Cpr Skil Blok27

7/23/2019 Cpr Skil Blok27

1/76

CPR SKILL

1

SILVIA TRIRATNA


2/76

Learning Objective

Upon completion of this training program, astudent will be able to Describe how to recognize and provide treatment for sudden cardiac

arrest.

Explain how to perform effective chest compressions for adults,children, and infants.

Describe how to perform effective rescue breaths using a CPR maskfor adults, children, and infants.

Describe how to perform effective rescue breaths using a bag-maskdevice.

Describe the steps of the primary assessment for an unresponsivepatient.

Describe the steps of performing CPR as a single provider for adults,children, and infantsIdentify basic skills in cardiopulmonary arrestresuscitation

Demonstrate the basic psychomotor skills in cardiopulmonary arrest

resuscitation 2


3/76

SKILL Objective

Correctly demonstrate how to perform externalchest compressions for adults, children, andinfants.

Correctly demonstrate how to perform rescuebreaths using a CPR mask.

Correctly demonstrate how to perform rescuebreaths using a bag-mask device.

Correctly perform a primary assessment for anunresponsive patient.

Correctly demonstrate CPR as a single provider

for adults, children, and infants.3


4/76

Pediatric Chain of Survival

Berg, M. D. et al. Circulation 2010;122:S862-S875

prevention Early CPR EMS Rapid PALS Intergrated

Post-cardiacArrest care
http://circ.ahajournals.org/content/vol122/18_suppl_3/images/large/zhc1431087590001.jpeghttp://circ.ahajournals.org/content/vol122/18_suppl_3/images/large/zhc1431087590001.jpeghttp://circ.ahajournals.org/content/vol122/18_suppl_3/images/large/zhc1431087590001.jpeghttp://circ.ahajournals.org/content/vol122/18_suppl_3/images/large/zhc1431087590001.jpeg


5/76

Not SICK

SICK

Stablepotential unstable.

UnStable Level 1 Resuscitative Level 2 Emergent

Level 3 Urgent

Level 4 Less urgent

Level 5 Non-urgent


6/76


7/76

Diagnosis of cardiac arrest

7

Loss

of time !!!


8/76

Symptoms of cardiac arrest

Absence of pulse on centralarteries

a pathognomonic symptom

Respiration arrest

may be in 30 seconds after cardiacarrest

Enlargement of pupils

may be in 90 seconds after cardiacarrest

8


9/76

9

Primary lesion of cardiac muscle leading to the

progressive decline of contractility, conductivitydisorders, mechanical factors

CARDIAC

EXTRA CARDIAC

all cases

accompanied with

hypoxia


10/76

CPR A technique combining artificial

ventilation and chest compressionsdesigned to perfuse vital organs orrestore circulation in cardiacstandstill.

10


11/76

CPR Indications should be performed immediately on

any person who has becomeunconscious and is found to bepulseless

11


12/76

For the purpose of resuscitation,children are divided into 3 age

groups:

Infants: under one year of age

Small children: 1 to 8 years of age

Older children/adults: 9 years and over


13/76


14/76

American Heart Association(AHA) guidelines 2010

standard for CPR comprises 3 steps:

chest compressions, airway, and

breathing

(CAB),

14


15/76

15

performed by

healthcare

providers and

not byrescuers


16/76

16


17/76

17


18/76

Preparation

1. Position a child on a hard surface.

2. Position a neonate or infant on a

hard surface or on the forearm of therescuer with the hand supporting thehead.

18


19/76

Determine Responsiveness

Gently tap on shoulder and speakloudly.

If responsive, place in position ofcomfort

19


20/76Copyright 2000 American Heart Association

Circulation 2000;102:253I--290I-

Brachial pulse check in infant


21/76Copyright 2000 American Heart Association


Carotid pulse check in child


22/76

Circulation, Circulation,Circulation

Push hard

Push fast


23/76

High quality CPR

Chest compressions ofappropriate rate anddepth.

