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Chapter 8
Cardiopulmonary
Resuscitation
and AED
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Outline
• Introduction to CPR
• Review of the Circulatory System
• Causes of Cardiac Arrest
• CPR
• AED
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Introduction
to CPR
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Time is Critical!
• > 300,000 people experience sudden
cardiac death in prehospital settings each
year.
• If resuscitation begins within a few
minutes, many of these individuals have a
chance for survival.
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Time is Critical!
To begin resuscitation within a few minutes:
• Patient’s collapse witnessed
• EMS immediately activated
• CPR started immediately
• Defibrillation within minutes
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Trained bystanders are not always available
or willing to do CPR.
The role of the FR is critical in reaching the
patient quickly and beginning resuscitation.
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Review of
the
Circulatory
System
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What is the function of the
circulatory system?
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The Circulatory System
• Delivers O2 and nutrients
• Removes CO2 and wastes
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Why is the function of the
circulatory system critical to our
survival?
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If the heart stops pumping
• Lack of O2 and accumulation of wastes
quickly lead to death
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Major
Arteries
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Where are capillaries found and
what is their purpose?
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Capillaries
• Found throughout the body
• Connect smallest arteries to smallest veins
• O2, nutrients, and
wastes move
through thin
walls
• Microscopic
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How does a vein differ from an artery?
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Veins
• Carry blood back to heart
• Lower pressure
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What is the function of blood?
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Blood
• The fluid of the circulatory system
• Carries O2, nutrients, and wastes
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Heart Physiology
• LV contracts – sends wave of blood
• Pressure wave felt as pulse
• No contraction = No blood flow = cardiac
arrest
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Time is Critical!
• Brain damage
begins in 4–6 min
• Brain damage
irreversible in 8–10
min
Circulation must be
restored within 4–
6 minutes.
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CPR
• Provides minimal amount of
circulation/oxygenation until cause of
cardiac arrest corrected
• External chest compressions circulate
blood
• Artificial ventilations provide O2 to lungs
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Causes of
Cardiac
Arrest
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Causes of Cardiac Arrest
• Heart disease
• Respiratory arrest
• Medical emergencies
• Drowning and suffocation
• Congenital heart defects
• Trauma
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The cause of cardiac
arrest is important
BUT
do not delay CPR to
obtain history
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CPR
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CPR
• Combines external chest compressions
with artificial ventilation
• Provides 30% (or less) of normal
circulation
• Only effective for short period of time
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CPR – 1 Rescuer
• Assess
responsiveness
• Summon EMS
• Position the
patient
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CPR – 1 Rescuer
• Open the airway
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CPR – 1 Rescuer
• Look, listen, and
feel for breathing
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CPR – 1 Rescuer
• If there is no
breathing, give
two breaths, each
lasting 1 second
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CPR – 1 Rescuer
• Check for a pulse
(≤ 10 seconds)
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CPR – 1 Rescuer
• If there is no
pulse, find your
landmarks, lower
half of the
sternum, between
the nipples
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CPR – 1 Rescuer
• Begin chest
compressions
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CPR – 1 Rescuer
• Perform 30 chest
compressions
• Push hard
• Push fast
• Allow the chest to
recoil after each
compression
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CPR – 1 Rescuer
• Administer two
ventilations then
return to
compressions
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CPR – 2 Rescuer
1
2
3
4
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CPR - Children
• Use heel of one
hand
• Keep airway open
with other hand
• 30 compressions:2
ventilations if alone
(2 rescuers use
15:2)
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CPR - Infant
• Give chest thrusts
and puffs of air
• 30 compressions:2
ventilations if alone
• 15 compressions: 2
ventilations with 2
rescuers
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Sequence of
Survival
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The chances of survival from cardiac
arrest depend upon the sequence
(chain) of survival being intact.
All links are equally important and one
weak link can break the chain.
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Sequence of Survival
Also known as Chain of Survival
• Recognition and Early Access
• Early CPR
• Defibrillation
• Early Advanced Care
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Recognition and Early Access
• Depends on public
education
• EMS must be
immediately
notified
• 9-1-1 dispatchers
can provide CPR
instructions
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Early CPR
• Must begin within
4-6 minutes of
collapse
• Public training is
necessary
• FR have a critical
role
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Defibrillation
•Ventricular fibrillation
a common cause of
arrest
•Can only correct with
defibrillation
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Defibrillation
• Chance of success
decreases with
time
• AEDs save lives!
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Ventricular Fibrillation
• The most common cause of sudden
cardiac death
– Chaotic, disorganized heart activity
– Heart muscle cannot pump blood
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Ventricular Fibrillation
• Requires immediate defibrillation
• CPR lengthens window of survival
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Early Advanced Care
• Medication
• Advanced airway
management
• Post-resuscitation
care
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AED
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AEDs
• Safe, accurate &
lightweight
• Easy to operate
What is public
access defibrillation?
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PAD
• AEDs in public
places
• Training the public
in CPR/AED
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Special Considerations
• Children
• Clothing
• Body hair
• Water
• Transdermal
medication patches
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• Implanted
defibrillators or
pacemakers
• Metal surfaces
• Jewelry and glasses
AED
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Assess
• Check your
patient
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Universal Steps
Power
↓
Patient
↓
Analyze
↓
Shock
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Power
• Turn the power
on
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Patient
• Apply pads to
patient
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Analyze
• Stay clear while
patient’s heart
rhythm analyzed
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Clear
• Head to toe and
toe to head:
everyone is
clear!
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Shock
• Defibrillate
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Patient
• Standard is set of 1
shock
• Immediately restart CPR
for 2 minutes then
check pulse
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Summary
• Continual beating, or contracting, of the
heart is necessary to keep blood circulating
throughout the body.
• Brain damage begins in 4 to 6 minutes of
cardiac arrest.
• There are many causes of sudden cardiac
death, but the most common is ventricular
fibrillation.
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Summary
• Survival from cardiac arrest depends on
the sequence (chain) of survival.
• First Responders are critically important in
maintaining the sequence (chain) of
survival.
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Shock,
Shock,
Shock!
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