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CPR Review Notes 2015 AHA Guidelines

CPR Review Notes 2015 AHA Guidelines - Departments & Programs, UW Health, Ambulatory Education, CPR, Resources



American Heart Association 2015 Guidelines
2016-2021 Certification
BASIC
LIFE
SUPPORT
REVIEW
NOTES!



2
THE CHAIN OF SURVIVAL
The Chain of Survival is a process of providing emergency care.
ADULT Chain of Survival
• Immediate Recognition and EMS activation (911)
• Early CPR
• Rapid Defibrillation (crash cart or AED)
• Effective Advanced Care (by EMS and Emergency Department)
• Integrated Post Cardiac Care
PEDIATRIC Chain of Survival
• Prevention of arrest
• Early high quality bystander CPR (2 minutes if alone)
• Rapid Activation of EMS (911)
• Effective Advanced Care (by EMS and Emergency Department)
• Integrated Post Cardiac Care

THE ’s of CPR

• C – Circulation/Compressions – ensure you have no response, breathing or
pulse and start 30 compressions.
• A – Open the Airway with a Head Tilt/Chin Lift or Jaw Thrust
• B – Deliver 2 adequate Breaths (1 sec. each – look for chest rise)



Rescuers Should


Rescuers Should Not
• Perform chest compressions at a
rate of 100 to 120/min
• Compress at a rate slower than
100/min or faster than 120/min
• Compress to a depth of at least
2 inches (5 cm)
• Compress to a depth of less than
2 inches (5 cm) or greater than
2.4 inches (6 cm)
• Allow full recoil after each
compression
• Lean on the chest between
compressions
• Minimize pauses in
compressions
• Interrupt compressions for
greater than 10 seconds
• Ventilate adequately (2 breaths
after 30 compressions, each
breath delivered over 1 second,
each causing chest rise)
• Provide excessive ventilation (ie,
too many breaths or breaths with
excessive force


BLS Dos and Don’ts of Adult High-Quality CPR

3
As soon as available attach an AED,
ideally within the first few minutes of collapse

What is AED?
Automated External Defibrillators are devices that can look at a
person's heart rhythm and can recognize ventricular fibrillation (VF)
or ventricular tachycardia (VT). AEDs are designed to be used by lay
rescuers or "first responders”.
What are the basic steps in using and AED?

1. Turn on the AED – and follow voice prompts.
2. Attach electrode pads to chest (upper right - near shoulder, lower left – at side).
3. Plug in electrode pads on the AED (as indicated by voice prompts).
4. Tell people to step back or “Clear” when analyzing and before shocking
5. Follow the instructions (voice prompts) from the AED
“Can I Hurt Someone with an AED?” YES & NO! - AEDs will NOT shock a person
who does not need to be shocked. It’s that simple. - A victim needing an AED is
essentially dead. Early defibrillation represents that person’s best chance for survival.
HOWEVER – If someone is touching the victim during the shock – that person could
receive part of the shock. So it is very important that no one be touching the victim.
Are there other ‘special’ things to remember about using AEDs?
• Make sure the victim’s CHEST is BARE and DRY.
• Remove medications patches and wipe medication off chest.
• Remove patient from any standing water.
• Do not place electrode pads over pacemakers, or any ‘implanted’ devices.
• Make sure that everyone is clear from victim during analysis and shocking phase.
• Defibrillation is acceptable for all ages. Use pediatric pads if available for under
55lbs.(approx 8yrs.) down through infants; use adult pads (placing front to back)
if child size not available. Always use adult pads/settings for over 55lbs.


Before any responding to any emergency always ‘Check the Scene’




4
BAG & POCKET MASK TECHNIQUES (Where are masks in your clinic?)

Pocket Mask
• Position yourself at the victim's side.
• Place the mask on the victim’s face, using the bridge of the nose as a guide for
correct position.
• Seal the mask against the face - use index finger and thumb around edge of
mask with hand at top of victim’s head; with chin lift, use thumb of second
hand along bottom edge of mask.
• Open the airway with head tilt-chin lift. Press firmly around the outside edge of
the mask to seal the mask against the face.
• Deliver each breath over 1 second; watch for chest rise.
• If the chest DOES NOT rise reposition the head and try again.



