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CPR procedure, CPR guidelines, basic CPR, compression rate CPR, CPR first aid
} Cardiopulmonary resuscitation was originally
conceived to save the lives of patients dying unexpectedly – ‘hearts too young
to die’.
} A DNAR decision should be considered when the
patient:
• does not wish to
have CPR, or
• will not survive
cardiac arrest even if CPR is attempted.
} Adult Basic Life Support
} Basic life support implies that no equipment is
employed other than a protective device.
} Guideline changes
} 1)
Make a diagnosis of cardiac arrest if a victim is unresponsive and not
breathing normally.
} 2) Place hands in the centre of the chest,
rather than ‘rib margin’ method.
} 3)
Give each rescue breath over 1 sec rather than 2 sec.
} 4)
Use a ratio of compressions to ventilations of 30:2 for all adult victims of
sudden cardiac arrest. Use this same ratio for children when attended by a lay
rescuer.
} 5)
For an adult victim, omit the initial 2 rescue breaths and give 30 compressions
immediately after cardiac arrest is established.
} Adult BLS sequence:
} 1
Make sure the victim, any bystanders, and you are safe.
} 2
Check the victim for a response.
} Gently shake and ask ‘Are you all right?’
} 3 A
If he responds:
} Leave him in the position in which you find him
provided there is no further danger.
} get help
} 3 B
If he does not respond:
Shout for help.
Turn
the victim onto his back and then open the airway using head tilt and chin lift
} 4
Keeping the airway open, look, listen, and feel for normal breathing.
} Look for chest movement.
} Listen for breath sounds.
} Feel for air on your cheek.
} Look, listen, and feel for no more than 10 sec to
determine if the victim is breathing normal
} 5 B
If he is not breathing normally:
} call for
ambulance ,
} Start chest compression
} Continue with chest compressions and rescue breaths
in a ratio of 30:2.
} Stop to recheck the victim only if he starts
breathing normally;
} Otherwise do not interrupt resuscitation.
} Continue resuscitation until:
• Qualified help
arrives and takes over,
• The victim starts
breathing normally, or
• You become
exhausted.
} The use of Automated External Defibrillators
} Electrical defibrillation is well established as the
only effective therapy for cardiac arrest caused by VF or pulse less
ventricular tachycardia (VT).
} The main guideline changes are:
} 1)
Place the axillary electrode pad vertically to improve efficiency.
} 2)
If possible, continue CPR whilst the pads are being applied.
} 3)
Program AEDs to deliver a single shock followed by a pause of 2 min for the immediate resumption of CPR
} Types of AEDs
} AEDs are sophisticated, reliable, safe, computerized
devices that deliver defibrillator shocks to victims of cardiac arrest.
} There are two types of AED: semi-automatic,
And
fully-automatic AEDs. All AEDs analyze the victim’s rhythm, determine the need
for a shock, and then deliver a shock.
} Sequence of actions when using an AED
} 1
Make sure the victim, any bystanders, and you are safe.
} 2
If the victim is unresponsive and not breathing normally:
} •
Send for AED and call for an ambulance
} 3
Start CPR according to the guidelines for BLS.
} 4
As soon as the AED arrives:
} •
Switch on the AED and attach the electrode pads. Continue CPR whilst this is done. (Some AEDs
may automatically switch on when the AED lid is opened).
• Ensure that nobody
touches the victim whilst the AED is analyzing the rhythm.
} 5 A
If a shock is indicated:
• Ensure that nobody
touches the victim.
• Push the shock
button as directed.
(Fully-automatic
AEDs will deliver the shock automatically).
} 5 B
If no shock is indicated:
• CPR using a ratio
of 30 compressions to 2rescue breaths.
} Placement of AED pads
} Expose the chest.
} Place one AED pad to the right of the sternum, below
the clavicle.
} Place the
other pad in the mid-axillary line, approximately level with the V6 ECG
electrode
} Place the mid-axillary pad with its long axis vertical.
} Although most AED pads are labelled left and right,
or carry a picture of their correct placement, it does not matter if they are
reversed. It is important to teach that
if an ‘error’ is made, the pads should not be removed and replaced as this
wastes time and they may well not adhere adequately when re-attached.
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