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ma.

magnolia rose partosa-etea


facilitator
What is CPR
– an emergency procedure which
consists of rescue breathing and
external chest compression.
to restore patient’s breathing;
 to assist blood circulation until it can
resume pumping blood throughout the
body and
 to maintain life until the victim recovers
or advanced life support is available.
 Check for Response
 Activate the EMS System
 Open the Airway and Check
Breathing
 Give Rescue Breaths
 Assess Circulation
 Chest Compressions
 -when breathing and circulation stop

› 0-4 minutes-brain damage not likely


› 4-6 minutes-brain damage probable
› 6-10 minutes-irreversible brain damage
probable
› Over 10 minutes-brain damage is certain
and irreversible
 The following may happen after
clinical death:

-Cerebral/ Cortical Death and or


Brainstem Death
-Brain death – death of brain tissues in
the cerebrum, cerebellum, mid brain and
brainstem
-Biological Death - death/ necrosis of all
tissues ( brain, heart, kidneys, liver, skin)
 place the victim on a hard surface in a
face up (supine) position.
 If an unresponsive victim is in prone
position, roll the victim to a supine
(face up) position.
 If a hospitalized patient with an
advanced airway cannot be placed
in the supine position (e.g., during
spinal surgery), may attempt CPR with
the patient in a prone position.
 Early access to medical treatment
 Early CPR
 Early Defibrillation
 Early Advanced Life Support

If any link is weak or missing, the chance


that the victim will survive is down
 Airway: Assess and manage the
Airway with noninvasive techniques.
 Breathing: Assess and manage
Breathing with positive-pressure
ventilations.
 Circulation: Assess and manage the
Circulation, performing CPR until an
AED is brought to the scene.
 Defibrillation: Assess and manage
Defibrillation, assessing the cardiac
rhythm for VF/VT and providing
defibrillatory shocks in a safe and
effective manner if needed.
 head tilt-chin lift maneuver to open
the airway of a victim without evidence
of head or neck trauma.
- one hand on client’s forehead, tilt head
with palm using firm backward
pressure
- fingers of other hand under lower jaw;
tilt jaw to bring teeth almost to
occlusion.
 Adult: maximum head tilt
 Child: Neutral plus position
 Jaw- thrust Maneuver
 use in suspected spinal cord injury.
 Open the airway without head extension.
 Stay at client’s head part, elbows on
the ground/bed, grasp both angles of
the lower jaw, lift both hands
displacing the mandibles forward
and tilting head
 While maintaining an open airway, look,
listen, and feel for breathing.
 If no adequate breathing detected within
10 seconds, give 2 rescue breaths
Give Rescue Breaths

 Give
2 rescue breaths, each over 1
second, with enough volume to
produce visible chest rise.
During CPR the purpose of
ventilation is to maintain
adequate oxygenation

-Inspired air has an oxygen concentration of


about 21% and trace of CO2.

-Of this ( 21 %), approximately 4-5 % O2 is
used by the body and the remaining16- 17 % is
exhaled together with 4% CO2
 Avoid rapid or forceful breaths.
 open the victim’s airway
 pinch the victim’s nose
 create an airtight mouth-
to- mouth seal
 Give 1 breath over 1
second, take a "regular"
(not a deep) breath,
and give a second
rescue breath over 1
second
 Taking a regular rather than a deep
breath prevents you from getting
dizzy or lightheaded.

 The most common cause of


ventilation difficulty is an improperly
opened airway, so if the victim’s
chest does not rise with the first
rescue breath, perform the head tilt-
chin lift and give the second rescue
breath
• Barrier devices may not
reduce the risk of infection
transmission, and some may
increase resistance to air flow.
• If you use a barrier device, do
not delay rescue breathing.
• 2 types: face shields and face
masks.
Mouth-to-nose
ventilation
- mouth cannot be
opened, victim is in water,
or mouth-to-mouth seal is
difficult to achieve
- case series suggests
that mouth-to-nose
ventilation in adults is
feasible, safe, and effective.
Mouth-to-stoma rescue
breaths
- tracheal stoma who
requires rescue breathing.
- reasonable alternative is
to create a tight seal over the
stoma with a round pediatric
face mask
- no published evidence on
the safety, effectiveness, or
feasibility of mouth-to-stoma
ventilation.
 Rescuers can provide bag-mask
ventilation with room air or oxygen.
 A bag-mask device provides
positive-pressure ventilation without
an advanced airway and therefore
may produce gastric inflation and its
complications.
 When using a bag-mask device,
deliver each breath over a period of
1 second and provide
sufficient tidal volume to
cause visible chest rise.
The Bag-Mask Device
 Masks should be made of
transparent material to allow
detection of regurgitation.
 capable of creating a tight seal on
the face, covering both mouth and
nose.
Bag-Mask Ventilation

 lone rescuer using a bag-mask


device should be able to
simultaneously open the airway with
a jaw lift, hold the mask tightly
against the patient’s face, and
squeeze the bag.
 rescuer must also watch to be sure
the chest rises with each breath.
 most effective when provided by 2 trained
and experienced rescuers.
 One rescuer opens the airway and seals
the mask to the face while the other
squeezes the bag. Both rescuers watch
for visible chest rise.
 use an adult (1 to 2 L) bag to
deliver a tidal volume sufficient to
achieve visible chest rise .

