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CPR

mashehabat@just.edu.jo

CPR
Introduction During a Cardiac Arrest, the heart stops pumping, the person stops breathing and becomes unconscious. The Brain, will suffer permanent & irreversible damage if blood circulation to the brain is not restored within 4 minutes. Heart Disease is the 2nd most common cause of death in Singapore cause of 24% of total mortality About 2400 people suffer from heart attack each year Nearly 1000 of them occur out-of-hospital Survival rate of 2.6% for out-of-hospital collapses

What can we do to reduce Sudden Death? Education & training in CPR In An Emergency - take action within first few minutes / ASAP

YOU & I can make the difference in helping a family member, loved one, a friend and maybe a stranger

CPR Programme
To familiarize the community (both staff and students) with the knowledge and skills in CPR so as to enable them to act in an emergency situation to save lives Training Objectives To understand the importance of CPR in a Arrest/Heart Attack emergency To perform the steps of CPR competently Cardiac

To be able to operate the AED confidently & safely

CPR Programme
Definition of Cardio-Pulmonary Resuscitation (CPR) CPR includes a series of assessments & interventions that support cardiac & pulmonary functions
Cardiac Arrest = Heart stops beating & oxygen circulation ceases

No Circulation > 4 mins = organ death, permanent irreversible damage

>>> Important to start CPR promptly <<<


CPR done correctly & promptly: Heart function can be restored Circulation may be maintained until application of other life support measures

CPR & AED Familiarization Programme


Concept of Chain of Survival

Early Recognition and Access

Early CPR

Early Defibrillation

Early Advanced Care

CPR Programme

How do you know it is a Heart Attack?


Chest discomfort or pain Other symptoms any or all may appear Sweating Nausea Shortness of breath Weakness Symptoms may appear suddenly & victim does not realize it is a heart attack; may think it is indigestion

What commonly causes Sudden Collapse?


Heart Attack Foreign Body Airway Obstruction Suffocation Drowning Stroke Drug Overdose Smoke Inhalation Electrocution Severe Allergic Reactions Severe Trauma, e.g.. an accident

Heart Attack death can be prevented?

Only if Prompt help by someone applying CPR until medical help arrives

CPR & AED Familiarization Programme


One-Man CPR Techniques

Step 1: Assessment Determine responsiveness


Check site for danger, e.g. chemical spill, exposed electrical wire, falling items, fire, leaked fuel & gas Check patient responsiveness tap shoulders gently call out loud Hello! Hello! Are you Ok?
Hello! Hello! Are you Ok?

One-Man CPR Techniques

Step 2 : Activate Emergency Service


Call loudly for help
Call 995 or campus security @ 6874 1616 for help Get someone to call for help
Call 995 for ambulance. Get the AED here.

One-Man CPR Techniques

Step 3 : Position the patient

patient must be lying flat on his/her back on a firm ground Place patient in correct position (flat on back)

One-Man CPR Techniques

Step 4: Open Airway


Place one hand on forehead & apply firm backward pressure with palm to tilt head back Place finger on the chin bone and lift the jaw forward (jaw trust) Open mouth gently and remove any obvious obstructing foreign body, e.g.. food, loose denture or secretions (finger sweep)

Head Tilt Chin Lift

One-Man CPR Techniques

Step 5 : Check Breathing


Do the head tilt-chin lift to open airway

Place own ear & cheek over casualtys mouth & nose for:
Look for chest rise and fall Listen air escaping during exhalation Feel - for the flow of air from patients nose

One-Man CPR Techniques

Step 6 : Mouth-to-Mouth Breathing


Maintain head tilt-chin lift to open airway
Pinch nose with thumb & index finger Cover mouth-to-mouth fully Give 2 short breaths (1 sec each) & watch chest rise Ventilation volume between 400 to 600mls
Use resuscitation mask / face mask for mouth-to-mouth resuscitation, if possible

One-Man CPR Techniques

Step 7 : Check for Circulation / Pulse


Maintain the head tilt-chin lift to open airway Use index finger centre of throat & slide into the groove to locate the carotid pulse Feel for pulse for about 10 secs & look for Signs of Circulation

