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Cpr Aed

Gram McGregor, 1Lt, CCAT Nurse
Jeff Pintler, SSgt, Combat Medic
141 Medical Group, Washington Air Guard

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Cpr Aed

  1. 1. Cardiopulmonary Resuscitation and the Automatic External Defibrillator Gram McGregor, 1Lt, CCAT Nurse Jeff Pintler, SSgt, Combat Medic 141 Medical Group, Washington Air Guard
  2. 2. Cardiopulmonary Resuscitation (CPR)* <ul><li>Establish Unresponsiveness </li></ul><ul><li>Send someone to call emergency services as able </li></ul><ul><li>If alone, leave the victim to call emergency services as able </li></ul><ul><li>* per American Heart Association guidelines </li></ul>
  3. 3. CPR cont. <ul><li>Airway </li></ul><ul><ul><li>Head tilt-chin lift </li></ul></ul><ul><li>Breathing-Look listen and feel </li></ul><ul><ul><li>Give two slow breaths </li></ul></ul><ul><li>Circulation-check for a pulse or other signs of circulation </li></ul><ul><ul><li>Start chest compressions </li></ul></ul>
  4. 4. Performing a pulse check <ul><li>Maintain head tilt </li></ul><ul><li>Place 2 or 3 fingers on the Adam’s apple. </li></ul><ul><li>Slide fingers into groove between Adam’s apple and the muscle, pull fingers towards you </li></ul><ul><li>Feel for pulse at this position no more then 10 seconds </li></ul><ul><li>If no pulse, start chest compressions </li></ul>
  5. 5. Performing chest compressions <ul><li>Find position on lower half of sternum right between nipples/middle of chest. </li></ul><ul><li>Place heel of one hand on this position </li></ul><ul><li>Place heel of second hand on top of first </li></ul><ul><li>Position body directly over hands </li></ul><ul><li>Begin chest compressions </li></ul>
  6. 6. By the numbers* <ul><li>Rate: 100 compressions a minute </li></ul><ul><li>One or two rescuer: </li></ul><ul><ul><li>15 compressions, then 2 slow breaths </li></ul></ul><ul><ul><li>Recheck pulse and respirations every 4 cycles or roughly one minute </li></ul></ul><ul><li>Continue until exhausted or relieved by higher level of medical care provider </li></ul><ul><ul><li>*per American Heart Association guidelines </li></ul></ul>
  7. 7. Choking-Foreign Body Airway Obstruction <ul><li>If conscious, confirm problem by asking patient </li></ul><ul><li>Universal sign </li></ul><ul><li>Contraindications </li></ul><ul><ul><li>Ability of patient to talk </li></ul></ul><ul><ul><li>Ability of patient to forcefully cough </li></ul></ul><ul><ul><li>Ability of patient to continue to move air </li></ul></ul><ul><ul><ul><li>Continue to monitor patient </li></ul></ul></ul>
  8. 8. Conscious-Heimlich Maneuver <ul><li>If patient conscious and standing but unable to talk </li></ul><ul><li>Make fist with one hand </li></ul><ul><li>Place thumb side of fist on patient’s abdomen </li></ul><ul><li>Grasp fist with other hand and provide quick upward thrusts </li></ul><ul><li>Repeat until object expelled or the victim becomes unconscious </li></ul>
  9. 9. Unconscious-Abdominal thrusts <ul><li>For unconscious patients </li></ul><ul><li>Place on back </li></ul><ul><li>Grasp jaw and lift the jaw and tongue with one hand </li></ul><ul><li>Perform a finger sweep with the index finger of other hand </li></ul><ul><li>Attempt slow rescue breathing </li></ul><ul><li>If chest fails to rise, reposition head and reattempt rescue breaths </li></ul>
  10. 10. Unconscious-Abdominal thrusts continued <ul><li>Straddle the patient </li></ul><ul><li>Place heel of one hand on abdomen just above the navel </li></ul><ul><li>Place the heel of the other hand on top of the first and provide up to 5 quick abdominal thrusts </li></ul><ul><li>Recovery position </li></ul>
  11. 11. Automatic External Defibrillator A shocking lecture
