Why is it so important that everyone/ lay people etc know the basics of CPR?
- Each year, UK ambulance services respond to approximately 60,000 cases of suspected cardiac arrest. Resuscitation is attempted by ambulance services in less than half of these cases .• Either because the Patient is dead by the time emergency services arrived OR they haven’t received bystander CPR
- Even when attempted, only less than 1/10 victims survive.
Strengthening the community response to cardiac arrest by training and empowering more bystanders to perform CPR and by increasing the use of automated external defibrillators (AEDs) at least doubles the chances of survival and could save thousands of lives each year (Resuscitation Council UK 2015).
CHAIN OF SURVIVAL:
1) Early recognition and call for help
- outline and explain why early recognition is so important
- Once cardiac arrest has occurred, early recognition is critical to enable rapid activation of the ambulance service and prompt initiation of bystander CPR.
- If untreated, cardiac arrest occurs in a quarter to a third of patients with myocardial ischaemia (not enough blood flow to heart) within the first hour after onset pf chest pain.
CHAIN OF SURVIVAL:
2) Early bystander CPR
- why is this good? is it done enough?
-The immediate initiation of bystander CPR can double or quadruple survival from out-of-hospital cardiac arrest. Despite this compelling evidence however, only 40% victims received bystander CPR in the Uk.
CHAIN OF SURVIVAL:
3) Early defibrillation
-why is this so important?
STATISTICS lol
- Defibrillation within 3-5 min of collapse can produce survival rates as high as 50-70%.
- This can be achieved through public access defibrillation, when a bystander uses a nearby AED to deliver the first shock.
- Each minute id delay reduces the probability for survival to hospital discharge by 10%.
- In the UK, fewer than 2% of victims have an AED deployed before the ambulance arrives .
CHAIN OF SURVIVAL:
4) Early advanced life support and standardised post-resuscitation care
- when might this be necessary?
-Advanced life support with airway management, drugs and the correction of casual factors may be needed if initial attempts at resuscitation are unsuccessful. The quality of treatment during the post-resuscitation phase affects outcome.
what does the Resuscitation council recommend to improve survival from cardiac arrest:
- All school children are taught CPR and how to use AED
- Everyone who is able to should learn CPR
- Defibrillators must be available in places where there will be large numbers of people, increased risk of cardiac arrest (e.g. gyms, sports facilities) or where access to emergency services can be delayed (e.g. aircraft and other remote locations)
- Owners of defibrillators should register the location and availability of devices with their local ambulance services.
- Systems are implemented to identify and deploy the nearest available defibrillator to the scene of a suspected cardiac arrest.
- All out of hospital cardiac arrest resuscitation attempts are reported to the National-out-of-hospital cardiac rest audit.
what is the SAFE approach?
Used in primary assessment
•S= Safety/Danger/Shout
-Shout for help!!! You have not assessed the patient so you do not need to call an ambulance/ resuscitation tea, at the this time as the patient may only be asleep.
• A= Approach with care
-Ensure that there are not any hazards, traffic, broken glass, fluids on the floor/ wires that you may trip over.
• F= Free from danger
-Not always better to move the casualty and carry out resuscitation where they have collapsed. However, switching off the power in an electric shock, moving the casualty if fire is present all needs to be considered.
• E= Evaluate
-Need to assess whether the casualty is unconscious or rousable.
Primary assessment:
-sequence and what you need to look for
• RESPONSE: check the victim for a response by gently shaking their shoulders and asking loudly, “Are you all right?”
- Responsive: If they respond, leave them in the position that you found them in; try to figure out what’s wrong with them and get help if needed; reassess regularly.
- Unresponsive: promptly assess the unresponsive victim to determine if they are breathing normally.
• Airway: open the airway by turning the victim onto their back. Place your hand on their forehead and gently tilt their head back; with your fingertips under the point of the victim’s chin, lift the chin to open up the airway.
- Look for any possible obstructions.
- Don’t delay assessment by checking for obstructions in the jaw.
- The jaw thrust and finger sweep are not recommended for the lay provider.
• Breathing: look, listen and feel for normal breathing for no more than 10 seconds while looking for signs of life.
- In the first few seconds after cardiac arrest, a victim may be barely breathing or taking infrequent, slow and noisy gasps. DON’T CONFUSE WITH ORMAL BREATHING.
- If in doubt that the breathing is normal, act as if they are NOT breathing normally and prepare for CPR.
How to carry out CPR:
1)Compressions
• Circulation: cardiopulmonary resuscitation (CPR).
