Adult Basic Life Support for the Health Care Worker

Based on the New 2010 CPR Guidelines of the AHA and ILCOR

Philippine Heart Association, Inc. Council on Cardio Pulmonary Resuscitation

A Full Member of the

The Asian Representative of

Sudden Cardiac Arrest A Health Burden

Approximately 50% of deaths from cardiovascular disease occur as SUDDEN CARDIAC ARREST.
Sudden Cardiac Arrest is the most common mode of death in patients with coronary artery disease.

Health Burden of Sudden Cardiac Arrest

Almost 80 percent of out-of-hospital cardiac arrests occur at home and are witnessed by a family member.
Only 4-6 % of sudden cardiac arrest victims survive because majority of those witnessing the arrest do not know how to perform CPR .
American Heart Association

Sudden Cardiac Arrest

Unpredictable and can happen to anyone, anywhere, at anytime Risk increases with age

Pre-existing heart disease is a common cause

May strike people with no history of cardiac disease or cardiac symptoms

Effective CPR done immediately after cardiac arrest can double a victims chance of survival.

If sudden cardiac death occurs outside the hospital setting, cardiopulmonary resuscitation (CPR) must begin within 4 to 6 minutes and advanced life support measures must begin within 8 minutes, to avoid brain death.

Objectives of this Presentation

To increase awareness and knowledge on Basic Cardiopulmonary Resuscitation (CPR) as a life-saving procedure for victims of sudden cardiac arrest. To demonstrate the different steps and techniques of CPR.

What is C P R ?

CPR = CardioPulmonary Resuscitation

The NEW Chain of Survival

Early access: immediate recognition and activation Early CPR

Early defibrillation Early advanced care Integrated postcardiac arrest care

The First Link- Early Access

A well-informed lay person - key in the early access link. Recognition of signs of heart attack and respiratory failure Call for help immediately if needed Activate the Emergency Medical System

EARLY WARNING SIGNS OF HEART ATTACK

prolonged compressing pain or unusual discomfort in the center of the chest may radiate to shoulder, arm, neck or jaw, usually on the left side may be accompanied by sweating, nausea, vomiting and shortness of breath

EARLY WARNING SIGNS OF RESPIRATORY FAILURE unable to speak, breath or cough clutches neck (universal distress signal) bluish color of skin and lips

Second Link - Early CPR

Life saving technique for cardiac & respiratory arrest Chest compressions +/Rescue breathing Lay persons and medical personnel

Why is early CPR important?

CPR is the best treatment for cardiac arrest until the arrival of ACLS care. prevents VF from deteriorating to asystole may increase the chance of defibrillation It significantly improves survival.

How does CPR work?

Brain (Cerebral)
All the living cells of our body need a steady supply of oxygen to keep us alive.
During CPR, you can breathe air into the victims lungs to provide oxygen into the blood. When you press on the chest, you move oxygen - carrying blood through the body.

Lungs (Pulmonary)

Heart (Cardiac)

When will you do CPR?

AS SOON AS POSSIBLE! Brain cells begin to die after 4-6 minutes without oxygen.

Who may learn about CPR?

CPR is an easy and life saving procedure and can be learned by anyone.
One does not need to be a doctor to learn how to do CPR.

THE TECHNIQUE AND STEPS IN CPR

IF YOU WITNESS A CARDIAC ARREST

CHECK AREA SAFETY.

Survey the scene.

See if the scene is safe to do CPR. Get an idea of what happened.

CHECK UNRESPONSIVENESS.
Tap or gently shake the victim Rescuer shouts Are you OK? Quick check for normal breathing If the victim is unconscious, rescuer calls for help.

CALL FOR HELP:

Ambulance, Emergency Services, Doctor

Rescuer ACTIVATES the EMERGENCY MEDICAL SERVICES.

Get AED/Defibrillator!

NON-RESPONSIVE, NO NORMAL BREATHING

PULSE CHECK
Palpate for Carotid Pulse within 10 seconds (at the same time CHECK FOR BREATHING) For trained healthcare providers only

If with definite pulse but no breathing

Do Mouth to Mouth Breathing

Give one breath every 5-6 secs (about 12 breaths/min) Recheck pulse every 2 minutes

MOUTH TO MOUTH BREATHING and PULSE CHECK

Deemphasized in the new guidelines For trained healthcare providers only As short and quick as possible Pulse check not more than 10 seconds If unsure, proceed directly to CHEST COMPRESSIONS!

After determining unconsciousness,

CAB
C. COMPRESSION Do chest compressions first A. AIRWAY Does the victim have an open airway (air passage that allows the victim to breathe)? B. BREATHING Is the victim breathing?

(to assist CIRCULATION)

After determining unconsciousness and calling for help,

COMPRESSION

proceed immediately to do

COMPRESSIONS!

CHEST

Chest Compressions

Kneel facing

victims chest
Place the heel of your hand on the center of the victim's chest. Put your other hand on top of the first with your fingers interlaced.

Chest Compressions

Place the heel of one hand on the sternum in the center of the chest between the nipples and then place the heel of the second hand on top of the first so that the hands are overlapped and parallel.