  12. 12. Rationale <ul><li>Most frequent initial rhythm in adult cardiac arrest: ventricular fibrillation </li></ul>
  13. 13. Rationale <ul><li>Most effective treatment for VF: defibrillation </li></ul>
  14. 14. Rationale <ul><li>Increased VF time = Decreased survival probability </li></ul>1 minute of VF = ~10% decrease in chance of survival
  15. 15. Rationale <ul><li>BLS cannot convert VF to normal sinus rhythm </li></ul><ul><li>BLS only increases time available to defibrillate </li></ul>
  16. 16. Principle of Early Defibrillation All personnel who respond to cardiac arrests must be trained to operate, equipped with, and permitted to operate a defibrillator
  17. 17. AED Definition <ul><li>Computerized defibrillator that can: </li></ul><ul><ul><li>Analyze the heart rhythm of a person in cardiac arrest </li></ul></ul><ul><ul><li>Recognize a shockable rhythm </li></ul></ul><ul><ul><li>Advise the operator whether the rhythm should be shocked </li></ul></ul><ul><li>Indicated in patients with sign of cardiac arrest such as unresponsive, not breathing and no pulse or other signs of circulation </li></ul>
  18. 18. AED Types Fully Automatic Semi- Automatic
  19. 19. Operational Steps <ul><li>Assess scene, patient </li></ul><ul><li>Confirm cardiac arrest </li></ul><ul><li>Turn on power </li></ul><ul><li>Attach AED to patient’s chest </li></ul><ul><li>Initiate rhythm analysis </li></ul><ul><li>Deliver shock if indicated </li></ul>
  20. 20. Standard Procedures <ul><li>Assess scene for safety </li></ul><ul><ul><li>Water </li></ul></ul><ul><ul><li>Explosive atmosphere </li></ul></ul><ul><ul><li>Patient on conductive surfaces </li></ul></ul>
  21. 21. Standard Procedures Do NOT use AED if patient is: < 8 years old Weighs < 55 pounds
  22. 22. Standard Procedures <ul><li>Assess patient </li></ul><ul><ul><li>ABCs </li></ul></ul><ul><ul><li>Presence of transdermal medication patches (nitro patches) </li></ul></ul><ul><li>Confirm arrest </li></ul><ul><ul><li>Unresponsive </li></ul></ul><ul><ul><li>Apneic </li></ul></ul><ul><ul><li>Pulseless </li></ul></ul>
  23. 23. Standard Procedures <ul><li>Start CPR </li></ul><ul><li>Attach defibrillator </li></ul><ul><li>Do NOT waste time setting up O 2 , suction, IVs, etc. </li></ul><ul><li>Place pads on patient as on picture on packaging </li></ul>
  24. 24. Standard Procedures <ul><li>Stop CPR, analyze rhythm </li></ul><ul><li>Avoid patient contact during analysis </li></ul><ul><li>If machine says “shock,” </li></ul><ul><ul><li>“Clear” patient </li></ul></ul><ul><ul><li>Deliver shock </li></ul></ul><ul><ul><li>Immediately reanalyze </li></ul></ul>
  25. 25. Persistent VF <ul><li>3 “stacked” shocks, no pulse checks in between </li></ul><ul><li>If unsuccessful, 1 minute of CPR </li></ul><ul><li>Then if no pulse present, 3 more “stacked” shocks </li></ul>
  26. 26. Persistent VF <ul><li>Always shock in sets of 3 </li></ul><ul><li>Whenever chest is touched after initial assessment, it should be to perform CPR for 1 minute </li></ul><ul><li>Continue to shock until “no shock indicated” message received </li></ul>
  27. 27. Post-Resuscitation Care <ul><li>Continue to support airway, ventilation </li></ul><ul><li>Supplemental O 2 </li></ul><ul><li>Clear airway if vomiting occurs </li></ul><ul><li>Monitor vitals </li></ul><ul><li>Stabilize, transport, meet emergency team </li></ul>
  28. 28. Skill Maintenance <ul><li>Practice </li></ul><ul><ul><li>Drill at least monthly </li></ul></ul><ul><ul><li>Rotate responsibility for checking machine </li></ul></ul>
  29. 29. Public Access Defibrillation
  30. 30. Summary Shock Early and Shock Often!
  31. 31. Questions? Hands On Practice
  32. 32. Reference <ul><li>Cummins, R.O. (2001) Advanced cardiac life support provider manual. </li></ul>