Look for
Signs of Circulation (CCMB) Consciousness Coughing Movement Breathing

One-Man CPR Techniques Step 8 : Locate Hand position for Chest Compressions
Run finger from rib cage to reach the sternal notch Place index finger next to center finger Place heel of the hand next to the index finger

Step 1

Step 2

Step 3

One-Man CPR Techniques

Step 9 : Perform Chest Compression


Place the other hand on top of the hand on the sternum & interlock the fingers Straighten both elbows and lock in position Position shoulder directly over the casualtys chest Use body weight to compress chest about 4-5cm

Step 1

Step 2

Ratio of CPR is 30 compression plus 2 ventilation Compression rate @ 100/min Perform 3 cycles of CPR

One-Man CPR Techniques

Step 10 : Reassessment
Check for Pulse or Signs of Circulation (CCMB) If No - Continue CPR 30 : 2 If Yes - Check for external injuries; - Place casualty in recovery position and maintain open airway Monitor casualty every few minutes until help arrives

One-Man CPR Techniques

Recovery Position
Step 1 : Position the Casualty (a) Tuck hand nearer to you, arm straight & palm upwards under thigh (b) Bring arm from across & place back of the hand against cheek (c) Bend the far knee to 90 degree angle

Recovery Position
Step 2 : Roll casualty towards the rescuer

Place palm on palm of patient hand on cheek & hold far hip and roll till lying on the side Use knee to support to prevent rolling too far forward

Recovery Position
Step 3 : Final Recovery Position Head (cheek) lie on the back of his palm Other hand lying free along side of body The former far leg should be bent at 90 degree

Automated External Defibrillation (AED)


The most important factors that increase the chance of survival in sudden cardiac arrest are external cardiac massage and time to the first electrical defibrillation. Survival rate as high as 90% has been reported when defibrillation is achieved within the 1st minute of collapse and this declines 7 - 10% for every minute that defibrillation is delayed, such that a cardiac arrest victim without defibrillation beyond 10 minutes has only a 2 - 5% chance of survival. What is an AED? A device that delivers electrical shock to restart the pumping action of the heart

When to use an AED? patient in full Cardiac Arrest Signs of Cardiac Arrest: - Unconscious - No breathing - No pulse / signs of circulation

When in doubt, apply the AED

Two-Man CPR+AED Techniques


Preparation of Casualty
Check indicator to confirm AED is functional Verify Cardiac Arrest before applying defibrillation Check Area for Dangers - Water, Metal & Gas. (WMG) If need be, move patient to safer place. Remove clothing to expose chest for AED application Check & Remove Hair (thick chest hair), Jewelry, Medicated Patches. Avoid placing pads over Pace Maker. Dry Skin if set. (HJMPS) Do any thing to improve the adhesion of electrodes to the skin

Placement & Attachment of AED Pads on Patient


Open AED & check defibrillation pad cables are firmed attached to AED Follow the AED Voice Prompt Instruction from now on Remove Pads from packet & the protective backing from pads Place one pad on the Right of Upper Half of Sternum (breastbone), just below the casualtys right clavicle (collarbone) Place the other pad just below and to the Left of the Left Nipple

For female casualty, place it just below and to the left side of the breast
Do not place pads over the nipples, or breast (for female)

Two-Man CPR+AED Techniques


Safety Issues when Using an AED (for Operator & By-Standers) Ensure area around the casualty is clear Do not allow anyone touch or come into contact with casualty, when: During Analysis: Contact will interfere with the accuracy of AED reading During Defibrillation: Ensure no one is touching the casualty when shock is delivered as electricity can be transmitted If casualty is on wet surface, move to a dry area, if available If casualty is on metal surface, place blankets, if available, between casualty and metal surface

DO NOT DEFIBRILLATE when; patient is responsive, breathing or has a pulse / signs of circulation Someone is touching the casualty There are flammable gases or in explosive environments

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