Bag Mask
• Position yourself directly above victim’s head.
• Place the mask on the victim’s face, using the bridge of the nose as a guide for
correct position.
• Use the E-C clamp technique hold the mask in place - use index finger and
thumb of one hand to make a ‘C’ on the side of the mask; use remaining
fingers to lift the angles of the jaw (three fingers form an ‘E’).
• Use E-C to open the airway with head tilt-chin lift. Press firmly around the
outside edge of the mask to seal the mask against the face.
• Squeeze the bag to give each breath over 1 second; watch for chest rise.
• If the chest DOES NOT rise reposition the head and try again.





Use of an Advanced Airway (Intubation) – if the patient is intubated during
CPR, do continuous compressions at a rate of at least 100-120/min. and breaths delivered
every 6 seconds with a bag mask.


5
QUICK REVIEW OF RESUSCITATION INTERVENTIONS 2015 ECC Guidelines
Intervention
Patients (Adult to Infant) – Not for Neonates
Establish
unresponsiveness
Tap the shoulders
(For Infants – tap bottoms of feet – DO NOT Shake)
Shout the person’s name
NEW –
Yell for Help
Activate Emergency
Response System (911)
Send for AED

Adults If alone - Activate EMS
Then go back to the person and begin CPR
Child/Infant If alone – Do 2 minutes of CPR (5 cycles)– then call
If others are present - Activate EMS after breathing check
Check for Breathing and
Pulse 5-10 seconds
NEW

Look at the chest for breathing signs
no need to open airway
Adults/Children – check carotid pulse
Infants - check brachial pulse
(also do CPR on child/infant if pulse is less than 60
beats/min.)
Compression landmarks At the nipple line on the lower half of the breastbone
DO NOT place hands over the Xiphoid process (end of
breath bone)
Compression method Adults - 2 hands – one on top of other
Children - Heel of 1 or 2 hands (depends on size of child)
Infants - 2 fingers 1 person
2 thumbs for 2 person
Compression depth

Adults – 2 to 2.4 inches (5-6cm) - NEW
Child(2”)/Infants(1½”)at least 1/3 the depth of the chest
Compression rate NEW 100-120 compressions per minute for all patients
Compression-ventilation
ratio
Single rescuer, all ages - 30 compressions : 2 breaths
Two Rescuer Adult – 30 compressions : 2 Breaths
Two Rescuer Infant/Child – 15 compressions: 2 Breaths
Rescue breathing Adults 1 breath every 5-6 seconds; reassess every 2 min.
Infant/Child 1 breath every 3-5 seconds; reassess every 2 min.
Advanced Airway
(intubation) NEW
If patient is intubated during CPR,
Compressions are continuous at 100-120/min.;1breath
delivered every 6 sec.
Mouth to Mouth
Breathing (non-clinical
setting)
Adults/Children – open airway head tilt/chin lift, pinch
nose, make a tight seal over the mouth with your mouth
Infants – your mouth over infant’s mouth and nose
Foreign-body
Conscious
Adults - Children Use Abdominal Thrusts (Heimlich)
Infants – 5 Back Slaps and 5 Chest Thrusts
Foreign-body
Unconscious
Begin CPR at 30 compressions (NO thrusts)
Look in mouth - perform a mouth sweep ONLY if object seen
The give 2 Breaths (if no chest rise) – continue with 30
compressions, Look, Breath until chest rises, then assess for
breathing and pulse, 5 to 10 sec.

6

Healthcare Provider:
Using your CPR skills as a “bystander”
The skills you learn in this training program will prepare you to respond to
unresponsive patients in the course of your professional duties as a healthcare
provider. For those patients who are unresponsive, not breathing normally and
pulseless, you will learn how to perform conventional CPR, that is CPR with breaths
combined with chest compressions of an adequate depth and rate, with full chest
recoil and minimal interruption.
Of course, those same skills can also be used in the event that you encounter a
victim of cardiac arrest, either in a public or private location, while not working in your
professional role as a healthcare provider. In other words, you may also need to use
your skills as a “bystander” to help an “out-of-hospital” victim of cardiac arrest. Just
as with the patients you care for in your professional role, you should focus on
providing good quality chest compressions with minimal interruption to an out-of-
hospital cardiac arrest victim.
In the event that the victim you encounter in the out-of-hospital setting is an adult
who has suddenly collapsed, your skills can be used to perform:
Conventional (30:2) CPR — breaths combined with chest compressions
or
Hands-Only CPR — chest compressions only
Both methods have been shown to be effective in the first few minutes of an out-of-
hospital adult cardiac arrest. You should perform the method with which you feel
confident you can deliver good quality chest compressions with minimal interruption.

