AHA ECC Chain of survival

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Resuscitation Update

Saturday, November
7, 2015

Life Support System

Oxygen
Atmospheric air
Exhaled air
Lungs extract

21 % Oxygen
16 % Oxygen
5 % Oxygen

O2

Life Support System

Lungs
Exchange of Oxygen and
carbon dioxide

Life Support System

Heart
To pump oxygenated blood
to the rest of the body

Life Support System

Brain
Brain cells will start to die if
no oxygen received for 4-6
minutes

FUNCTION OF THE HEART &

LUNGS
BLOOD + O2

BLOOD - O2

BLOOD + O2
O2

CPR through the ages

Challenges

Saturday, November
7, 2015

Some not so celebrated

instances

Saturday, November
7, 2015

CPR Milestone
1956

James Elam and Peter Safar

Mouth-to-mouth resuscitation

1960

Dr Kouwenhowen and team

External chest compression

1963

AHA formally endorses CPR

1966

First conference on CPR

Standardize training and
performance standards

1972

Mass citizens training in CPR

Over 100,000 trained over 2 years

1970s

More than 60% bystanders will

perform CPR

Saturday, November
7, 2015

10

CPR Milestone

1970s: citizens CPR in US

1985 : Malaysian Society of Anesthesiologists
& Min. Of Health (AHA)
1997 : Utstein style for reporting of CPR
2000 : new guidelines on CPR
2005 : update on international guidelines
2010 : latest update on international guidelines

WHY CPR?
Help to save lives
Most of the sudden
cardiopulmonary
arrest may be
successfully
resuscitated
Prompt CPR can
prevent permanent
brain damage

Challenges today
Too few people know CPR
Too few people willing to perform CPR
We are not training the most important group of
people
Trained providers cannot remember how to
perform CPR
We have forgotten the importance of time
Our duty to train others

CPR Principles

Remember !!!!!!!!!
The human body may live for
4 weeks without food;
4 days without water;
BUT
Only 4 minutes without
oxygen

Dont wait
Call 999
Start C.P.R.

Time of the essence

Every 1 minute pass (after cardiac arrest)

10 %

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7, 2015

18

REMEMBER YOU ONLY HAVE

4 MINUTES

Look out for

danger before
you start CPR

Are you OK??

SHOUT

ALWAYS TAP THE VICTIM ON

THE SHOULDERS AND ASK
THE VICTIM ARE YOU OK

POSITION VICTIM ON A HARD SURFACE

 Look
Open airway maneuvers

Open the Airway

Perform head tilt-chin lift to
open the airway
Head tilt: place one hand
on the forehead and not
the eyes, to tilt the head
back
Chin lift: place fingers of
the other hand on the bony
part and not the soft tissue
of the jaw, to lift the chin

OPEN AIRWAY
Jaw Thrust

 .
NOT
BREATHING
or
GASPING?

Give cycles of 30 compressions to 2 breaths

Until AED, Defib, ALS Provider take over,
or victims start to move
Push HARD and FAST (100/min)
and release completely
Minimise compression interruptions

AED, Defibrillator ARRIVES

SHOCKABLE RHYTHM?

YES

Give 1 shock
Resume CPR For 5 cycles

Saturday, November
7, 2015

NO

Resume CPR For 5 cycles

and CHECK RHYTHM ;
Cont. till ALS Provider take over, victims start to move

30

Recovery position
Main purpose:
To maintain the patency of the airway &
prevent aspiration in a non-trauma
patient while waiting for the ambulance
after patient successfully resuscitated

NO RESPONSE / MOVEMENT

CALL FOR HELP

Get AED / Defibrillator

Open AIRWAY, Check BREATHING

Give cycles of 30 compressions and 2 breath

Until AED, Defib, ALS Provider take over, victims start to move
Push HARD and FAST (100/min) and release completely
Minimise compression interruptions
AED, Defibrillator ARRIVES

SHOCKABLE RHYTHM?
YES
Give 1 shock
Resume CPR For 5 cycles

NO
Resume CPR For 5 cycles
and CHECK RHYTHM ;
Cont. till ALS Provider take over, victims start to move

33

Rescue
Breath

2 rescue breaths that make the chest

rise.
Each rescue breath should be given over 1
second (Class IIa).
This recommendation applies to all rescuers.

