Download RCP Advanced Life Support

RCP Advanced Life Support
Education for Life
720 N. Valley St. Ste. F, Anaheim, CA 92801
Tel. (714) 808-9036 www.rcpals.com
New CPR Guidelines for the Healthcare Provider
Modern CPR was first described in 1960, and the first conference in CPR was held in 1966. Since the advent of
those original guidelines, the American Heart association has published four major updates in 1974, 1980, 1986
and 1992. The International guidelines 2000 conference in September 2000 was the first international
conference on Cardiopulmonary Resuscitation and Emergency Cardiac Care. The new guidelines strongly
emphasize evidence as the basis for all new clinical recommendations. The highest potential survival rate from
cardiac arrest can be achieved only when the following sequence of events occur as rapidly as possible: (1)
recognition of early warning signs, (2) activation of the EMS system, (3) basic CPR, (4) defibrillation,
(5)management of airway and ventilation, and (6) intravenous administration of medications.
BLS for the Healthcare Provider: New Course Objectives
The primary goal of the BLS for Healthcare Provider Course is to improve rates of survival from sudden cardiac
arrest. It emphasizes the importance of early activation of EMS, CPR (with mouth-to-mask and bag-mask
ventilation, with and without oxygen), and the use of an AED for victims >8 years of age. The course continues
too include relief of foreign body airway obstruction (FBAO) and the prevention of death and disability due to
heart attack and stroke. Teaching now includes methods to reduce death caused by sudden infant death
syndrome in infants and injuries in children. At the end of the course, the participant will be able to
demonstrate the following skills: (1) Phone 911, (2) Rescue breathing including bag-mask ventilation on adult,
child, and infant victims, (3) One and Two Rescuer CPR for adult, child and infant, (4) Use of an AED, (5)
Relief of FBAO in responsive and unresponsive victims of any age.
The HUNT for V-FIB
Early defibrillation is the single most important factor in determining the patients’ outcome in most adult
patients. Some studies report a conversion rate (to a perfusing rhythm) of 80-95% in VF patients treated with
early defibrillation (within the first minute). As each minute passes the window of opportunity slowly closes.
In adult cardiac arrests, the hunt for V-FIB starts as soon as the code is called. The clock keeps ticking as we
try to get the defibrillator to the patient’s room and attach the leads. According to the AHA, we should be able
to deliver 3 stacked shocks to all patients with VF within 3 minutes. Any delay in defibrillation increases
mortality. Evidence supports timely defibrillation in public places, in the homes of high-risk patients, and in
commercial aircraft, airports, hospitals, doctor’s offices, and outpatient clinics. An AED can be used in
children 8 years of age and older. Healthcare providers with a duty to perform CPR need to be trained,
equipped, and authorized to use an AED.
Modification of the “Phone First vs. Phone Fast” Guidelines: Recognition of Special Situations
New for Adults – Guidelines now recognize 4 special resuscitation situations where airway compromise, rather
than VT/VFib is the cause of the arrest. The new BLS guideline for these victims is “phone fast”. This means
provide 1 minute of CPR before phoning the EMS. These situations are (1) Submersion/near drowning, (2)
Poisoning, drug overdose, (3) Trauma, and (4) Respiratory arrest.
New for Pediatrics – The major exception to the “phone fast” rule is those children at risk for VT/VFib/Cardiac
history, who experience sudden collapse. For that select group “phone first” is recommended.
Primary Survey
Establish Unresponsiveness – Activate EMS as delineated in “Phone First vs. Phone Fast” Guidelines
A.
OPEN AIRWAY – Head tilt-chin lift (if trauma is present, use jaw thrust).
B.
CHECK FOR BREATHING – Look, listen, and feel for no more than 10 seconds.
 If victim is breathing or resumes effective breathing, place in the recovery position.
 If victim is not breathing, give 2 slow breaths using [pocket mask or bag-mask or barrier device.
C.
CHECK FOR SIGNS OF CIRCULATION – “Normal breathing, coughing, or movement” and pulse
check.
D.
DEFIBRILLATION – Using Automated External Defibrillator (AED) in victims over 8 years of age.
Age
Adult
Child
1- 8
years
Initial Breaths
2 breaths
2 sec. per breath
Compressions:
Ventilations*
Compressions
Rescue
Breathing
FBAO – Heimlich
15:2 one/two
rescuer
5:1 when airway
protected
Carotid
2 hands
& signs of lower half of sternum
circulation 1 ½ to 2 inches
100 x per minute
2 breaths
1 – 1 ½ sec. per breath
5:1 one-rescuer
5:1 two-rescuer
Carotid & Heel of one hand
3 seconds
signs of
Lower half of sternum 20 x per minute
circulation 1 – 1 ½ inches
( 1/3 to ½ the depth of
chest)
100 x per minute
5:1 one-rescuer
5:1 two-rescuer
3:1 for newborn
(< 1 month)
Brachial
or
Femoral
FBAO - Heimlich
Infant
less than
1 year of
age
Pulse
Site
2 breaths
1 – 1 ½ sec. per breath
FBAO – 5 back blows
5 chest
thrusts
(If heart rate is less
than 60 with signs of
poor perfusion, begin
chest compressions.)
2 fingers or 2 thumbs
with encircled hands
1 fingerbreadth below
the nipple line
½ - 1 inch
at least 100x/minute
newborn 90/min
1 breath every
4-5 seconds
10 – 12 minutes
20 x per minute
newborn x 30
per minute