CPR & EKG Flashcards
WHAT IS CPR?
IT STANDS FOR : Cardiopulmonary Resuscitation
WHAT IS Cardiopulmonary Resuscitation ?
is a combination of oral resuscitation (mouth-to-mouth breathing), which supplies oxygen to the lungs, and external cardiac compressions, which are intended to re-establish cardiac function and circulation
WHEN IS CPR USED?
CPR is used as a response to cardiac failure (cardiac arrest) and respiratory failure.
WHAT DOES AHA STAND FOR?
American Heart Association (AHA).
WHAT DID THE AHA CPR RECOMMENDED?
In October 2010, new guidelines for CPR were released by the American Heart Association (AHA).
WHAT WAS A SIGNIFICANT CHANGE ?
The most significant change was the order in which CPR was started
CPR provides external support for circulation and respiration,
it also consists of three primary aspects known as –
ABC’s – Airway, Breathing and Circulation/Chest Compressions.
WHAT DID THE AHA REPLACED TO ABC ORDER TO?
CHEST COMPRESSION/CIRCULATION-C
AIRWAY-A
BREATHING-B
New guidelines have replaced the ABC order with CAB emphasizing the need, particularly for non-health care providers, to start with chest compressions first.
CPR IS NOW - C A B
COMPRESSION- PUSH HARD AND FAST ON THE CENTER OF THE VICTIMS CHEST
AIRWAY- TILT THE VICTIMS HEAD BACK AND LIFT THE CHIN TO OPEN THE AIRWAY
BREATHING- BREATHING- GIVE MOUTH TO MOUTH RESCUE BREATHS
WHAT CAN EARLY CHEST COMPRESSION DO?
IT CAN IMMEDIATELY CIRCULATE OXYGEN THAT IS STILL IN A BLOOD STREAM
WHAT DID AHA RECOMMENDED THE INITIAL PROCESS TO BE?
The initial process should begin with 30 compressions at a rate of 100 compressions/minute followed by the establishment of an airway and rescue breathing.
WHAT IS THE VENTILATION RATIO?
A universal compression-ventilation ratio (30:2) is recommended for all single rescuers for infant, child, and adult victims.
WHAT IS THE 30:2 RATIO?
30 chest compressions
2 ventilations or rescue breaths
WHAT IS A CARDIAC ARREST?
Sudden cessation of functional ventilation and circulation.
The heart stops beating, and no pulse can be found.
WHAT ARE THE SYMPTOMS OFCARDIAC ARREST?
-Absence of carotid or femoral pulse
-Apnea
-Dilated pupils
WHAT DOES Cyanosis becomes evident with?
Cyanosis becomes evident with respiratory failure.
WHAT COLOR IS THE SKIN WITH Cyanosis?
BLUE
CALLING FOR HELP
Help inside the hospital includes calling a code.
Each hospital will have its own procedure and protocol for calling a code (i.e. red, code 99).
Once the code is called within the hospital, an emergency response team will respond STAT.
The radiographer should be able to perform CPR or assist the emergency response team as needed.
If a code is called outside the hospital (i.e. a MVA site, 911 is called).
HOW MANY MINUTES CAN THE BRAIN SURVIVE WITHOUT OXYGEN?
The human brain cannot go longer than 4 to 6 minutes without oxygen before brain damage will occur.
WHAT CAN HAPPEN IF THE BRAIN GOES ON 4-6 MINS WITHOUT O2?
BRAIN DAMAGE
STEPS INVOLVED IN CPR (One Person CPR)
Establish the unresponsiveness of the patient.
The “shake and shout method should be used to produce a response from the patient.
If there is no response, check the patient’s breathing and feel for a pulse.
If the patient has stopped breathing and no pulse can be detected follow the next step.
WHAT DO YOU DO IN A CPR?
Call for help STAT (i.e., you with the black shirt, call 911 and get back to me).
Position the patient on their back on a flat, hard surface if necessary.
Put on gloves.
WHAT WOULD BE THE STEP FOR CIRCULATION/COMPRESSIONS?
Apply external cardiac compressions.
Apply 30 compressions
WHERE WOULD THE HAND PLACEMENT BE?
Place the heel of the hand on the
midline of the sternum directly above the xiphoid process.
