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1.0 5/24/2011 This module provides the audience with an overview of the American Heart Associations 2010 changes to CPR procedures for healthcare professionals. The module contains 45 slides and should take ~25 minutes to complete. None
05/24/2011
Childrens Healthcare of Atlanta has developed this module to present the updated CPR protocol from the American Heart Association (AHA) to clinicians who perform CPR. On April 1, 2011, we will begin utilizing this new protocol when CPR is performed in our hospitals and neighborhood locations. You will be thoroughly instructed in this protocol during your next CPR recertification or your initial CPR certification course. Meanwhile, there are some important points you must know so that you and all those performing CPR are using the same protocol. If you have any questions about any of these points you can ask your educator or contact Shannon Dunlap.
Note: The new guidelines are highlighted in red throughout the CBT.
05/24/2011
At the completion of this module you will be able to describe the American Heart Associations 2010 revisions to providing basic life support (including CPR) for: Adult victims Infant and child victims Victims with foreign body obstructions in their airways
05/24/2011
In late 2010, the American Heart Association or AHA modified its recommendations on Cardio Pulmonary Resuscitation (CPR) procedures to improve survival rates of adult and pediatric victims. These recommendations were based upon empirical studies that indicated improved survival. They include:
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CPR Overview
Successful resuscitation following cardiac arrest requires several key actions also know as the Chain of Survival. These are: Immediate recognition of cardiac arrest and activation of the emergency response system Early CPR emphasizing chest compressions Rapid defibrillation Effective advanced life support
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Change in Sequence
The new AHA guidelines recommend a fundamental change in CPR sequence from A-B-C to C-A-B C-A-B Compressions: Push hard and fast on the center of the victims chest. Airway: Tilt the victims head back and lift the chin to open the airway.
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Cardiac Arrest
Cardiac arrest in adults is usually sudden, and the primary cause is cardiac related. Therefore circulation produced by chest compressions is crucial. Cardiac arrest in children is mostly asphyxial which requires both compressions and ventilations.
Rescue breathing may be more important for children than adults in cardiac arrest.
05/24/2011
In this lesson you learned about general changes to CPR guidelines that the AHA has recommended: Changes to the Chain of Survival Changes to the CPR sequence from A-B-C to C-A-B In the next lesson you will be presented the specific changes to the AHA CPR guidelines for adults.
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In this lesson you will learn about changes to the CPR procedures for adults that are provided by our caregivers here at Childrens. These include revisions to: Chest compressions Pulse checks Rescue breaths You will also learn about revisions on using an Automated External Defibrillator (AED) in conjunction with CPR.
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Check the pulse if definite pulse within 10 seconds give 1 breath every 5 to 6 seconds and re-check carotid pulse every 2 minutes.
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If rhythm is shockable, give 1 shock and resume CPR immediately for 2 minutes.
If rhythm is not shockable, resume CPR for 2 minutes; check rhythm every 2 minutes and continue until advanced life support providers take over or the patient starts to move. The AED will automatically prompt you to perform the above actions.
2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved. 13
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Minimize interruptions in compressions Avoid excessive ventilations If multiple rescuers are available, they should rotate the task of compressions every 2 minutes
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Pulse Checks
Studies have shown that healthcare providers and lay rescuers have difficulty detecting pulses. To avoid delay in CPR, healthcare providers should take no more than 10 seconds to check for a pulse. If a pulse is not detected within 5-10 seconds then compressions should be started.
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Rescue Breaths
The 2010 AHA Guidelines recommend the initiation of compressions before ventilations. Once compressions have been started, a trained rescuer should deliver rescue breaths by mouth-to-mouth or bag/mask.
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Rescue Breaths
Rescue breaths should be delivered over 1 second. Give sufficient tidal volume to produce visible chest rise. Use compression to ventilation ratio of 30 compressions to 2 ventilations. If there is a pulse give 1 breath every 5-6 seconds.
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AED/Defibrillation
Defibrillation sequence Turn on the AED. Follow the AED prompts. Resume chest compressions immediately after the shock; minimize interruptions. Pad placement The 4 pad positions are anterolateral, anteroposterior, anterior-left infrascapular, and anterior-right infrascapular. All of these positions are equally effective.
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Pulse
No Pulse
5 AED/defibrillator arrives.
In this lesson you learned about revisions to CPR procedures for adults including: Chest compressions Pulse checks Rescue breaths You also learned about revisions on using an Automated external defibrillator (AED) in conjunction with CPR. In the next lesson information about BLS for children and infants is presented.
