CARDIO PULMONARY CEREBRAL
RESUSCITATION (CPR) (18 OCT 2010
GUIDELINES) (CAB)
DR J MYBURG
DEPT OF FAMILY MEDICINE
UNIVERSITY OF THE FREE STATE
INTRODUCTION
• DEFINITION: CPR is an intervention that attempts to give a person
with cardiac and/or respiratory arrest:
1) MECHANICAL CIRCULATION,
2) AN OPEN AIRWAY
3) ADEQUATE VENTILATION
in order to restore some blood supply and oxygenation to the
brain and other vital organs until such a time that the heart can be
restarted.
This procedure should take place with GREAT URGENCY
because:
• Permanent brain damage will occur after 3 – 4 minutes of hypoxia at
normal temperature.
• Possibility of successful resuscitation, decreases by 10% for every
minute that passes after the onset of cardiac arrest. (After 10
minutes prognosis therefore is= +/- 0 at normal body temperature)
ADULT CHAIN OF SURVIVAL
CONSISTS OF 4 LINKS:
1)
2)
3)
4)
Early recognition and call for help (improve prognosis)
Early CPR (to buy time)
Early defibrillation (to restart the hart)
Good post resuscitation care (to restore quality of life)
IN ADULTS VENTRICULAR FIBRILLATION IS USUALLY THE
CAUSE – NEED DEFIBRILLATOR TO TREAT
Exceptions:
1)
Near-drowning
2)
Cardiac arrest associated with trauma
3)
Respiratory arrest is present (drug overdose, airway obstruction)
PEDIATRIC CHAIN OF SURVIVAL
CONSISTS OF 4 LINKS:
1)
2)
3)
4)
Prevention
Early CPR
Early activation of EMS
Early advanced cardio vascular care
IN CHILDREN RESPIRATORY ARREST MOST COMMON CAUSE
Exceptions:
1) Children known to be at high risk for cardiac arrest (congenital heart
lesions)
SEQUENCE OF CPR
1) HAZARDS: Assess whether the scene is safe.
2) HELLO: Check responsiveness. Gently shake
shoulders and ask loudly: “Are you all right?”
If responsive: Treat illnesses or injuries as necessary.
REASSESS frequently.
3) HELP: Call for help, defibrillator/AED. Activate EMS
Above known as 3 x Hes
4) CABD (Previous: ABCD)
CABD
• C = COMPRESSIONS OF THE CHEST
• A = AIRWAY
• B = BREATHING
• D = DEFIBRILLATION
(CIRCULATION)
DIAGNOSIS of CARDIAC ARREST
Types of arrest: 1) Ventricular fibrillation (80%)
2) Asystole (20%)
3) Pulse less electrical activity PEA (0,5%)
Diagnosis: 1) Absent central pulses (take long to detect)
2) Unconscious patient with no breathing: Start
compressions immediately. ( New approach)
C: CHEST COMPRESSIONS
(CIRCULATION)
• FEEL FOR PULSE: (<10 seconds)
ADULT: CAROTID PULSE
CHILD: BRACHIAL PULSE
IF PRESENT: CONTINUE WITH AIRWAY, BREATING AND RESCUE
BREATHS:
ADULT: 10/min
CHILD: 12-20/min
IF ABSENT: IMMEDIATELY START WITH 30 CLOSED CHEST
COMPRESSIONS (+/-18 - 20 Seconds, rate 100/min)
CIRCULATION
CIRCULATION (method)
•
•
•
•
•
•
•
•
•
•
•
•
•
Kneel by the side of the victim
Place the heel of one hand in the centre of the chest (2 fingers above
xiphysternum, or line connecting the nipples)
Place the heel of the other hand on top of the first hand.
Lock fingers above the chest wall
Position of arms (Elbows locked in extension)
Position of rescuer (Vertically above patient)
Depth of compression: 1/3 of thickness of chest (5-6cm in adult)
Rate: 100-120/min
Push hard, fast, ensure full chest recoil between compressions, minimize
interruptions
Do 30 COMPRESSIONS (18-20 seconds), THEN OPEN AIRWAY AND
CHECK FOR BREATHING.
Give 2 RESCUE BREATHS in absence of breathing
CPR RATIOS: 30 compressions : 2 ventilations
Perform 5 cycles / 2 minutes of CPR, then re evalute the patient.
CIRCULATION
Two-finger chest compression technique in infant (1 rescuer).
Berg M D et al. Circulation 2010;122:S862-S875
Copyright © American Heart Association
Two thumb-encircling hands chest compression in infant (2 rescuers).
Berg M D et al. Circulation 2010;122:S862-S875
Copyright © American Heart Association
A: AIRWAY
•
•
•
•
•
Assesses and open the airway.
Open mouth – inspect for foreign objects, vomitus & secretions
Remove any FOREIGN OBJECTS with FINGER SWEEP & suction.
HEAD TILT, CHIN LIFT
JAW THRUST with neck stabilization in case of ? neck injury.
B: BREATHING
• LOOK, LISTEN AND FEEL for adequate breathing (<10 seconds)
• If in doubt, act if person is not breathing
BREATHING
• If there is adequate breathing, put patient in RECOVERY position
• Get help from ambulance service
• Continue to assess and monitor breathing.
BREATHING
• If there is no breathing, give 2 rescue breaths delivering each breath
over 1 second
• Making sure that the patient’s chest rises with each breath.
• Allow 1 second for exhalation between breaths
BREATHING (METHOD)
• Open airway with head tilt, chin lift / jaw thrust
• Pinch person’s nose, using index finger & thumb of hand on
forehead
• Allow mouth to open, but maintain chin lift
• Take deep breath, place your lips around the person’s mouth,
ensure a good seal
• Blow steadily into person’s mouth, while watching for the chest to
rise. Take about 1 second to make the chest rise as in normal
breathing. This is an effective rescue breath.
• Maintain head tilt / chin lift, take your mouth away from the person’s
mouth and watch for the chest to fall back as air flows out.
• Repeat above actions for a 2nd time.
• The 2 breaths all together should not take more than 5 seconds.
• Ambubag, Mask, Oropharyngeal airway can also be used instead.
D: DEFIBRILLATION
• IN CASE OF WHITNESSED COLLAPSE: CONNECT
DEFIBRILLATOR / AED IMMEDIATELY IF AVAILABLE AND
PROCEED WITH DEFIBRILLATION IF THE DIAGNOSIS IS VF OR
VT
• IF TIME FROM COLLAPSE > 5 MINUTES, FIRST DO 2 MINUTES
(5 cycles) CPR, STARTING WITH CHEST COMPRESSIONS,
BEFORE ANALYZING THE RHYTHM AND PERFORMING OTHER
INTERVENTIONS
• DEFIBRILLATION: SEE SEPARATE LECTURE.
WHEN TO STOP OR WITHHOLD CPR
•
•
•
•
•
•
•
•
Restoration of effective spontaneous circulation & ventilation
Transfer of care to other medical personnel
The rescuer is physically unable to continue resuscitation
Recognition of reliable criteria for determination of death
Presentation of a VALID no-CPR order to the rescuers
Failure to restore circulation despite adequate CPR for >30 minutes
The patient has a terminal condition which will not benefit from CPR
Deterioration in an inpatients condition despite maximum therapy
• GOOD SAMARITAN laws generally provide that persons who
render aid at the scene of an emergency will not be liable for civil
damages, if they act in good faith and not for any remuneration.