Early recognition and Call for help

(*to prevent cardiac arrest)

Early CPR

(*to buy time)

Early Defibrillation

(to restart the heart)

Post resuscitation care

(*to restore quality of life)

1. approach safely
2. check response
3. shout for help
4. open airway
5. check breathing
6. call 112
7. 30 chest compressions
8. 2 rescue breaths

occurs shortly after the heart stops in up to 40% of cardiac arrests;

described as barely, heavy, noisy, or gasping breathing

recognized as a sign of cardiac arrest

Place the heel of one hand in the center of the chest;
Place other hand on top;
interlock fingers or avoid putting pressure on the side of the chest;
compress the chest (*100-100/min + 5-6cm + equal compression and relaxation)
change CPR operator every 2 minutes

pinch the nose;
take a normal breath;
place lips over mouth;
blow until the chest rises;
take about 1 second;
allow chest to fall;
repeat

switch on AED;
attach pads to patient's bare chest;
analyzing cardiac rhythm (NO TOUCH);
Stay Clear to Deliver Shock;
30 chest compressions;
2 rescue breaths

if patient starts to breathe, place in recovery position (*turning to right side)

adult CPR techniques

compressions of 1/3 in depth

use only 8+ years old (with Adult AED)

1-8 years old with pediatric pads if available

the emphasis on "high-quality chest compression"

carotid pulse check;
pocket mask;
bag-mask ventilation;
general points of using face mask;
use of oxygen;
choking;
drowning;
two-rescuer CPR

not recommended for lay rescuers;
use index and middle fingers in the groove on one side of the neck only;
check for breathing and carotid pulse at the same time (*extend neck; no more than 10 seconds)

1) start chest compressions
2) continue 30 chest compression
3) 2 rescue breaths
4) do NOT re-check for carotid pulse

1. Give rescue breaths on their own (*10 per minute)

2. Re-check for carotid pulse / signs of life after 1 minute

extend neck fully;
create a good seal between mask and mouth/nose;
deliver each breath over 1 second
blow just enough to make chest rise and fall as in normal breathing (*NO Over Ventilation)
Combine 30 + 2

Supplemental Oxygen can be used in cardiac arrest if available;
given via a bag-vale mask or pocket-mask;
give as MUCH as possible
as SOON as possible
(*flow rate of 10-15L/min)

Removal of Oxygen from Patient during defibrillation at least 1m away

encourage victim to cough;
closely monitor for deterioration

conscious patient:
5 back blows + 5 abdominal thrusts

unconscious patient:
activate EMS + start CPR

early rescue breaths;
safety of rescuer is very important;
patient should be removed from water;
only when trained, rescue breaths can be given in water;
AED must be on dry land/rescue boat + dried chest of patient

30 chest compressions + 2 rescue breaths;
1 rescuer performs rescue breaths + 1 rescuer performs chest compressions;
operating AED + performing CPR

Basic Life Support - Defibrillation

Terminal event (*natural death)

or

Sudden event (*unpredicted death)

appx. 700,000 cardiac arrests annually in Europe;
survival to hospital discharge rate of 5-10%
early resuscitation and prompt defibrillation (1-2 mins) 60+ %

80% of cardiac arrests occur known or unknown underlying heart diseases;
in western countries, 80%+ of cardiac arrest due to coronary diseases;
20% of congenital heart diseases, myocarditis, valvular disease, and electrophysiological anomalies such as prolonged QT and pre-excitation syndrome

few cardiac arrest due to acute failure of pulmonary gas exchange or type I/II acute respiratory failure, or hypothermia/electrocution;
most frequently by drowning, smoke inhalation, sedation, narcotic overdose, pulmonary embolism, cerebrovascular accident

sudden cardiac arrest --> loss of consciousness --> no breath or gasping --> loss of central pulses --> pale cyanosis --> mydriasis (*fixed) --> biological death

abnormal pattern of breathing;
occurs shortly after cardiac arrest (up to 40%)
barely, heavy, noisy, gasping;
a sign of cardiac arrest

loss of cerebral blood flow --> (15 sec) loss of consciousness --> (1 min) loss of brainstem functions (*gasping, mydriasis) --> (4-5 min) ATP depletion and anaerobic metabolism --> irreversible damage

Shockable (80%) --> VF (*ventricular fibrillation)

Non-shockable (20%) --> pulseless ventricular tachycardia, "asystole (: no electrical activity" / only P waves, large QRS complexes (6/min)

Airway
Breathing
Circulation

head tilt (*not for suspected trauma)
+
chin lift
+
jaw thrust (*professional)

+
finger sweep (*NO, unless object seen)

30 chest compression (*15-20 sec)
+ 2 rescue breaths (*500-600 ml);
look, listen, and feel for normal breathing;
AGONAL breathing (*gasping)

qualified help arrives and takes over;

return of spontaneous circulation (*patient has NO longer signs of clinical death);

rescuer becomes exhausted

lateral safety position (*right)

Foreign Body Airway Obstruction

mild or severe

answer of "Yes"
+
can speak, cough, and breathe

unable to speak (*may nod)

+

no breathing or wheezy breathing, silent attempts to cough + unconsciousness

1) severe / ineffective cough --> unconscious (: CPR start) or conscious (: 5 back blows + 5 abdominal thrusts or Heimlich maneuver)
2) mild / effective cough --> encourage to cough (*continue to check for deterioration to ineffective cough or until obstruction removed)

heart beat + respiratory rate + temperature + blood pressure + O2 saturation

normal vital signs change with AGE, SEX, WEIGHT, EXERCISE TOLERANCE, and CONDITION

Patient at seated posture;
5 mins prior rest;
observation before measuring patient (*anxious, painful, upset);

control by hypothalamus;
age/infection/medication affect;
core temperature different from anatomical sites

reflects circulating volume and strength of contractility; intravascular volume/contractility/oxygen demand affect; at least for 30 sec, regularity, strength, and equality should be checked

regulated by vasomotor center in the medulla;
intravascular volume/vascular tone/contractility affect;
automated monitors less reliable

controlled by respiratory centers in the medulla and pons;
hypercapnia/hypoxemia/acidosis affect;
establish baseline, critical illness, change in oxygenation, and evaluate response to treatment

above 37 orally or 37.5 rectally

below 35

bradycardia < 60-100 /min < tachycardia

40 - 60 for athletes

female has higher

babies up to 1 (*100-160) / 1-10 (*60-140)

rate; rhythm; volume; synchronous with other pulse (*radio-femoral delay); state of the vessel wall

altered mental status;
fast respiratory rate;
low blood pressure