CPR Katarina Zadrazilova, FN Brno, September 2011 First aid - literature •Lectures + practice •First aid manual 9th revised edition •European resuscitation council • guidelines for resuscitation 2010 ▫www.erc.edu • • Cardiopulmonary resuscitation Why do adults die? The top 5 causes of death 1.Ischemic heart disease 2.Cancer 3.Stroke 4.Chronic lower respiratory disease 5.Accidents •Sudden cardiac arrest is a leading cause of death in Europe •700 000 Europeans a year •40 % of SCA victims have VF •Immediate CPR can double or triple survival Ischemic heart disease Why are we talking about CPR Every person is legally liable to give First aid including CPR. You may go to jail for up to 3 years er 5a85252dbf86d3e5 grey-anatomy CPR Succese rate 77 % ! ...reality only 25% Succes rate 77 % in CPR Real life 25% Overview •Adult Basic Life Support sequence •Foreign-body airway obstruction/choking • •Airway management •Ventilation • Basic life support • Maintaining airway patency and supporting breathing and the circulation without the use of equipment other then a protective device Chain of survival •Early recognition •Early bystander CPR •Early defibrillation •Early Advanced life support • Make sure the victim and bystanders are safe •ARE YOU ALL RIGTH ? • JSTE V POŘÁDKU ? • • HEAD TILT CHIN LIFT 10 SEC LOOK LISTEN AND FEEL INFREQUENT, NOISY GASPS ARE NOT NORMAL BREATHING •If breathing normally • Turn to recovery position and get help 2 EFFECTIVE RESCUE BREATHS CONTINUE CPR RATIO 30 : 2 When to stop CPR •Qualified help arrives and takes over •The victim starts to breath normally •You become exhausted FOREIGN BODY AIRWAY OBSTRUCTION Foreign body airway obstruction Causes of choking • adults: fish, poultry • kids: sweets, peanuts Up to 5 sharp back blows Abdominal thrusts Up to 5 times, then alternate 5 back blows - 5 abdominal thrusts If unconscious – start CPR with chest compressions Finger sweep – only if you can see the obstruction in the airway AIRWAY MANAGEMENT AND VENTILATION A for Airway •Patients with cardiorespiratory arrest often have an obstructed airway •Prompt control of the airway is essential to prevent secondary hypoxic damage to the brain and without oxygenation it may be impossible to restore spontaneous cardiac output Airways why Causes of the airway obstruction 19595 Can be partial or complete Recognition of airway obstruction •LOOK, LISTEN AND FEEL • •Partial obstruction • •Stridor obstruction above larynx •Wheeze lower airway •Gurgling semisolid/liquid FB •Snoring soft palate/epiglotis •Crowing laryngeal spasm Recognition of airway obstruction •Complete obstruction • •Look for paradoxical chest and abdominal movement –´see-saw breathing´ Basic airway management Head tilt chin lift Jaw trust Airway management with suspected cervical spine injury Trauma5 Manual in line stabilization Airway adjuncts •Oropharyngeal airways ▫Better in comatose patients • •Nasopharyngeal airways ▫Better tolerated by patient ▫Can cause nose bleed ▫ ▫ CAREFUL! Both can cause airway obstruction ! Proper size Airway adjuncts Insertion of oropharyngeal airway Oxygen •Give oxygen whenever it is available • • Type of oxygenation Oxygen concentration Mouth to mouth 16 % Face mask Up to 50% Face mask with reservoir Up to 85% More O2 for brain Alternative airway devices •High incidence of complications without adequate training and experience • •Best technique depends on the circumstances and competence of the rescuer Alternative airway devices •Laryngeal mask airway •Combitube •Tracheal tube Laryngeal mask airway Combitube Gold standart – tracheal intubation intubation1_ipyw Gold standart – tracheal intubation •Advantages: ▫Maintainance of patent airway ▫Protection from aspiration ▫Ability to ventilate reliably ▫Free the rescuers hands ▫Route for giving drugs •Disadvantages ▫Unrecognised misplaces tracheal tube ▫Prolonged period without compressions B for breathing •Mouth to mouth •Mouth to nose •Mouth to protective device •Using self inflating bag or ventilator Pocket resuscitation mask Isolated reports of transmission of infections such as tuberculosis and Severe acute respiratory distress syndrome (SARS) Ventilation •Inspiration 1 sec •Volume : enough to make the chest rise ▫Larger volumes lead to gastric inflation •Once the tracheal tube is in place ventilate the lungs at a rate of 10 breaths/min and continue chest compressions without pausing during ventilation SUMMARY •Open the airway •Look listen and feel for breathing •Use airway adjuncts you’re familiar with to enable ventilation •Ventilation : chest compressions 2:30 ▫ Until airway protected, then ▫ 10 breaths / min and 100/min chest compressions Questions ?