Rescue
Breath
Face shield

Rescue
Breath

Rescue
Breath

Pulse check
Health providers
Check pulse within 10
secs
after 2 minutes/ 5 cycles
of CPR
Non health care
providers - no need to
check for pulses

Rhythm
if AED or Defib machine available : Rhythm
check

check on monitor every 2 minutes (together with

pulse checking)
Shockable Defib

Compression : Ventilation
Ratios
Guidelines 2000
15 : 2 ratio for adults; rate 100 / min
4 cycles

Guidelines 2005

Changes

30 : 2 ratio for all rescuers, all ages > age of 1 yr

Rate 100 / min; push hard and push fast
5 cycles in 2 minutes
No interruptions except for defibrillation and rhythm analysis

Guidelines 2010

Guideline 2010

42

Defibrillation

(one-shock

strategy)
Energy
Levels
used
for
Manual defibrillation
VF/VT
Monophasic 360 J for all shocks
Changes

Biphasic
BTE 150 to 200 J initial shock
If unsure which waveform, use default 200 J
For second and subsequent shocks, use same
or higher energy levels

AED defibrillation
Biphasic

Device specific

Defibrillation
Attention must be paid to DETAILS
Reducing interruptions to chest
compressions
Proper technique
Changes

Proper placement
Proper equipment
Proper energy levels
Resuming chest compressions immediately

Make each shock count!!

Terminating a Resuscitation
in a BLS out-of-Hospital
Rescuers who start BLS should continue until one of
System
the following occurs:

1. Restoration of effective, spontaneous circulation

and ventilation.
2. Care is transferred to a more senior-level
emergency medical professional who may
determine that the patient is unresponsive to the
resuscitation attempt.

3. Reliable criteria indicating irreversible death

are present
4. The rescuer is unable to continue because of
exhaustion or
5. the presence of dangerous environmental
hazards or because continuation of
resuscitative efforts places other lives in
jeopardy.
6. A valid DNAR order is presented to rescuers.

PAEDIATRIC CPR
DANGER
IF POSSIBLE REMOVE THE SOURCE OF
DANGER .
ONLY REMOVE THE VICTIM AS A LAST
RESORT

PAEDIATRIC CPR
RESPONSE ( Gentle tapping or shaking
the shoulder.

PAEDIATRIC CPR
If unresponsive , shout for HELP !

PAEDIATRIC CPR
A - AIRWAY ( head tilt chin lift or jaw
thrust )

PAEDIATRIC CPR
B Breathing : look , listen and feel <10s
Absent ?

PAEDIATRIC CPR
B Breathing (5 initial rescue breaths)

PAEDIATRIC CPR
C Circulation :<10 s

Feeling for the brachial pulse in infant and carotid pulse if the child
is over 1 year of age.

PAEDIATRIC CPR
Chest Compression : No Pulse or Pulse
< 60/min
Child

PAEDIATRIC CPR

PAEDIATRIC CPR
Infant and children
one
rescuer

Give cycle of 30 compressions and 2

breath for 5 cycle

two
rescuer

Give cycle of 15 compressions and

2 breath for 5 cycle

 If there is palpable pulse> 60/min but in

adequate breathing , to continue rescue
breaths 12-20/min.

Saturday, November
7, 2015

60

Guideline 2010

61

Adult Foreign-body
Airway Obstruction

Adult choking
(conscious)
No finger sweep unless foreign body
visible
In conscious pt, give 5 back slaps
following with 5 abdomen thrust/chest
thrust
No abdominal thrust in unconscious pt
but CPR instead.

Adult choking

Abdominal Thrust

Chest Thrust

Foreign-Body Airway
Obstruction infant
Conscious : Serious signs
Check serious difficulty in breathing
Ineffective cough
No strong cry
Dusky colour

Foreign-Body Airway
Obstruction infant
Conscious
Give 5 back blows and 5 chest thrusts

Foreign-Body Airway
Obstruction infant
If FBAO becomes Unconscious
Activate EMS
Open Airway ( if FB seen, remove it )
Start CPR

 Phone fast or phone first for lone rescuer

Paediatric chain of survival..
Assessment in conscious adult choking victim by asking
question..
Reference
Guidelines for Resuscitation Training In Ministry of Health
Malaysia Hospitals and Health Care Facilities 2012 - NCORT