CPR and AED

Basic Pre-Hospital Emergency Care Training Project

Basic Life Support Adult CPR and AED Reminders and a Summary of changes for ACTIVE volunteers
8: Patient Assessment

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Outline
Introduction BLSD Sequence Reminders and changes BLSD Sequence Flowchart Automatic External Defibrillators (For stations NOT using an AED yet) Special situations

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References

Major changes in 2005 Sequence changes in November 2010 Priority to Chest Compressions
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BLS AED and survival link

Time is Critical!

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BLSD sequence

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Steps to perform BLSD

Scene safety Responsiveness Positioning the patient Circulation Airway Breathing Defibrillation
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Steps to perform BLSD 2011

Scene safety: BSI, bystanders Responsiveness: does the patient MOVE, TALK, or Respond in
any way? Does he appear to be breathing?

Positioning the patient: on back on a hard surface Circulation: start compressions as soon as possible Airway: checked after first 30 compressions or by second
rescuer

Breathing: slow breaths that make the chest rise, dont

hyperventilate

Defibrillation: as soon as AED is ready

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Assess Circulation

Feel for palpable pulse in the carotid artery (5 to 10 sec) Check on ONE side If in doubt, and patient is NOT responsive, start CPR

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Chest Compressions

If no pulse or in doubt start chest compressions: Hands in center of chest Begins chest compressions as soon as possible: Ratio of 30 compressions to 2 breaths Rate of compression: at least

100/min Depth of at least 5cm 30 compressions should take less than 18 seconds
5 cycles (about 2 minutes) Change persons doing compressions every 2 minutes if possible
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Performing Chest Compressions

Compression depth should be at least 5cm Allow chest to recoil!

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Opening the Airway (1 of 2)

Remove any obstruction Suction any liquid

Managing the airway should be performed without interrupting the chest compressions
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Opening the Airway (2 of 2)

Head tiltchin lift maneuver Insert canulla

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Ventilations

Place mask on patients face (BVM use) . Squeeze bag to deliver ventilations. Give 2 slow rescue breaths that make the chest rise (1 second each).

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C & E Technique for Holding Mask

Trouble Shoot if Air Doesnt Enter (without interrupting 15 compressions)

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Gastric Distention
Gastric distention is most likely to occur if: You blow too hard as you ventilate. You give breaths too fast. The patients airway is obstructed.

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Switching Positions
Switch every 2 minutes (5 cycles). First EMT-B moves into position to deliver compressions after giving two breaths. Second EMT-B delivers 30th compression then moves to patients head. Second EMT-B checks pulse while positioned at the head

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Any questions?

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Key Messages
Dont delay compressions! Push HARD (at least 5cm), and FAST (at least 100/min) on center of chest Allow full chest recoil Give breaths that make chest rise and dont hyperventilate Defibrillate as soon as possible Switch every 2 minutes when possible Minimize interruptions Work and practice as a team

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Steps to perform BLSD

Scene safety Responsiveness Positioning the patient Circulation Airway Breathing Defibrillation
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DEFIBRILLATION
The most common rhythm in cardiac arrest is Ventricular fibrillation (VF) 40% VF deteriorates to Asystole within 3 to 5 min if not treated The most effective treatment for (VF) is defibrillation Defibrillation is also the most effective treatment for Ventricular Tachycardia (VT)
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AED Usage Information

Factors affecting AED analysis: Patient movement (agonal gasps) Moving the patient Vibrations (engine) Mobile phones or electronic equipment
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AED Risks and precautions

Do not defibrillate a patient lying in a pool of water. Dry a soaking wet patients chest first. Do not defibrillate a patient who is touching metal. Remove nitroglycerin patches. Remove any jewelry on the neck Shave a hairy patients chest if needed (patches cant stick) Do not touch patient during analysis or shock Do not over-dramatize safety precautions. A Patient can be shocked on the stretcher in the ambulance without any risk if no one is touching the patient or stretcher
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Using an AED

AED is prepared while 1st EMT is checking the pulse Ideally 3rd person should prepare the AED

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Using an AED

Remove clothing from the patients chest area. Apply patches to the chest. Turn on the AED (as soon as possible) Connect patches to AED when ready Stop CPR. State aloud, Clear the patient.

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Using an AED

Push the analyze button, if there is one. Wait for the computer. If shock is advised, make sure that no one is touching the patient.(visual check and response) Push the shock button.

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Using an AED

After the shock 5 cycles of CPR 30 compressions, 2 ventilations After 5 cycles reanalyze patients rhythm. If the machine advises a shock clear the patient and push shock button. If no shock advised check for pulse.

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Transport Considerations
When to transport: When patient regains pulse After delivering two analyzes (finishing up with a CPR cycle) Keep patches attached on the chest Check pulse continuously Stop ambulance to use an AED. Drive carefully in a way that allows the rescuers to perform efficient CPR

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Special situations

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Cardiac Arrest During Transport

While monitoring the patients pulse. If pulse is not present: Stop the vehicle and turn off the engine Perform CPR until AED is available. Analyze rhythm. Deliver shock when advised Continue resuscitation according to local protocol.

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Cardiac Arrest Drowned Patient

CPR for drowning victims should use the traditional A-B-C approach in view of the hypoxic nature of the arrest. Start chest compressions as soon as you deliver 2 rescue breaths. Use AED as soon as possible Maintain spinal protection and immobilization during extrication and treatment if there is any likelihood of head or neck trauma.

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Interrupting CPR
CPR is a continuous action. Try not to interrupt CPR for more than 10 seconds Do not move the patient until transport arrangements are made. When patient is ready to be moved, move to ambulance without exceeding 90 seconds without CPR
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When Should CPR Be Stopped?

S Patient Starts breathing and has a pulse T Patient is Transferred to another person O You are Out of strength P A Physician asks you to stop

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When CPR Should Not Be Started

BLS should not be started if the following situations exist: Rigor mortis or stiffening of the body Putrefaction or decomposition of the body Evidence of a non-survivable injury Existing no-CPR order Dependent lividity

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Any questions?