAEDs, or automated external defibrillators, arecomputerized devices that can help preventcomputerized devices that can help preventdeath due to sudden cardiac arrest.death due to sudden cardiac arrest.

These devices monitor the heart rhythm andThese devices monitor the heart rhythm andcan, if need be, deliver an electric shock to thecan, if need be, deliver an electric shock to thechest wall much like a traditional (paddle)chest wall much like a traditional (paddle)defibrillator in a hospital.defibrillator in a hospital.

AEDs are now carried on commercial aircraft andAEDs are now carried on commercial aircraft andare becoming increasingly available at variousare becoming increasingly available at variouslocations in the community.locations in the community.

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The most common cause ofThe most common cause ofsudden cardiacsudden cardiac

deathdeath is anis an arrhythmiaarrhythmia of the heart. Arrhythmiasof the heart. Arrhythmiasare abnormalities of the heartbeat (severe heartare abnormalities of the heartbeat (severe heartattacks can also lead to cardiac arrhythmias andattacks can also lead to cardiac arrhythmias andsudden death).sudden death).

The arrhythmia that most often causes suddenThe arrhythmia that most often causes suddencardiac death is ventricular fibrillation. Itcardiac death is ventricular fibrillation. Itprevents the heart from pumping blood andprevents the heart from pumping blood anddeprives the body of oxygen. The only way todeprives the body of oxygen. The only way to

reversereverse ventricular fibrillationventricular fibrillation isis defibrillationdefibrillation ----the delivery of an electrical impulse to the heartthe delivery of an electrical impulse to the heartto restore its normal rhythm.to restore its normal rhythm.

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AEDsAEDs are notare not a substitute for CPRa substitute for CPR

Who?Who?Anyone trained tooperate anAED must beAnyone trained tooperate anAED must betrained inCPR, since early CPR is a critical step intrained inCPR, since early CPR is a critical step inresuscitation tohelp reestablish the circulationofresuscitation tohelp reestablish the circulationof

blood and the delivery ofoxygen to the body.blood and the delivery ofoxygen to the body.AEDs may alsoprompt the rescuer to continueAEDs may alsopromptthe rescuer to continueCPR while it is analyzing the heartbeatoftheCPR while it is analyzing the heartbeatofthepatient.patient.

CPR is alsono substitute forAED. Even if CPR isCPR is alsono substitute forAED. Even if CPR isgiven, studies have shownthatgiven, studies have shownthatsurvival decreasessurvival decreases77--10% foreach minute10% foreach minute of waiting time beforeof waiting time beforedefibrillation is carried out.defibrillation is carried out.

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How AEDs work?How AEDs work?

If you are qualified in CPR, and to use an AED, theIf you are qualified in CPR, and to use an AED, therescuer first should check the victim of a suddenrescuer first should check the victim of a suddencardiac arrest for unresponsiveness. If the victim iscardiac arrest for unresponsiveness. If the victim isnot breathing or breathing is abnormal, the rescuernot breathing or breathing is abnormal, the rescuershould start CPR, check for a pulse and, if there isshould start CPR, check for a pulse and, if there is

no pulse, turn on the AED. A second rescuer shouldno pulse, turn on the AED. A second rescuer shouldcontinue CPR until the AED is attached.continue CPR until the AED is attached.

An AED has patches (electrode pads) that areAn AED has patches (electrode pads) that are

applied to a victims chest.

The patc

hes areapplied to a victims c

hest.

The patc

hes areconnected to a computerized monitoring deviceconnected to a computerized monitoring device

capable of delivering an electric current. There arecapable of delivering an electric current. There aredifferent brands of AEDs but all of them operate indifferent brands of AEDs but all of them operate inthe same basic way.the same basic way.

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After the patches are applied to the victimsAfter the patches are applied to the victims

chest, the device records and evaluates thechest, the device records and evaluates theheart rhythm. It directs the rescuer, ifheart rhythm. It directs the rescuer, ifnecessary, to stand clear and deliver electricnecessary, to stand clear and deliver electricimpulses by pushing a shock button onimpulses by pushing a shock button on

the unit.the unit.

The rescuer only needs to follow theThe rescuer only needs to follow the

instructions delivered by the device. AEDsinstructions delivered by the device. AEDsuse verbal prompts, lights, and/or textuse verbal prompts, lights, and/or textmessages to deliver instructions to themessages to deliver instructions to therescuer.rescuer.