"Push fast": push at a rate of at least 100compressions per minute.

"Push hard": push with sufficient force todepress the chest (at least 1/3 of the AP diameterof the chest or approximately 1 in. = 4 cm ininfants and approximately 2 in. = 5 cm inchildren)

allowing complete recoil of the chest after eachcompression

minimizing interruptions in compressions


24/76

High quality CPR Effective PALS

the cornerstone of asystem of care that canoptimize outcomes

beyond return ofspontaneous circulation(ROSC).

Return to a prior qualityof life and functionalstate of health is theultimate goal of aresuscitation system of

care.


25/76

INFANTCPR

25


26/76

Infant CPR

26

Place infant on firmsurface and maintainairway.

Place two fingers in themiddle of the sternum.

Use two fingers to

compress the chestabout 1" at a rate ofleast 100/min


27/76

27


28/76


29/76

Slide 29

CPR InfantFinger/Thumb

position:lower 1/2 of the sternum

Compression depth:

1/3 of the depth of the chest


30/76


31/76


32/76

Allow sternum toreturn briefly to itsnormal positionbetween compressions.

Coordinate rapidcompressions andventilations in a15:2 or 30 :2 ratio.

32


33/76

33


34/76


35/76

CHILDCPR

35


36/76


37/76


38/76


One-hand chest compressiontechnique in child


39/76

39


40/76


41/76


42/76

42


43/76

43


44/76


45/76


46/76


47/76

After eachcompression allow the

chest to recoil fully

because complete

chest reexpansionimproves blood flow

into the heart


48/76

should be performed 5 times - 30compressions and 2 breaths

check the victim's artery for pulse(for no longer than 10 seconds) andother signs of consciousness.

If you not feel a pulse within 10

seconds, you should begin cycles ofchest compressions and ventilations.

48


49/76

Minimize interruptions in compressions

Avoid excessive ventilation

Rotate compressor every 2 minutes If no advanced airway, 15:2

compressionventilation ratio.

If advanced airway, 8 -10 breaths perminute with continuous chestcompressions

49


50/76

Drug Therapy

Epinephrine IO/IV Dose:

0.01 mg/kg (0.1 mL/kg of 1:10,000concentration). Repeat every 2- 3

minutes.

If no IO/IV access, may giveendotracheal dose: 0.1 mg/kg (0.1

mL/kg of 1:1,000 concentration).

Amiodarone IO/IV Dose:

50


51/76

Advanced Airway

Endotracheal intubation orsupraglottic advanced airway

Waveform capnography orcapnometry to confirm and monitorET tube placement.

Once advanced airway in place give 1

breath every 3- 6 seconds (10 -20breaths per minute)

51


52/76

AIRWAY

52


53/76

53


54/76

54


55/76


56/76


57/76

Slide 57

Airway Opening ManoeuvresChin lift/head tilt

InfantsNeutral head position

with chin lift

Smaller children

Sniffing position

with chin lift


58/76

Slide 58

Airway Opening ManoeuvresChin lift/head tilt

Older children/adultsBackward head tilt

with pistol grip


59/76

59


60/76


61/76

Slide 61

Airway Opening ManoeuvresJaw thrust

Jaw thrust

Use when concerned re

cervical spine injuryMay also facilitate

bag and mask

ventilation


62/76

62


63/76

63


64/76


65/76


66/76


67/76

Bag to Mask Ventilation


68/76


69/76


70/76

70

Monitor the Effectiveness of


71/76

Monitor the Effectiveness of

Ventilation


72/76

Visible chest rise with each breath.

Oxygen saturation.

Heart rate. Blood pressure.

Distal air entry.

Patient response

72


73/76


74/76

cpr

Any question ?

74

Check for pulsE


75/76

75


76/76

Cpr Skil Blok27

Documents

Transcript of Cpr Skil Blok27