Hands-Only CPR for adults who suddenly
collapse
Hands-Only CPR has been widely publicized by the AHA as an appropriate
bystander response to adult victims of out-of-hospital, witnessed, sudden cardiac
arrest. So, don’t be surprised if others at the scene of such an event are performing
Hands-Only CPR, that is, CPR without breathing. They’ve probably learned the
following two simple steps:
Call 911 Push hard and fast in the center of the chest
Hands-Only CPR is NOT recommended for:
• Unresponsive infants and children
• Victims of
– drowning
– trauma
– airway obstruction
– acute respiratory diseases
– apnea, such as associated with drug overdose

7
RELIEF OF CHOKING TECHNIQUES
CLEARING AN OBSTRUCTED AIRWAY IN A CONSCIOUS
ADULT/CHILD – OVER 1YR OLD
1. Determine if the person can speak or cough. Ask the person to speak. Ask the person if
they are choking. If the person cannot speak and if the person is choking, tell the person that you
will help them and proceed to the next step.

2. Abdominal thrust (Heimlich maneuver): Stand or kneel behind the person. Make a fist
with one hand just above the belly button. Cover the fist with your other hand. Perform an
abdominal thrust (Heimlich maneuver) inward and upward repeatedly until the foreign body is
expelled or until the person becomes unresponsive. A chest thrust may be used for markedly
obese persons, late stages of pregnancy or persons with recent abdominal surgery.


3. If the adult or older child becomes unresponsive, lower the person to the floor. If you are
alone, call 9-1-1 first. If you are with someone, have that person call 9-1-1. Begin 30 Chest
Compression, Look in the mouth for any foreign object;remove it only if seen. DO NOT perform
a "blind finger sweep." Attempt a rescue breath, if there is no chest rise, reposition the airway and
attempt another breath again. If still no chest rise repeat sequence of 30 compressions, look in
the mouth for object, and attempt of breaths. Continue the sequence until chest rises, or person
begins breathing.
CONTINUE CARE UNTIL HELP ARRIVES
If you remove the object from the mouth, proceed with two rescue breaths. This is to help re-
oxygenate the person. If the chest rises, then check the carotid pulse closest to you. If no pulse,
begin CPR. If there is a pulse but no breathing continue with rescue breathing and reassess every 2
minutes as long as pulse is present.

8
Determine if the infant (up to approx. 1yr old) can cry or cough. If not, proceed to
Step 1.
1. Hold the infant face down. Protect the infant's face by holding the jaw. Support infant on
thighs or lap. Head lower than chest. Give 5 back slaps with the heel of your free hand.

2. Turn the infant over face up. Protect the infant's head by holding the back of the head.
Support infant on thighs or lap. Head lower than chest. Give 5 chest thrusts on the middle of the
chest, just below the nipple line.

3. Repeat steps one and two above until the obstruction comes out of the infant's mouth or
the infant becomes unresponsive. If the infant becomes unresponsive, begin the three-step
process listed below.
THREE STEP PROCESS
1. Begin 30 Chest Compressions – After compressions, Look in the mouth for a foreign
object; if you see an object in the mouth, remove it. However if you do not see the object, DO
NOT perform a "blind finger sweep" on an infant.
2. Give two rescue breaths. This is to help oxygenate the infant and will not push the object
further down into the lungs. If chest does not rise, reposition airway and try breaths again. If no
chest rise continue CPR.
3. Continue with 30 chest compressions, look in mouth for object, 2 breaths. Repeat until
chest rises, then check pulse, continue with either CPR, Rescue Breathing or maintaining airway
if infant is breathing.
CONTINUE CARE UNTIL HELP ARRIVES
If you remove the object from the mouth, proceed with two rescue breaths. This is to help re-
oxygenate the person. If chest rises with 2 rescue breaths, then check the brachial pulse closest to
you. If no pulse, begin infant CPR. If there is a pulse but no breathing continue rescue breathing 1
breath every 3 seconds. Reassess every 2 minutes as long as pulse is present.