CPR

Cardiopulmonary Resuscitation

Definition of Cardiopulmonary resuscitation

 Cardiopulmonary

resuscitation: The emergency substitution of heart and lung action to restore life to someone who appears dead.  The two main components of cardiopulmonary resuscitation (CPR) are: 1. chest compression to make the heart pump. 2. mouth-to-mouth ventilation to breath mouth-tofor the victim.

the event of an early heart attack, death attack, can often be avoided if a bystander starts CPR promptly (within 5 minutes of the onset of ventricular fibrillation).  When paramedics arrive, medications and/or electrical shock (cardioversion) to the heart can be administered to convert ventricular fibrillation to a normal heart rhythm.  Therefore, prompt CPR and rapid paramedic response can improve the chances of survival from a heart attack.
 In

What is a heart attack?

A heart attack (also known as a myocardial infarction) is the death of heart muscle from the sudden blockage of a coronary artery by a blood clot. Coronary arteries are blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery deprives the heart muscle of blood and oxygen, causing injury to the heart muscle. Injury to the heart muscle causes chest pain and pressure. If blood flow is not restored within 20 to 40 minutes, minutes, irreversible death of the heart muscle will begin to occur. Muscle continues to die for 6-8 hours at which time the heart attack usually is "complete." The dead heart muscle is replaced by scar tissue.

POINTS OF CPR:
Artificial ventilation + External Chest Compressions To oxygenate and circulate blood when the patient is in arrest

Depressing the sternum causes enough blood to flow to sustain life for a short period of time

nly effective for a short period of time: 1. Cannot sustain life indefinitely 2. Must be started as early as possible 3. Effectiveness decreases the longer you doing CPR 4. Some cases defibrillated needed 5. CPR increases the amount of time that defibrillation will be effective

 CPR

produce a pumping activity only 252539% as effective as the action of a normal heart.  Thus, 90- 100% oxygen should be 90delivered to all patients who have sustained a cardiac arrest, as soon as possible.

CPR Interruption
should not be interrupted for more than 5 seconds.  Unless, it is necessary to move the patients up or down a stairway.  Such interruptions should not exceed 15 seconds!
 CPR

CPR Complications
 Fractured

ribs  Fractured sternum  Lacerations of the liver, spleen, lung or heart  Damage to the pleura resulting from broken ribs

Beginning and Terminating CPR

CPR is not indicated for a patient known to be in the terminal stages of an incurable condition, if sign DNR orders are present.

Once started, CPR should be terminated only when one of the following occurs: 1. The patient s heart resume normal beating 2. A physician/ other properly trained person assumes responsibility for the patient 3. The rescuer is exhausted and unable to continue 4. The patient is pronounced dead by the physician, coroner or other individual with the legal authority to do so.

AED


AEDs, or automated external defibrillators, are computerized devices that can help prevent death due to sudden cardiac arrest. These devices monitor the heart rhythm and can, if need be, deliver an electric shock to the chest wall much like a traditional (paddle) defibrillator in a hospital. AEDs are now carried on commercial aircraft and are becoming increasingly available at various locations in the community.

The most common cause of sudden cardiac death is an arrhythmia of the heart. Arrhythmias are abnormalities of the heartbeat (severe heart attacks can also lead to cardiac arrhythmias and sudden death). The arrhythmia that most often causes sudden cardiac death is ventricular fibrillation. It prevents the heart from pumping blood and deprives the body of oxygen. The only way to reverse ventricular fibrillation is defibrillation -the delivery of an electrical impulse to the heart to restore its normal rhythm.

AEDs are not a substitute for CPR



Who? Anyone trained to operate an AED must be trained in CPR, since early CPR is a critical step in resuscitation to help reestablish the circulation of blood and the delivery of oxygen to the body. AEDs may also prompt the rescuer to continue CPR while it is analyzing the heartbeat of the patient. CPR is also no substitute for AED. Even if CPR is given, studies have shown that survival decreases 7-10% for each minute of waiting time before defibrillation is carried out.

How AEDs work?



If you are qualified in CPR, and to use an AED, the rescuer first should check the victim of a sudden cardiac arrest for unresponsiveness. If the victim is not breathing or breathing is abnormal, the rescuer should start CPR, check for a pulse and, if there is no pulse, turn on the AED. A second rescuer should continue CPR until the AED is attached. An AED has patches (electrode pads) that are applied to a victim s chest. The patches are connected to a computerized monitoring device capable of delivering an electric current. There are different brands of AEDs but all of them operate in the same basic way.

 After

the patches are applied to the victim s chest, the device records and evaluates the heart rhythm. It directs the rescuer, if necessary, to stand clear and deliver electric impulses by pushing a shock button on the unit. rescuer only needs to follow the instructions delivered by the device. AEDs use verbal prompts, lights, and/or text messages to deliver instructions to the rescuer.

 The

 

AEDs allow defibrillation to be done without having to transport a victim to a hospital. Lay persons with a few hours of training can safely operate an automated external defibrillator. The American Heart Association supports placement of AEDs in areas where large groups of people gather or where emergency response times may be slowed. Office complexes, shopping malls, and sports arenas are examples of venues where AEDs can save critical minutes of emergency response time.

