lecture-basic cpr
TRANSCRIPT
8/7/2019 lecture-Basic CPR
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James
Jude Guy Knickerbocker Peter Safar
1962 training video
promoted artificial respiration combined withchest compressions as a key part of
resuscitation following cardiac arrest
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Technique of CPR was originally developed
First effort at testing the technique was
performed on a dog by Redding, Safar and
JW Perason
ABC of resuscitationin 1957
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One is cautioned to onlyperform CPR onunconscious animals to
avoid the risk of being bittenand that animals, depending on species, have a lowerbone density than humans,
causing bones to becomeweakened after CPR isperformed.
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CPR involves chest compressions at a rate of at least 100 per minute in an effort to createartificial circulation by manually pumping
blood through the heart Rescuer may provide breaths by either
exhaling into their mouth or utilizing a device that pushes air into the lungs. The processof externally providing ventilation is termed artificial respiration.
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CPR alone is unlikely to restart the heart; its
main purpose is to restore partial flow of
oxygenated blood to the brain and heart
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CPR may however induce a shockable
rhythm. CPR is generally continued until the
person regains return of spontaneous
circulation (ROSC) or is declared dead.
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CPR is indicated for any person who
is unresponsive with no breathing or only
gasps as breathing as it is most likely that
they are in cardiac arrest. If a person still has
a pulse, but is not breathing (respiratory
arrest), artificial respirations are more
appropriate.
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CVAH-NET In 2010, the American Heart
Association and International Liaison
Committee on Resuscitation updated theirCPR guidelines. The importance of high
quality CPR (sufficient rate and depth
without excessively ventilating) wasemphasized. The order of interventions was
changed for all age groups
except newborns from airway, breathing,
chest compressions (ABC) to chest
compressions, airway, breathing (CAB).
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One rescuer
Adult, child, infant- 30:2
At least 2 rescuers
Child & infant 15:2 preferred
Newborn 3:1 recommended (unless a
cardiac cause is known in which case a 15:2
ratio is reasonable.
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As of 2010 the Resuscitation Council
(UK) still recommends ABC for children.
In adults rescuers should use two hands for
the chest compressions, while in children
they should use one, and with infants two
fingers (index and middle fingers)
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There is no substitute for learning cardiopulmonary
resuscitation (CPR), but emergencies don't wait for training. These instructions are for conventional adultCPR. If you've never been trained in CPR and thevictim collapsed in front of you, use hands-only CPR.
Difficulty: Easy
Time Required: CPR should start as soon as possible
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1. Attempt to wake victim
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2. Begin chest compressions
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3. Begin rescue breathing
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4. Repeat chest compressions
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5. Repeat rescue breaths.
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6. Keep going.
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7. After 2 minutes of chest compressions and
rescue breaths, stop compressions and
recheck victim for breathing.
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8. Repeat the process, checking for breathingevery 2 minutes (5 cycles or so), until helparrives. If the victim wakes up, you can stop
CPR.
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9. Place victim on recovery position
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Chest compressions are extremelyimportant. If you are notcomfortable giving rescue breaths,
still perform chest compressions!It's called Hands Only CPR.
If the victim is breathing, briskly rub
your knuckles against the victim'ssternum. If the victim does not
wake, call 911.
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If the victim wakes up, but is confused or not
able to speak, call 911.
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There is no substitute for proper training.
However, emergencies wait for no one.Use these steps to provide CPR to babies
under 1 year old.
Time Required: As long as it takes
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1. Stay Safe
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2. Try to wake the infant
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If the infant does not wake up, have
someone call 911 immediately. If no one
else is available to call 911 and the baby is
not breathing, continue to step 3 and do CPRfor about 2 minutes before calling 911.
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3. Begin chest compressions
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4. Give the baby two breaths
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5. Keep doing CPR and call 911 after 2 minutes
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Once 911 has been called or you have
someone else calling, keep doing CPR. Don't
stop until help arrives or the baby wakes up.
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6. Place in recovery position
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When checking for breathing, if you're not
sure then assume the baby isn't breathing.
It's much worse to assume a baby is
breathing and not do anything than toassume he or she isn't and start CPR.
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Put a book under the baby's shoulders -- if
you have time -- to help keep his head tilted
back.
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When asking someone else to call 911,
make sure you tell them why they are calling.
