CPR or defibrillation first? And why?

Abd El Aal Elbahnasy, MD

WHAT IS CPR ????.........

Cardio pulmonary resuscitation is a series of

steps used to establish artificial ventilation

and circulation in the patient who is not

breathing and has no pulse.

WHEN YOU HAVE TO START CPR ????.......

1-No response

2-If the victim is not breathing normally such as gasping for breath or not breathing at all

3-No pulse

4- heart rate less than 60 beat\m

CHAIN OF SURVIVAL

STEPS OF CPR

1- Check the scene safety

2- Check for consciousness

3- check breathing

4- call for help

5- check pulse

6- start chest compression

CHECK RESPONSE

• Gentle taping the foot of baby

• And call him baby baby……

No response

Check breathing

• Look for chest rise

• Hear agonal breathing

No breathing

Agonal breathing

Activate emergency response

• If the infant not respond

&no breathing

Immediately call for help

and get automated

external defibrillator (AED)

Check pulse

• Check pulse in

brachial artery

within 10 seconds

No pulse

Start compression

One rescuer By two fingers at lower 1|2 of breast bone (sternum)

30 compression to 2 breaths

Depth about 4 cm

Two rescuer

Encircle the chest by

both hands

15 compression to 2

breaths

Switch every 2

minutes or 10 cycle

Hand placement

Infant:

compress the sternum with 2 fingers

placed just below the inter-mammary

line

Child:

compress the lower half of the

sternum at least one third of the AP

diameter of the chest (2 inches) with

one or two hands

Note: do not compress over the

xiphoid or ribs

High quality C P R

Start chest compression within 10 second of recognition

Push hard about 4 cm, push fast at least 100 compression in minute

Avoid interruption

Give effective breath

Avoid excessive ventilation

Count out loud

Defibrillator • Defibrillators are either

manual or automated (AED).

• AED can be used for infants

and children up to

approximately 25 kg (8 years

of age).

• In infants 1 year of age a

manual defibrillator is

preferred.

Paddle Size

Two sizes of hand-held paddle

“Adult” size : 8 to 10 cm for

children > 10 kg

( approximately 1 year)

“Infant” size :4-5 cm for

infants < 10 kg

Paddle Position: Place over the right

side of the upper chest and the apex of the heart (to the left of the nipple over the left lower ribs) so the heart is between the two paddles.

Apply firm pressure

Defibrillation sequence

Switch ON the device

Apply Paddles

Clear the patient for analyzing the rhythm

Charging if shock needed

Clear patients before applying the shock

Continue CPR

DEFIBRRILATION

Manual Defibrillation Dosing

The recommended first energy dose for defibrillation is 2 J/kg.

If second dose is required, it should be doubled to 4 J/kg.

AED with pediatric attenuator is preferred for children < 8 years of age.

If I heard “I will forgot”

If I saw “I will remember”

If I did “I will become perfect”

SO you must practice

CPR

CPR OR DEFIBLLITAION FIRST?

END RESULT

Take home message

Infant not small adult

C A B not A B C nothing delay compression

HIGH QUALITY C P R

CPR is so easy only you want 2 hands &training

CPR before defibrillation improving outcome