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CPR SKILL

SILVIA TRIRATNA

Learning Objective
Upon completion of this training program, a
student 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 mask
for adults, children, and infants.
Describe how to perform effective rescue breaths using a bag-mask
device.
Describe the steps of the primary assessment for an unresponsive
patient.
Describe the steps of performing CPR as a single provider for adults,
children, and infantsIdentify basic skills in cardiopulmonary arrest
resuscitation
Demonstrate the basic psychomotor skills in cardiopulmonary arrest
resuscitation

SKILL Objective
Correctly demonstrate how to perform external
chest compressions for adults, children, and
infants.
Correctly demonstrate how to perform rescue
breaths using a CPR mask.
Correctly demonstrate how to perform rescue
breaths using a bag-mask device.
Correctly perform a primary assessment for an
unresponsive patient.
Correctly demonstrate CPR as a single provider
for adults, children, and infants.
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Pediatric Chain of Survival

prevention

Early CPR

EMS

Rapid PALS

Intergrated
Post-cardiac
Arrest care

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

Not SICK
SICK
Stable
potential unstable.
UnStable Level 1
Level 2
Level 3
Level 4
Level 5

Resuscitative
Emergent
Urgent
Less urgent
Non-urgent

patients with cardiac arrest


survival rates and neurologic outcomes are poor,

early appropriate resuscitation(CPR),


early defibrillation,
appropriate postcardiac arrest care,
leads to improved survival and
neurologic outcomes.
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Diagnosis of cardiac arrest

Loss
of time !!!

Symptoms of cardiac arrest


Absence of pulse on central
arteries
a pathognomonic symptom
Respiration arrest
may be in 30 seconds after cardiac
arrest
Enlargement of pupils
may be in 90 seconds after cardiac
arrest
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all cases
accompanied with
hypoxia

EXTRA CARDIAC

CARDIAC
Primary lesion of cardiac muscle leading to the
progressive decline of contractility, conductivity
disorders, mechanical factors

CPR
A technique combining artificial
ventilation and chest compressions
designed to perfuse vital organs or
restore circulation in cardiac
standstill.

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CPR Indications
should be performed immediately on
any person who has become
unconscious and is found to be
pulseless

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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

Technique

ABC
CAB

??
??

or

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American Heart Association


(AHA) guidelines 2010
standard for CPR comprises 3 steps:
chest compressions,
airway, and
breathing

(CAB),
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performed by
healthcare
providers and
not by
rescuers

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Preparation
1. Position a child on a hard surface.
2. Position a neonate or infant on a
hard surface or on the forearm of the
rescuer with the hand supporting the
head.

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Determine Responsiveness
Gently tap on shoulder and speak
loudly.
If responsive, place in position of
comfort

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Brachial pulse check in infant

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

Copyright 2000 American Heart Association

Carotid pulse check in child

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

Copyright 2000 American Heart Association

Circulation, Circulation,
Circulation

Push hard
Push fast

High quality CPR


Chest compressions of appropriate rate and
depth.
"Push fast": push at a rate of at least 100
compressions per minute.
"Push hard": push with sufficient force to
depress the chest (at least 1/3 of the AP diameter
of the chest or approximately 1 in. = 4 cm in
infants and approximately 2 in. = 5 cm in
children)
allowing complete recoil of the chest after each
compression
minimizing interruptions in compressions

High quality CPR = Effective PALS


the cornerstone of a
system of care that can
optimize outcomes
beyond return of
spontaneous circulation
(ROSC).

Return to a prior quality


of life and functional
state of health is the
ultimate goal of a
resuscitation system of
care.

INFANT
CPR
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Infant CPR
Place infant on firm
surface and maintain
airway.
Place two fingers in the
middle of the sternum.
Use two fingers to
compress the chest
about 1" at a rate of
least 100/min
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27

CPR Infant
Compression depth:
1/3 of the depth of the chest

Finger/Thumb
position:
lower 1/2 of the sternum

Slide 29

Allow sternum to
return briefly to its
normal position
between compressions.
Coordinate rapid
compressions and
ventilations in a
15:2 or 30 :2 ratio.
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33

CHILD
CPR
35

37

One-hand chest compression


technique in child

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

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After each
compression allow the
chest to recoil fully
because complete
chest reexpansion
improves blood flow
into the heart

should be performed 5 times - 30


compressions and 2 breaths
check the victim's artery for pulse
(for no longer than 10 seconds) and
other signs of consciousness.
If you not feel a pulse within 10
seconds, you should begin cycles of
chest compressions and ventilations.
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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 per
minute with continuous chest
compressions

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Drug Therapy
Epinephrine IO/IV Dose:
0.01 mg/kg (0.1 mL/kg of 1:10,000
concentration). Repeat every 2- 3
minutes.
If no IO/IV access, may give
endotracheal dose: 0.1 mg/kg (0.1
mL/kg of 1:1,000 concentration).
Amiodarone IO/IV Dose:
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Advanced Airway
Endotracheal intubation or
supraglottic advanced airway
Waveform capnography or
capnometry to confirm and monitor
ET tube placement.
Once advanced airway in place give 1
breath every 3- 6 seconds (10 -20
breaths per minute)
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AIRWAY

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Airway Opening Manoeuvres


Chin lift/head tilt

Infants
Neutral head position
with chin lift

Smaller children
Sniffing position
with chin lift
Slide 57

Airway Opening Manoeuvres


Chin lift/head tilt

Older children/adults
Backward head tilt
with pistol grip
Slide 58

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Airway Opening Manoeuvres


Use when concerned re
Jaw thrust

cervical spine injury


May also facilitate
bag and mask
ventilation

Slide 61

Jaw thrust

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Bag to Mask Ventilation

70

Monitor the Effectiveness of


Ventilation

Visible chest rise with each breath.


Oxygen saturation.
Heart rate.
Blood pressure.
Distal air entry.
Patient response

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cpr
Any question ?

Check for pulsE


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