If not, they may not tell the 911 dispatcher
exactly what's going on. If the dispatcherknows the baby isn't breathing or
responding, the dispatcher may be able to
give you instructions to help.
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There is no substitute for proper
training. However, emergencies wait forno one. Use these steps to provide CPR to children 1 to 8 years old.
Time Required: As long as it takes
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1. Stay Safe
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2. Try to Wake the Child
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If the child does not wake up, have someone
call 911 immediately. If no one else is
available to call 911 and the child is not
breathing, continue to step 3 and do CPR forabout 2 minutes before calling 911.
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3. Begin chest compressions
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4. Give the child two breaths
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5. Keep doing CPR and call 911 after 2 minutes
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Once 911 has been called or you have
someone else calling, keep doing CPR. Don't
stop until help arrives or the child wakes up.
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6. Place in recovery position
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When checking for breathing, if you're not
sure then assume the child isn't breathing.
It's much worse to assume a kid is breathing
and not do anything than to assume he orshe isn't and start rescue breaths.
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When giving rescue breaths, using a CPR
mask helps with making a proper seal and
keeps vomit out of the rescuer's mouth.
Put a book under the child's shoulders -- if
you have time -- to help keep his or her head
tilted back.
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When asking someone else to call 911,
make sure you tell them why they are calling.
If not, they may not tell the 911 dispatcher
exactly what's going on. If the dispatcherknows a child isn't breathing or responding,
the dispatcher may be able to give you
instructions to help. If you call 911, be calmand listen carefully.
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Choking requires a quick response to
remove the airway obstruction before it
leads to unconsciousness. These stepsare for conscious adults and children
aged 1 to 8.
Difficulty: Easy
Time Required: N/A
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1.Stay Safe!
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2.Establish that the victim is actually choking.Choking victims cannot speak, cough, orbreath.
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3.Stand behind the victim.
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4.Wrap your hands around the victim as
if to give a hug.
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5.Make a fist with your right hand and place
it just above the victim's belly button
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6.Grab your fist with your left and thrust
inwards and upwards forcefully.
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7.Repeat thrusts until the victim is able to breath
again - or until the victim becomes unconscious
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8.If the victim becomes unconscious, begin adultCPR if the victim is over 8 years old and child
CPR if the victim is between 1 and 8 years old.
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Do not slap the victim on the back.
Dislodging the airway obstruction while
the victim is upright will result in a deeper
obstruction (gravity will pull it down).
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There's no substitute for proper training when itcomes to saving an infant from choking.However, emergencies don't wait for training.Follow these steps for a choking infant under 1year old.
Time Required: As long as it takes
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1.Stay Safe
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2.Quickly Assess the Infant
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3.Give 5 Blows to the Back
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4.Give 5 Chest Thrusts
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5.Look in the Baby's Mouth
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When asking someone else to call 911,
make sure you tell them why they are
calling. If not, they may not tell the 911
dispatcher exactly what's going on. If thedispatcher knows the baby isn't breathing
or responding, the dispatcher may be
able to give you instructions to help.
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No more looking, listening and feeling.
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Push a little harder
Push a little faster
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2010 American Heart Association Guidelines forCPR and Emergency Cardiovascular Care
Comparison Chart of Key Changes
EMBARGOED FOR RELEASE
Oct. 18, 12:30 a.m. EST
2010Recommendation
2005Recommendation
Explanation
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Basic Life Support
A change in the basic life
support (BLS) sequenceof steps for trained
rescuers from “A-B-C”
(Airway, Breathing, Chest
compressions) to “C-A-B”
(Chest compressions,
Airway, Breathing) foradults and pediatric
patients
Use of the “A-B-C”
basic life supportsequence.
In the majority of cardiac arrests, the
critical initial elements of CPR are chestcompressions and early
defibrillation.
• In the C-A-B sequence, chest
compressions will be initiated
sooner and ventilation only minimally
delayed until completion of the first cycleof chest compressions.
• The A-B-C sequence could be a reason
why fewer than a third of people in
cardiac arrest receive bystander CPR.
ABC starts with the most difficult
procedures: opening the airway and
delivering rescue breaths.
2010Recommendation
2005 Recommendation Explanation
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“Look, Listen and Feel”
has been removed from
the BLS algorithm.Also applies to BLS for
healthcare providers.
“Look, Listen and Feel”
Included in BLS algorithm
Performance of “Look, Listen and
Feel,” is inconsistent and
time consuming.