Lock elbows and arms.
Give 30 compressions in a smooth even rhythm about
2 inches in depth at a rate of 100 compressions per minute.
HOW DO YOU OPEN THE AIRWAY?
Open the Airway by tilting the head back gently to prevent the tongue from falling back and obstructing the airway.
Place one hand on the forehead and the other on the victim’s chin.
HOW DO YOU ESTABLISH BREATHLESSNESS?
Place an ear over the victim’s nose and mouth and look at the chest.
Look for the rise and fall in the chest.
Listen for breath sounds. No more than 10 seconds to check for breathing.
Feel for the flow of air from the victim’s nose.
if no breath is apparent, then proceed with rescue breathing.
continue
Perform Rescue Breathing
Place one hand on the forehead of the victim and using the thumb and fingers pinch the victim’s nostrils shut.
Take a deep breath and seal your lips around the victim’s mouth or place a one-way airway mask tightly over the mouth and nose.
Give two rescue breaths for 1 second each and observe if the chest rises and falls.
How to Establish Circulatory Inadequacy?
Establish Circulatory Inadequacy by palpating the carotid artery.
If after 5 to 10 seconds, the pulse is absent, then proceed with the continued closed chest compressions.
reassess
Re-assess the patient’s condition after 5 complete cycles of compressions and ventilations (30:2) ratio, by taking no more than 7 seconds to reevaluate the patient, if breathing and pulse are still absent then continue CPR, checking every few minutes for a return of pulse and breathing.
What are some complications of CPR?
- RIBS FRACTURE
-PHENUMTHORAX
-FRACTURED STERNUM
-FAT EMBOLI
-LACERATED LIVER AND SPLEEN
What is Pneumothorax ?
a collection of air or gas in the pleural space, that surrounds the lungs, causing the lungs to collapse.
What is a Fat Emboli?
An embolus is a blockage of an artery in the lungs by fat, air, clumped tumor cells, or a blood clot.
How is THE TWO-PERSON RESCUE CPR DONE?
The protocol for two persons performing CPR is similar but this involves one person doing ventilations and the other doing the compressions with periodic switching of positions.
Person Placement:
One rescuer is at the victim’s side and performs chest compressions
The second rescuer is at the victim’s head and maintains an open airway and provides breathing, usually using a one-way airway mask.
Rescuers often switch positions when they become fatigued, in an organized manner.
HOW IS INFANT CPR DONE?
The protocol for two persons performing CPR is similar but this involves one person doing ventilations and the other doing the compressions with periodic switching of positions.
Person Placement:
One rescuer is at the victim’s side and performs chest compressions
The second rescuer is at the victim’s head and maintains an open airway and provides breathing, usually using a one-way airway mask.
Rescuers often switch positions when they become fatigued, in an organized manner.
INFANT CPR
Air Volume
Just enough to cause the chest to rise and fall.
Placement of hands
For children 8 y/o and older it is the same as for adults.
For infants, the two fingers are used instead of the palm/heel of the hand on the sternum.
Depth of Compressions
For children 8 y/o and older the sternum is compressed about 1 to 1/½ inches in depth.
For Infants, the sternum is compressed about ½ to 1 inch in depth.
WHAT IS HEALTH CARE PROXY ALSO KNOWN AS?
Advanced Health Care Directi
What is a HEALTH CARE PROXY?
A written, signed legal document that allows you to designate a person to speak for you when you are unable, to direct the medical care that you will receive.
What is a Life-Sustaining Treatment ?
includes drugs or machines, or medical procedures that you would keep you alive but would not cure you. Even if you choose not to have life sustaining treatment, you will get medications and treatments that ease your pain and keep you comfortable.
What is Artificially Provided Food and Hydration?
If you become permanently unconscious you may be given food and water through a tube or IV to keep you alive if you can no longer chew or swallow on your own.
BASIC CARDIAC MONITERING
Cardiac output is determined by two key factors:
Heart rate
Left ventricular output (stroke volume)
Electrocardiography is an electric assessment of the heart’s ability to perform its vital function.
EKG and ECG can be used synonymously.
ELECTROCARDIOGRAM (ECG, EKG)
An electrocardiogram (ECG, EKG) measures the heart’s electrical signal as it triggers each of the four heart chambers to pump (contract).
