Airway + Breathing disorders
CPR with AED
Lukas Dadak, MD
St. Ann's University Hospital, Brno
Kamil Hudacek, MD
University Hospital Brno
BLS algorithm
• Danger
• Response = consciousness (AVPU scale)
• Shout / Send for help
• Airway = open it
• Breathing
• Circulation
Primary Survey = 20s
Choking Conscious Adult
• uncommon but potentially treatable
• less than 1% of these incidents are fatal
- mostly witnessed
• food partitions
• trauma / burns
• edema = swelling
Choking
Sings:
• clutch throat or mouth
• cough, gurgle, vomiting sound, wheezing
• inability to speak
• heavy breathing
• anxiety
• turns blue (cyanosis) from lack of oxygen
• if breathing is not restored, the victim falls
into unconsciousness
Inability to relieve the obstruction can cause:
• Breathing failure
• Brain damage
• Death
Narrowest part of airway:
Adult: glotis Child: subglotic space
Foreign Body Airway Obstruction
• relief FBAO = life saving procedure
• safe, effective, simple
• Cough and bend forwards
• 5 Back blows / slaps
• 5 Abdominal thrusts = (Heimlich maneuver)
• Chest thrusts
often you will need more than 1 procedure to clean the airway
Mild obstruction
• Coughing generates high and sustained airway
pressures and may expel the foreign body.
• Aggressive treatment, (back blows, abdominal thrusts,
chest compression), may cause potentially serious
complications and could worsen the airway
obstruction.
• Continuous observation until they
– improve
– severe airway obstruction may develop
First aid:
155
Back blows
 Stand to the side and slightly behind the victim.
 Support the chest with one hand and lean the victim well
forwards so that when the obstructing object is
dislodged it comes out of the mouth rather than goes
further down the airway.
 Give up to five sharp blows between the shoulder blades
with the heel of your other hand.
Back blows
Heimlich man. = abdominal
thrust
Increase pressure
below foreign body
• Stand behind the victim and put
both arms round the upper part of
his abdomen.
• Lean the victim forwards.
• Clench your fist and place it
between the umbilicus and
xiphisternum.
• Grasp this hand with your other
hand and pull sharply inwards and
upwards.
• Repeat up to five times
Chest thrust
• markedly obese persons
• late stages of pregnancy
Increase pressure
under foreign body
Following successful treatment:
Victims with a persistent cough, difficulty swallowing
or the sensation of an object being still stuck in the
throat should be examined
 Abdominal thrusts can cause serious internal injuries
 All victims treated with abdominal thrusts should be
examined for injury by a doctor
First Aid - Choking - Adult & Child
Clear airway if necessary
during coma
• with the casualty supported on the side,
tilt the head backwards and slightly down.
• Open the mouth and clear any foreign object.
Only remove dentures if loose or broken.
• Use your 2 fingers only - if you see solid material in
the mouth
• Do not push fingers where you can not see
Keep airway open
head tilt, chin lift Esmarch maneuver
/ Jaw thrust
BLS – breathing with face-mask
Face mask ventilation
Positive pressure ventilation by bag-valve mask
 correct volume = movement of chest
 Fr. 10/min
 100% O2
 1 hand hold:
 inch + index f.
 3 ff. - chin
 2 hands
Guedel airway
Oro-Pharyngeal Airway
I: unconsciousness
+ airway obstruction with tongue
Correct size OPA:
 distance angle of mouth --- ear
Risk in mild unconsciousness:
 vomitus + aspiration
Naso-Pharyngeal Airway
(trumpet)
Correct size of NPA:
 distance nostril --- ear
Risk:
 bleeding from nasal cavity
 Use of lubricant is essential
Chain of survival
European resuscitation council
Approximately 700,000 cardiac arrests per year in
Europe
Survival to hospital discharge presently approximately
5-10%
Bystander CPR is vital intervention before arrival of
emergency services
Early resuscitation and prompt defibrillation (within 5
minutes) can result in >50% survival
Automated External Defibrilator
Ventricular fibrilation
Most common cause of cardiac arrest in adults out of hospital
- caused by obstructed coronary artery in myocardial infarction
- electric shock is the only treatment
Defibrilation
in Czech provided by ambulance
services or lay persons
 continue with CPR
Attach AED
Follow voice prompts
Start of AED
 Some AEDs will automatically switch
themselves on when the lid is opened
ATTACH PADS TO
CASUALTY’S BARE CHEST
ANALYSING RHYTHM
DO NOT TOUCH VICTIM
SHOCK INDICATED
 Stand clear
 Deliver shock
SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS
30 : 2
Successful defibrillation
- could wake up if shock applied until 5 min
- starts to breath, cough
Victim could be turned to recovery position – monitor vital signs till
ambulance come
Do not take the electrodes off !!
RECOVERY POSITION
If the affected person begins to breathe normally, turn
him / her sideways to the recovery position
Always check for breathing
Do not remove the electrodes
NO SHOCK ADVISED
FOLLOW AED INSTRUCTIONS
30 : 2
http://www.fsps.muni.cz/aed/mapa/
TACPR
Telephone Asisted CPR
No consciousness, No breathing …
Next person call 155
.. Open the green box by code given by phone.
http://www.fsps.muni.cz/aed/videa/zelny-trh-dlouhe/
Precordial thump
No more part of BLS !!
(ERC guidelines since 2005)
reserved :
 witnessed cardiac arrest when no
defibrillator is immediately available
 if done in first 20s
25% regain cardiac function
Thanks for your attention
142221@mail.muni.cz
Hudacek.Kamil@fnbrno.cz