A compression rate of at
least 100/min.
A compression rate of
“approximately”100/min.
The number of chest compressions
delivered per minuteduring CPR is an important
determinant of return of
spontaneous circulation (ROSC) and
survival with good
neurologic function. In most studies,
delivery of more compressionsduring resuscitation is associated
with better
survival, and delivery of fewer
compressions is associated with
lower survival.
2010Recommendation
2005 Recommendation Explanation
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If a bystander is not
trained in CPR, the
bystander should provide
Hands-Only™(compression-only)
CPR for the adult victim
who suddenly collapses,
with an emphasis to
“push hard and fast” on
the center of the chest,or follow the directions of
the EMS dispatcher. All
trained lay rescuers
should, at a minimum,
provide chest
compressions for victimsof cardiac arrest. In
addition, if the trained lay
rescuer is able to perform
rescue breaths,
compressions and
breaths should be
The 2005 AHA Guidelines
for
CPR and ECC did not
provide differentrecommendations for
trained versus untrained
rescuers
but did recommend that
dispatchers provide
compression-only CPRinstructions to untrained
bystanders. The 2005
AHA
Guidelines for CPR and
ECC did note that if the
rescuer was unwilling orunable to provide
ventilations, the rescuer
should provide chest
compressions only.
Hands-Only (compression-only) CPR
is easier for an untrained rescuer to
perform and can be more readily
guidedby dispatchers over the telephone.
In addition, survival rates from
cardiac arrests of cardiac etiology
are similar with either Hands-Only
CPR or CPR with both compressions
and rescue breaths. However, for the trained lay rescuer who is able, the
recommendation remains for the
rescuer to perform both
compressions and ventilations
2010 Recommendation 2005Recommendation
Explanation
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The new
recommendation for
chest compression
depth: push down on theadult breastbone at
least 2 inches (5 cm).
Also applies to BLS for
healthcare providers.
Depress adult breastbone
approximately 1 1/2 to 2
inches
(approximately 4 to 5 cm).
Compressions generate critical blood
flow and oxygen and energy delivery
to the heart and brain. Rescuers
often do not push the chest hardenough.
2010Recommendation
2005Recommendation
Explanation
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Pediatric Basic Life
Support
Initiate CPR for infants
and children with chest
compressions rather than
rescue breaths (C-A-B
rather than A-B-C). CPR
should begin with 30
compressions (any lone
rescuer) or 15
compressions (for
resuscitation of infants
and children by two
healthcare providers)
rather than with twoventilations.
Cardiopulmonary
resuscitation was
initiated with opening of
the airway and the
provision of 2 breaths
before chest
compressions.
This proposed major change in CPR
sequencing to compressions before
ventilations (C-A-B) led to vigorous
debate among experts in pediatric
resuscitation. Because most pediatric
cardiac arrests are asphyxial, rather
than sudden primary cardiac arrests,
both intuition and clinical data
support the need for ventilations and
compressions for pediatric CPR.
2010Recommendation
2005Recommendation
Explanation
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To achieve effective chest
compressions, rescuers
should compress at least
one third of the anterior
posterior diameter of the
chest. This corresponds
to approximately 1-1.5
inches (about 4 cm) in
most infants and about 2
inches (5 cm) in most
children.
Push with sufficient
force to depress the
chest approximately one
third to one half the
anterior posterior
diameter of the chest.
Evidence from radiologic studies of
the chest in children
suggests that compression to one half
the anterior-posterior
diameter may not be achievable.
However, effective chest
compressions require pushing hard,
and based on new data,
the depth of about 1 . inches (4 cm)
for most infants and
about 2 inches (5 cm) in most
children is recommended.
2010Recommendation
2005 Recommendation Explanation
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For infants, a manual
defibrillator is preferred
to an AED fordefibrillation. If a manual
defibrillator is
not available, an AED
equipped with a pediatric
dose attenuator is
preferred. If neither is
available,
an AED without a
pediatric dose attenuator
may be
used.
Data have shown that
AEDs can be used safely
and effectively inchildren 1 to 8 years of
age. However, there are
insufficient data to make
a recommendation for or
against using an AED in
infants < 1 year of age.
Newer case reports suggest that an
AED may be safe and
effective in infants. Because survivalrequires defibrillation
when a shockable rhythm is present
during cardiac arrest,
delivery of a high-dose shock is
preferable to no shock.
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