Small pads (electrodes) are attached to the surface of the skin to detect electrical signals.
The electrodes are attached with wires to a machine that draws a graph of the electrical signals.
ELECTRODE PLACEMENT
A comprehensive measurement of the heart’s signal requires 10 electrodes, 6 on the chest and 4 distributed across the arms and legs.
Each electrode measures the heart’s electrical activity. An ECG translates the heart’s electrical activity into line tracing on paper.
Your physician may use the EKG to:
If a heart condition is suspected, an EKG is a quick, safe, painless test that is often part of a routine physical exam.
Your physician may use the EKG to:
-Assess your heart rhythm
-Diagnose poor blood flow to the heart muscle (ischemia)
-Diagnose a heart attack
-Evaluate certain abnormalities of your heart, such as an enlarged heart.
CARDIAC FUNCTION
Heart function is to pump blood through vessels to vital organs and tissues.
Maintains cellular perfusion
Generally, requires a systolic pressure greater than 90 mm Hg
Four heart chambers:
Left heart
-Lt atrium
-Lt ventricle
Right heart
-Rt atrium
-Rt ventricle
CARDIAC CYCLE
Cardiac events that occur from the beginning of one ventricular contraction (systole) until the beginning of another.
Systole
Diastole
Rhythmic
Cardiac Conduction System
The heart is composed of two principal cell types:
Working cardiac cells (myocardium)
Specialized neural conductive cells
Cardiac Conduction System (Cont.)
Sinoatrial node (SA node)
-Pacemaker of the heart
Atrioventricular node (AV node)
Bundle of His
Purkinje fibers
Cardiac Conduction System (Cont.)
Specialized neural cells originate in and transmit electrical impulses across the myocardium and regulate the rhythm of a cardiac cycle.
Independent of nerves or hormones
Automaticity
Influenced by sympathetic and parasympathetic nervous systems
Abnormalities within the neural conduction system create arrhythmias.
ECG Tracing
Represents an electrical graphic display of changes in cardiac membrane potentials as a function of time
Isoelectric line
WAVES
P wave
QRS complex
T wave
U wave
PR interval
WAVES
The individual spikes and dips in the line tracings are called waves.
The P wave represents the electrical activity in the atria (depolarization or contraction).
The Q, R and S wave called the QRS complex represents the electrical activity in the ventricles (depolarization or contraction).
WAVES
The T wave represents the electrical recovery or repolarization of the ventricles.
Repolarization is the restoration of a polarized state across a membrane, as in a muscle fiber following a contraction.
During the straight-line segments, the heart is in arterial and ventricular systole (relaxation).
Cardiac Events Seen on ECG
Depolarization of atrial muscle:
P wave
Depolarization of ventricular muscle:
QRS complex
Repolarization of ventricular muscle:
T wave
ECG ANALYSIS
Is the rhythm regular or irregular?
Are all QRS complexes similar, and are they narrow?
Are all P waves similar, and are PR intervals normal?
Is the rate normal?
Do waves and complexes proceed in normal sequence?
COMMON ARRHYTHMIAS
-Bradycardia
-Tachycardia
-Fibrillation
-Premature ventricular contractions (PVC)
-Ventricular Tachycardia
-Ventricular Fibrillation
-Asystole
What is ATRIAL FIBRILLATION (AFIB)
IS THE MOST COMMON TYPE OF HEART ARRHYTHMIA
WHAT IS AFIB?
IT OCCURS WHEN THE UPPER CHAMBERS AND THE LOWER CHAMBER ARE NOT COORDINATED CAUSING THE HEART TO BEAT TOO SLOWLY, TOO QUICKLY OR IRREGULARLY.
Treatment of Arrhythmias
Antiarrhythmic medications
Cardioversion therapy
Cardiac surgery
Cardiac ablation
Implantable devices
* Cardiac pacemaker
* Implantable cardioverter defibrillator(ICD)
CONCLUSION
-Assessment of the hearts ability to perform its vital function as possible using a device called a electrocardiograph
ECG analysis requires a thorough understanding of the cardiac cycle
abnormalities of the heart that interfere with its neutral conduction system cause cardiac arrhythmias
Treatment of arrhythmia are varied on the basis of severity and location of the disorder