ADULT CPR
1. Check for responsiveness. 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 the person. 3. Carefully place the person on his or her back. If there is a chance the person has a spinal injury, two people are needed to move the person without twisting the head and 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 breath on 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 lifted and head tilted - Give 2 slow, full breaths

7. If the chest does NOT rise, try the chin lifthead tilt again, and give 2 more breaths. If the chest still doesn't rise, check to see if something is blocking the airway and try to remove it. 8. Look for signs of circulation -- normal breathing, coughing, or movement. If these signs are absent, begin chest compressions.

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 body directly over your hands. Your shoulders should be in line with your hands. DO NOT lean back or forward. As you gaze down, you should be looking directly down on your hands. -Give 30 chest compressions. Each time, press down about 2 inches into the chest. These compressions should be FAST and hard 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 should rise. 11. Continue cycles of 30 chest compressions followed by 2 slow, full breaths. 12. After about 2 minute (four cycles of 30 compressions and 2 breaths), re-check for signs of circulation. 13. Repeat steps 11 and 12 until the person recovers or help arrives.

DO NOT !!!
If a spinal injury is suspected, DO NOT tilt the head back when attempting to open the airway. Instead, place your fingers on the jaw on each side of the head. Lift the jaw forward. This keeps the head and neck from moving. If the person has signs of circulation -- normal breathing, coughing, or movement -- DO NOT begin chest compressions. Doing so may cause the heart to stop beating. Unless you are a health professional, DO NOT check for a pulse. Only a healthcare professional is properly trained to check for a pulse.

CHILDREN CPR
1. Steps for unresponsive infants (<1 year) and children (1 year to puberty): open airway; give 2 breaths if not breathing; begin compressions if no pulse; activate EMS system, use automated external defibrillator (AED) after 5 cycles of CPR in children; if rhythm shockable, give 1 shock and resume CPR for 5 cycles; if rhythm not shockable, resume CPR and check rhythm every 5 cycles until response or PALS providers intercede. 2. For sudden collapse in child, activate EMS and get AED before CPR. 3. Barrier devices do not reduce infection risk and might increase resistance to air flow. 4. Bag-mask ventilation is as effective as endotracheal intubation for short periods; use 100% oxygen until more information known. 5. If definite pulse, give 12 to 20 breaths/minute (1 breath every 3 - 5 seconds) and check pulse every 2 minutes; if no pulse or if pulse < 60 beats/minute with poor perfusion, begin chest compressions at 100 per minute.

CHILDREN CPR
6. Cycle consists of 30 compressions (1 rescuer) or 15 compressions (2 rescuers) per 2 breaths. Ideal ratio unknown, but previously recommended 5:1 ratio resulted in less than 60 compressions/minute. 7. If rescuer unable to ventilate patient, chest compressions alone are recommended vs no resuscitation. 8. Changing rescuer every 2 minutes will maintain good compressions (forceful, fast, full chest recoil, minimal interruptions). 9. For severe foreign body airway obstruction, perform subdiaphragmatic abdominal thrusts (child) or 5 back blows alternating with 5 chest thrusts (infant). 10. For drowning victims, ventilation, but not compressions, can be started in the water if it does not prolong removal from water.

Cardiac Arrest Symptoms and Causes

 

Medical Author: Melissa Conrad Stppler, MD Medical Editor: Dennis Lee, MD Cardiac arrest is the sudden loss of cardiac function, when the heart abruptly stops beating. A person whose heart has stopped will lose consciousness and stop normal breathing, and their pulse and blood pressure 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 sudden death or sudden cardiac death (SCD). Ventricular fibrillation is the most common cause of cardiac arrest. Ventricular fibrillation occurs when the normal, regular, electrical activation of heart muscle contraction is replaced by chaotic electrical activity that causes the heart to stop beating and pumping blood to the brain and other parts of the body. Permanent brain damage and death can occur unless the flow of blood to the brain is restored within five minutes. Heart attack is the most common cause of ventricular fibrillation. Less common causes of cardiac arrest include respiratory arrest (loss of breathing function), choking, trauma, electrocution, and drowning. choking, trauma, Early cardiopulmonary resuscitation (CPR) and defibrillation (electrical impulses delivered to the chest to restore normal heart rhythm) are the only way to reverse a cardiac arrest. These lifesaving measures must be instituted within a few minutes after cardiac arrest in order to have any chance of success. For every minute that passes without defibrillation, a person s chances of survival 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 arrest has been reported to be as high as 49%. It is rare for a resuscitation to be successful if more than ten minutes have elapsed following a cardiac arrest.

Guidelines Suggest When Resuscitation Works for Cardiac Arrest

Guidelines to help emergency-medical technicians emergency(EMTs) decide whether or not to end resuscitation efforts for patients having cardiac arrest outside of a hospital have been devised by Canadian researchers.  The guidelines, published in the Aug. 3 issue of the New England Journal of Medicine, aren't the final word, said Medicine, Dr. Jose Martinez, assistant professor of clinical medicine at the University of Miami Miller School of Medicine. "As technical and medical knowledge evolve, we are modifying guidelines on how to proceed," he said. "This adds a bit more to our armamentarium."  Practically speaking, guidelines depend on a number of factors, including cost and geographic region.