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AEDs allow defibrillation to be done withoutAEDs allow defibrillation to be done without

having to transport a victim to a hospital.having to transport a victim to a hospital. Lay persons with a few hours of training canLay persons with a few hours of training can

safely operate an automated externalsafely operate an automated externaldefibrillator.defibrillator.

The American Heart Association supportsThe American Heart Association supportsplacement of AEDs in areas where large groupsplacement of AEDs in areas where large groupsof people gather or where emergency responseof people gather or where emergency responsetimes may be slowed.times may be slowed.

Office complexes, shopping malls, and sportsOffice complexes, shopping malls, and sportsarenas are examples of venues where AEDs canarenas are examples of venues where AEDs cansave critical minutes of emergency responsesave critical minutes of emergency responsetime.time.

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1. Check forresponsiveness. Shake or tap the person gently. See if the

person moves or makes a noise. Shout, "Are you OK?"2. Call 911 if there is no response. Shout for help and send someone to

call 911. If you are alone, call 911 even if you have to leave theperson.

3. Carefully place the person on his or her back. If there is a chance theperson has a spinal injury, two people are needed to move the person

without twisting the headand neck.4. Open the airway. Lift up the chin with 2 fingers. At the same time,

push down on the forehead with the other hand.5. Look, listen, and feel for breathing. Place your ear close to the

person's mouth and nose. Watch for chest movement. Feel for breathon your cheek.

6. If the person is not breathing:- Cover the person's mouth tightly with your mouth- Pinch the nose closed- Keep the chin liftedand head tilted- Give 2 slow, full breaths

ADULT CPR

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7. If the chest does NOT rise, try the chin lift-head tilt again, andgive 2 more breaths. Ifthe chest still doesn't rise, check to see ifsomething is blocking the airwayand try to

remove it.

8. Look for signs of circulation -- normalbreathing, coughing, or movement. If thesesigns are absent, begin chest compressions.

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9. Perform chest compressions:-Place the heel of one hand on the breastbone -- right between

the nipples.-Place the heel of your other hand on top of the first hand.-Position your bodydirectly overyour hands. Your shoulders

should be in line with your hands. DO NOT lean back orforward. As you gaze down, you should be lookingdirectlydown on your hands.

-Give 30 chest compressions. Each time, press down about 2inches into the chest. These compressions should be FAST andhard with no pausing. Count the 30 compressions quickly:"1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30, off."

10. Give the person 2 slow, full breaths. The chest shouldrise.11. Continue cycles of 30 chest compressions followed by 2 slow,full breaths.

12. Afterabout 2 minute (four cycles of 30 compressions and 2breaths), re-check for signs of circulation.

13. Repeat steps 11 and 12 until the person recovers or help

arrives.

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DO NOT !!!

If aspinal injury is suspected, DO NOT tilt the headback when attempting to open the airway. Instead,place your fingers on the jaw on each side of thehead. Lift the jaw forward. This keeps the headandneck from moving.

If the person has signs of circulation -- normalbreathing, coughing, or movement -- DO NOT beginchest compressions. Doing so may cause the heartto stop beating.

Unless you are a health professional, DO NOT checkfora pulse. Onlyahealthcare professional isproperly trained to check fora pulse.

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1. Steps for unresponsive infants (

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6. Cycle consists of 30 compressions (1 rescuer) or 15 compressions

(2rescuers) per 2 breaths. Ideal ratio unknown, but previouslyrecommended 5:1 ratio resulted in less than 60compressions/minute.

7. If rescuer unable to ventilate patient, chest compressions aloneare recommended vs no resuscitation.

8. Changingrescuer every 2 minutes will maintain goodcompressions (forceful, fast, full chest recoil, minimalinterruptions).

9. For severe foreign bodyairway obstruction, perform

subdiaphragmatic abdominal thrusts (child) or 5 back blowsalternating with 5 chest thrusts (infant).

10. Fordrowning victims, ventilation, but not compressions, can bestarted in the water if it does not prolongremoval from water.