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This lesson presents information about revisions to the CPR procedures for infants and children.
These include:
The differences between CPR for infants and children Inadequate breathing issues Poor Perfusion You will also learn about revisions on using an Automated External Defibrillator (AED) in conjunction with CPR for children and infants.
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Victim is unresponsive. Not breathing or gasping. Send someone to activate The emergency response system and get an AED/defibrillator.
One rescuer: For SUDDEN COLLAPSE activate the emergency response system and get AED/defibrillator
TWO rescuers: For SUDDEN COLLAPSE send someone to activate the emergency response system and get AED/defibrillator
3 Pulse
No Pulse
One rescuer: Begin cycles of 30 compressions and 2 breaths Two rescuers: Begin cycles of 15 compressions and 2 breaths
* Indicates a change to AHA protocol
After about 2 mins, activate emergency response system and get AED (if not already done). Use AED ASAP to check rhythm.
No
8 No shockable rhythm: Resume
CPR immediately for 2 mins. Check rhythm every 2 mins. Continue until ALS providers take over or victim starts to move.
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In infants, manual defibrillators are preferred. If a manual defibrillator is not available then one with a pediatric dose attenuator (pediatric pads) is preferred.
2011 Childrens Healthcare of Atlanta Inc. All Rights Reserved. 34
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No pulse palpated within 10 seconds for all ages (HCP only) CPR Sequence Compression rate Compression depth At least 2 inches (5cm) C-A-B At least 100/min At least AP diameter About 2 inches (5cm) At least AP diameter About 1 inches (4cm)
Chest wall recoil Compression interruptions Airway Compression-toventilation ratios (until advanced airway placed) Ventilations: when rescuer untrained or trained and not proficient Ventilations with advanced airway (HCP)
Allow complete recoil between compressions HCPs rotate compressions every 2 minutes Minimize interruptions in chest compressions Attempt to limit interruptions to < 10 seconds Head tilt-chin lift (HCP suspected trauma: jaw thrust) 30:2 Single rescuer 15:2 2 HCP rescuers
30:2 1 or 2 rescuers
Compressions only
1 breath every 6-8 seconds (8-10 breaths/min) Asynchronous with chest compressions About 1 second per breath Visible chest rise Attach and use AED as soon as possible. Minimize interruptions in chest compressions before and after shock; resume CPR beginning with compressions immediately after each shock.
Source: Highlights of the 2010 AHA Guidelines for CPR & ECC
Defibrillation
The differences between CPR for infants and children versus adults Inadequate breathing issues Poor perfusion You also learned about using an Automated External Defibrillator (AED) in conjunction with CPR for children and infants.
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This final lesson will present information about foreign body obstructions in victims airways, including: Relief for responsive and unresponsive victims Recognizing and responding appropriately to mild and severe obstructions You will also learn about Hands-only CPR.
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Attempt to give 2 breaths and continue with cycles of chest compressions and ventilations until the object is expelled. Look for the object after each round of compressions and sweep if seen. After 2 minutes, if no one has done so, activate the emergency response system.
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Hands-only CPR
Because we are in a healthcare setting, this CBT has focused primarily on CPR for Healthcare Providers. Hands-only CPR is for layperson cardiac arrest rescue in the community or out of the hospital when unable to provide breaths (no mask/barrier) because:
Lay rescuers are more likely to provide CPR if they do not have to give ventilations. It is easier for emergency response personnel to instruct lay rescuers how to perform chest compressions when they are untrained. Survival rates from cardiac arrest are similar for Hands-only CPR and CPR using both compressions and ventilations. If the lay rescuer is trained, it is still recommended that the rescuer perform both compressions and ventilations.
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05/24/2011
This lesson presented information about foreign body obstructions in victims airways, including: Relief for responsive and unresponsive victims Recognizing and responding appropriately to mild and severe obstructions You also learned about Hands-only CPR used by laypeople.
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You have completed this module. In it you learned about the changes to the AHAs new recommendations for providing CPR. These changes impact providing basic life support for: Adult victims Infant and child victims Victims with foreign body obstructions in their airways
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References
2010 American Heart Association Guidelines for CPR and ECC, Supplement to Circulation November 2,2010, Volume 122, Issue 18, Supplement 3.
www.heart.org
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