Give Chest Compressions at 100 per minute

Compress breastbone at least 2 inches deep Compress at a rate of 100 per minute or more Compress 30 times initially Allow the chest to return to its normal position

Give 30 Compressions
Compress breastbone at least 2 inches (30 compressions should take 15-18 sec) Count aloud 1, 2, 3, 4, 5,6,7,8,9,10,11,12,13,14,15,16,17,1 8,19,20,21,22,23,24,25,26,27,28,29, and ONE! Minimize interruptions Allow recoil after each compression

A - AIRWAY

Open the Airway: Use the head tilt/chin lift method

Place one hand on the victims forehead
Place fingers of other hand under the bony part of lower jaw near chin

Tilt head and lift jaw-avoid closing victims mouth

Head Tilt Chin Lift Maneuver

This maneuver prevents airway obstruction by the epiglottis.

B - BREATHING Give 2 one-second

breaths
Maintain airway Pinch nose shut Open your mouth wide, take a normal breath, and make a tight seal around outside of victims mouth Give 2 full breaths (1 sec/ breath) Observe chest rise & fall; listen & feel for escaping air

PULSE CHECK
RECHECK PULSE EVERY 2 MINUTES (equivalent to 5 cycles CPR) Very brief pulse check should take less than 10 seconds (at the same time check for normal breathing) In case there is any doubt about the presence or absence of pulse, CONTINUE CHEST COMPRESSIONS For trained healthcare providers only

UNTIL

HELP ARRIVES.
(Emergency Services, Ambulance, Doctor, AED)

PERSON IS REVIVED.

If the victim is breathing

THE RECOVERY POSITION Maintain open airway & position the victim
The unresponsive victim with spontaneous respirations should be placed in the recovery position if no cervical trauma is suspected. Placement in this position consists of rolling the victim onto his or her side to help protect the airway.

Summary of Key BLS Components for Adults and Children

Maneuvers
RECOGNITION

Adults
UNRESPONSIVE No breathing, not breathing normally (eg. only gasping)

Children
No breathing or only gasping

CPR Sequence Compression Rate Compression Depth Chest wall Recoil Compression interruptions Airway Compression-Ventilation ratio

CAB At least 100/min At least 2 inches (5 cm)

CAB

At least 1/3 AP depth; About 2 inches

Allow complete recoil between compressions HCPs rotate compressors every 2 minutes

Minimize interruptions in chest compressions Attempt to limit interruptions to less than 10 seconds Head tilt chin lift (HCP suspected trauma: jaw thrust) 30 : 2 (one or 2 rescuers) 30:2(single rescuer); 15:2(2 rescuer)

Ventilations: when rescuer untrained or trained and not proficient

Ventilations with advanced airway (HCP)

Compressions only

Compressions only

1 breath every 6-8 seconds (8-10 breaths/min) Asynchronous with chest compressions About 1 second per breath Visible chest rise Attach and use AED as soon as available. Minimize interruptions in chest compressions before and after shock, resume CPR beginning with compressions immediately after each shock

DEFIBRILLATION ( AED )

 NOT TRAINED DO NOT KNOW MOUTH TO MOUTH VENTILATION NOT SURE ABOUT MOUTH TO MOUTH VENTILATION HESITANT TO DO MOUTH TO MOUTH VENTILATION DO NOT WANT TO DO MOUTH TO MOUTH VENTILATION

 Hands Only CPR

Compression-only bystander CPR

Hands Only CPR should only be used for adult victims who have suddenly collapsed or become unresponsive.

Hands Only CPR

Recommendations: All victims of cardiac arrest should receive high-quality chest compressions

When an adult suddenly collapses, all bystanders should activate their community EMS and provide high-quality chest compressions, minimizing interruptions (Class I).

Hands Only CPR

Recommendations: If not trained in CPR, provide hands-only CPR (Class IIa) until
AED arrives EMS providers take over care of the victim

If trained in CPR, provide either conventional CPR using a 30:2 compression-to-ventilation ratio (Class IIa) or handsonly CPR (Class IIa)

Key Changes in the New Guidelines

CAB instead of ABC Compress first No more Look Listen and Feel Harder! At least 2 inches compression (old: 1 to 2
inches)

Faster! At least 100/min compression (old: up to

100/min)

Deemphasize pulse checks

For trained healthcare providers not more than 10 secs

Check for normal breathing together with check for unresponsiveness Hands only CPR for the untrained lay rescuer

Important Points
There are no mistakes when you perform CPR. The only harm is to delay responding. Start chest compressions now viewed as the most effective procedure All victims in cardiac arrest need chest compressions. Don't stop pushing. Keep pushing as long as you can. Push until the AED is in place and ready to analyze the heart. When it is time to do mouth to mouth, do it quick and get right back on the chest.

80-90% of cardiac emergencies occur at home.

Training is now simpler and more accessible Reduced number of steps and simplified process

 Being trained to do CPR can save a loved one. Effective CPR done immediately after cardiac arrest can double a victims chance of survival.

LEARN CPR TODAY!

INQUIRE FROM THE PHILIPPINE HEART ASSOCIATION!

www.philheart.org

If you want know more about Sudden Cardiac Arrest and CardioPulmonary Resuscitation, contact the Philippine Heart Association Council on CPR PHA Heart House
Suite 1108, 11th Flr. East Tower, PSE Centre Exchange Road, Ortigas Center, Pasig City Philippines Tel. +63 2 470-5525; +63 2 687-7797

www.philheart.org