CHILDREN CPR

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Cardiac Arrest Symptoms and CausesCardiac Arrest Symptoms and Causes

Medical Author:Medical Author: Melissa Conrad Stppler, MDMelissa Conrad Stppler, MDMedical Editor:Medical Editor: Dennis Lee, MDDennis Lee, MD

Cardiac arrestCardiac arrestis the sudden loss of cardiac function, when the heart abruptly stops beating. Ais the sudden loss of cardiac function, when the heart abruptly stops beating. Aperson whose hearthas stopped will lose consciousness and stop normal breathing, and theirperson whose hearthas stopped will lose consciousness and stop normal breathing, and theirpulsepulse andand blood pressureblood pressure will be absent. Unless resuscitative efforts are begun immediately,will be absent. Unless resuscitative efforts are begun immediately,cardiac arrest leads to death within a few minutes. This is often referred to by doctors as suddencardiac arrest leads to death within a few minutes. This is often referred to by doctors as suddendeath or sudden cardiac death (SCD).death or sudden cardiac death (SCD).

Ventricular fibrillationVentricular fibrillation is the most common cause of cardiac arrest. Ventricular fibrillation occursis the most common cause of cardiac arrest. Ventricular fibrillation occurswhen the normal, regular, electrical activation ofheart muscle contraction is replaced by chaoticwhen the normal, regular, electrical activation ofheart muscle contraction is replaced by chaoticelectrical activity that causes the heart to stop beating and pumping blood to the brain and otherelectrical activity that causes the heart to stop beating and pumping blood to the brain and otherparts of the body. Permanent brain damage and death can occur unless the flow of blood to theparts of the body. Permanent brain damage and death can occur unless the flow of blood to thebrain is restored within five minutes.brain is restored within five minutes. Heart attackHeart attack is the most common cause of ventricularis the most common cause of ventricularfibrillation. Less common causes of cardiac arrest include respiratory arrest (loss of breathingfibrillation. Less common causes of cardiac arrest include respiratory arrest (loss of breathingfunction),function), chokingchoking,, traumatrauma, electrocution, and drowning., electrocution, and drowning.

EarlyEarly cardiopulmonary resuscitationcardiopulmonary resuscitation (CPR) and(CPR) and defibrillationdefibrillation (electrical impulses delivered to the(electrical impulses delivered to thechest to restore normal heart rhythm) are the only way to reverse a cardiac arrest. Thesechest to restore normal heart rhythm) are the only way to reverse a cardiac arrest. Theselifesaving measures must be instituted within a few minutes after cardiac arrest in order to havelifesaving measures must be instituted within a few minutes after cardiac arrest in order to have

any chance of success. For every minute t

hat passes wit

hout defibrillation, a persons c

hances ofany c

hance of success. For every minute t

hat passes wit

hout defibrillation, a persons c

hances ofsurvival decrease by seven to ten per cent. In areas where emergency medical services are ablesurvival decrease by seven to ten per cent. In areas where emergency medical services are able

to provide defibrillation within five to seven minutes, the survival rate for cardiac arresthas beento provide defibrillation within five to seven minutes, the survival rate for cardiac arresthas beenreported to be as high as 49%. It is rare for areported to be as high as 49%. It is rare for a resuscitationresuscitation to be successful if more than tento be successful if more than tenminutes have elapsed following a cardiac arrest.minutes have elapsed following a cardiac arrest.

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Guidelines Suggest WhenGuidelines Suggest WhenResuscitation Works forCardiacResuscitation Works forCardiac

ArrestArrest Guidelines to help emergencyGuidelines to help emergency--medical techniciansmedical technicians

(EMTs) decide whether or not to end(EMTs) decide whether or not to end resuscitationresuscitation

efforts for patientshavingefforts for patients

having cardiac arrestcardiac arrestoutside of aoutside of ahospital have been devised by Canadian researchers.hospital have been devised by Canadian researchers.

The guidelines, published in the Aug. 3 issue of theThe guidelines, published in the Aug. 3 issue of the NewNewEngland Journal of MedicineEngland Journal of Medicine, aren't the final word, said, aren't the final word, saidDr. Jose Martinez, assistant professor of clinical medicineDr. Jose Martinez, assistant professor of clinical medicine

at the University of Miami Miller School of Medicine. "Asat the University of Miami Miller School of Medicine. "Astechnical and medical knowledge evolve, we aretechnical and medical knowledge evolve, we aremodifying guidelines on how to proceed," he said. "Thismodifying guidelines on how to proceed," he said. "Thisadds a bit more to our armamentarium."adds a bit more to our armamentarium."

Practically speaking, guidelines depend on a number ofPractically speaking, guidelines depend on a number of

factors, including cost and geographic region.factors, including cost and geographic region.