-Start chest compressions
1. Kneel by side of the victim and place heel of one hand in the middle of the victim’s chest
2. Place the heel of your other hand on top of the first hand
3. Interlock the fingers of your hands and ensure that pressure is not applied over the victim’s ribs
• Chest compressions:
-Keep arms straight
-Don’t apply pressure in the upper abdomen or the bottom end of the bony sternum (breastbone)
-Press down on the sternum to a depth of 5-6cm.
-After each compression, release all the pressure on the chest without losing contact between your hands and the sternum.
-Repeat a rate of 100-120 min-1
CPR:
2) Rescue breaths in adults VS children
adults- 30:2
child- 15:2
CPR:
3) If an AED arrives
- Attach the electrode pads on the victim’s bare chest
- If more than one rescuer is present, CPR should be continued while electrode pads are being attached to the chest.
- Follow the spoken/visual directions
- Ensure that nobody is touching the victim while the AED is analysing the rhythm
How do you fo the recovery position?
- Kneel next to person and remove their glasses and any other bulky objects on their person- but do not search pockets for small items
- Make sure their legs are straight
- Take the arm nearest and place at a right angle to the body facing upwards
- Take the other arm and bring it across the chest and place the back of the hand against their cheek nearest to you and hold it there.
- With your other hand lift their far knee up until the foot is flat on the floor.
- Whilst keeping the casualty’s hand pressed against their cheek, pull the far leg and carefully roll the casualty towards you and onto their side.
- Once you’ve done this, adjust the top leg so that it is at a right angle.
- Tilt the casualty’s head back so that the airway remains open.
- If needed, adjust the hand on the cheek to help keep the airway open. - If has not already been done, call 999 or 112
- Keep checking the level of response.
For all in-hospital cardiac arrests, esure that:
- cardiorespiratory arrest is recognised immediately
- help is summoned using a standard telephone number (e.g. 2222)
- CPR is started immediately and, if indicated, defibrillation is attempted as soon as possible (within 3 min)
what are the basic principles of the ABCDE approach?
The ABCDE Approach 1 Underlying principles 2 First steps 3 Airway (A) 4 Breathing (B) 5 Circulation (C) 6 Disability (D) 7 Exposure (E)
In-hospital cardiac arrests: how to open airways
- Use whatever equipment is available immediately for airway and ventilation (e.g. a self-inflating bag-mask, or a supraglottic airway device (LMA) and bag according to local policy).
- Use an inspiratory time of about 1 second and give enough volume to produce a visible rise of the chest wall. Avoid rapid or forceful breaths.
- Add supplemental oxygen as soon as possible.
what is tracheal intubation and who can perform it?
- Tracheal intubation should be attempted only by those who are trained, competent and experienced in this skill, and can insert the tracheal tube with minimal interruption (less than 5 seconds) to chest compressions.
- Waveform capnography must be used routinely for confirming that a tracheal tube is in the patient’s airway and subsequent monitoring during CPR.
- Waveform capnography can also be used to monitor the quality of CPR, as an indicator of a return of spontaneous circulation (ROSC) and to help with determining prognosis during CPR.
what do you do when the defibrillator when it/ if it arrives?
what shoudd you look for on the ECG?
next actions?
Defibrillation
• As soon as a defibrillator arrives, apply the self-adhesive pads to the patient’s chest whilst chest compressions are ongoing. The use of adhesive electrode pads will enable rapid assessment of heart rhythm compared with the use of ECG electrodes.
• Once the pads are applied, pause briefly for a rapid rhythm check – aim for a pause in chest compressions of less than 5 seconds.
ECG- (Electrocardiogram)
• If the rhythm is ventricular fibrillation / pulseless ventricular tachycardia (VF/pVT), restart chest compressions.
-VF= heart quivers instead pf pumps because of discorganized electrical activity in ventricles.
-pVT= MEDICAL EMERGENCY! Coordinated ventricular contractions replaced by very rapid but ineffective contractions.
• All other team members must now be informed to stand clear of the patient whilst the defibrillator is charged and a safety check performed. Once the defibrillator is charged and the safety check completed, stop chest compressions, deliver the shock and restart chest compressions immediately.
• Do not delay restarting chest compressions to check the cardiac rhythm.
• Using a manual defibrillator, it is possible to reduce the pause between stopping and restarting of chest compressions to less than 5 seconds.
• If staff cannot use a manual defibrillator, use an automated external defibrillator (AED). Switch on the AED and follow the audio-visual prompts.