 If the airway is open and there are


no leaks this volume can be
delivered by squeezing a 1-L adult
bag about one half to two thirds of
its volume or a 2-L adult bag about
one-third its volume.
 consist of rhythmic applications of
pressure over the lower half of the
sternum.
 Creates blood flow by increasing
intrathoracic pressure and directly
compressing the heart.
 properly performed chest compressions
can produce systolic arterial pressure
peaks of 60 to 80 mm Hg
› diastolic pressure is low and mean arterial
pressure in the carotid artery seldom exceeds
40 mm Hg.
 Blood flow generated delivers a small
but critical amount of oxygen and
substrate to the brain and
myocardium.
 In victims of VF, increase the likelihood
that a shock (ie, attempted
defibrillation) will be successful.
 especially important if the first shock is
delivered 4 minutes after collapse.
1. "Effective" chest compressions are
essential for providing blood flow
during CPR.
2. To give "effective" chest compressions,
"push hard and push fast.
• Compress the adult chest at a rate
of about 100 compressions per
minute, with a compression depth
of 1 to 2 inches (approximately 4
to 5 cm).
• Allow the chest to recoil
completely after each
compression, and allow
approximately equal compression
and relaxation times.
3. Minimize interruptions in chest
compressions.
 Tomaximize the
effectiveness of
compressions, the
victim should lie supine
on a hard surface (e.g.
backboard or floor) with
the rescuer kneeling
beside the victim’s
thorax
 compress the lower half of
the victim’s sternum in the
center (middle) of the chest,
between the nipples

 place the heel of the hand


on the sternum in the
center (middle) 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.
 Depress the sternum
approximately 1 to 2 inches
(approximately 4 to 5 cm)
and then allow the chest to
return to its normal position.
 Complete chest recoil allows
venous return to the heart, is
necessary for effective CPR,
and should be emphasized in
training.
 Compression and chest
recoil/relaxation times should
be approximately equal.
 compression rate of about
100 compressions per
minute.
 30:2
 designed to increase the number of
compressions, reduce the likelihood of
hyperventilation, minimize
interruptions in chest compressions for
ventilation, and simplify instruction for
teaching and skills retention
 Once an advanced airway is in place, 2
rescuers no longer deliver cycles of
CPR (ie, compressions interrupted by
pauses for ventilation).
 Instead, the compressing rescuer
should give continuous chest
compressions at a rate of 100 per
minute without pauses for ventilation.
Adult Child Infant
Depth: 11/2-2 in 1-11/2 in ½-1 in
Rate: 100 per min 100 per minute 100 per minute
C:V Ratio 30:2 (Old =15:2 30:2 (Old=30:2 30:2 (for
for 1 rescuer; 5:1 for 1 rescuer; old=30:2 for 1
for 2 rescuers) 15:2 for 2 rescuer; 15:2 for
rescuer) 2 rescuers)
Rescue Breathing 1 blow every 5-6 1 blow every 3 1 blow every 3
secs (2 mins=24 secs (2 mins = secs (2 mins =
cycles) 40 cycles 40 cycles

What to use 2 hands (overlap) 1 hand 2 fingers


during
compression?
Where to locate? In between nipple In between nipple In between nipple
line line line
S- spontaneous recovery
T- turned over to advance medical
practitioner
O- operator is exhausted
P- physician assumes responsibility
S- Scene becomes unsafe
  Most cases in adults are caused by
impacted food and occur while the
victim is eating
  Most episodes of choking in infants
and children occur during eating or
play, when parents or childcare
providers are present.
 Signs of FBAO
- universal sign of choking (hands
clutching throat)
- inability to speak
- weak, ineffective or silent coughs
- high pitched sounds while inhaling
- inc. difficulty in breathing
-blue lips and skin
 Intervention is done if the choking victim
has signs of severe airway obstruction.
› silent cough, cyanosis, or inability to
speak or breathe.
› victim may clutch the neck
 Quickly ask, "Are you choking?" If
the victim indicates "yes" by
nodding his head without
speaking, this will verify that the
victim has severe airway
obstruction.
 mild obstruction and victim is coughing
forcefully, do not interfere with the
patient’s spontaneous coughing and
breathing efforts
 attempt to relieve the obstruction only if
signs of severe obstruction develop
 Activate the EMS system quickly if the
patient is having difficulty breathing.
 If more than one rescuer is present, one
rescuer should phone 911/117 while the
other rescuer attends to the choking victim.
 recommended that the abdominal
thrust be applied in rapid sequence
until the obstruction is relieved.
 If abdominal thrusts are not
effective, the rescuer may consider
chest thrusts.
 It is important to note that
abdominal thrusts are not
recommended for infants <1 year of
age because thrusts may cause
injuries.
 abdominal thrusts
 chest thrusts
› Middle of sternum
- For obese and pregnant
forcefully
cough and
speak…….
 used for unresponsive adult victims
who have normal breathing and
effective circulation
 designed to maintain a patent airway
and reduce the risk of airway
obstruction and aspiration
 victim is placed on his or her side with
the lower arm in front of the body
 position should be stable, near a true
lateral position, with the head
dependent and no pressure on the
chest to impair breathing.
 extension of the lower arm above the
head and rolling the head onto the
arm, while bending both legs, may be
feasible for victims with known or
suspected spinal injury
 Fractured ribs

 Lacerated liver

 Punctured Lungs

 Gastric Distention
 Good Samaritan Laws – intended to
minimize fear of legal consequences
for providing CPR.
 Protects the liability of laypersons and
health professionals who do not have a
duty to respond, who are acting in
“good faith” and who are not guilty of
negligence.