Welcome to the American Heart Association 2010 Update for CPR.

2010 AHA Update for CPR

1.0 5/24/2011 This module provides the audience with an overview of the American Heart Association’s 2010 changes to CPR procedures for healthcare professionals. The module contains 45 slides and should take ~25 minutes to complete. None

404-785-6767 Shannon Dunlap

Clinical staff – all levels

shannon.dunlap@choa.org Mark Guerrein

05/24/2011

©2011 Children’s Healthcare of Atlanta Inc. All Rights Reserved.

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Children’s 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

©2011 Children’s Healthcare of Atlanta Inc. All Rights Reserved.

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At the completion of this module you will be able to describe the American Heart Association’s 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

©2011 Children’s Healthcare of Atlanta Inc. All Rights Reserved.

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Lesson 1: CPR Overview In late 2010. 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. 5 . These recommendations were based upon empirical studies that indicated improved survival. All Rights Reserved. the American Heart Association or AHA modified its recommendations on Cardio Pulmonary Resuscitation (CPR) procedures to improve survival rates of adult and pediatric victims. They include: •Changes to the “Chain of Survival” •Changes to the CPR sequence In this lesson you will be presented with an overview of these changes.

CPR Overview Successful resuscitation following cardiac arrest requires several key actions also know as the Chain of Survival. All Rights Reserved. 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 • • • • Integrated post-cardiac care 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. 6 .

7 . 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. All Rights Reserved. •Airway: Tilt the victim’s head back and lift the chin to open the airway.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 victim’s chest. •Breathing: Give mouth-to-mouth or bag/mask rescue breathing.

Change in Sequence continued The new AHA guidelines have also eliminated “Look. and Feel” from the CPR sequence because performing it is inconsistent and time consuming. Listen. 8 . 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. All Rights Reserved.

and the primary cause is cardiac related. 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.Cardiac Arrest • Cardiac arrest in adults is usually sudden. Cardiac arrest in children is mostly asphyxial which requires both compressions and ventilations. Therefore circulation produced by chest compressions is crucial. 9 . • • Rescue breathing may be more important for children than adults in cardiac arrest. All Rights Reserved.

Lesson 1: CPR Overview 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. 10 . All Rights Reserved. 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.

Lesson 2: Adult Basic Life Support for Healthcare Providers In this lesson you will learn about changes to the CPR procedures for adults that are provided by our caregivers here at Children’s. 11 . 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. All Rights Reserved. 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.

• • 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. All Rights Reserved. Activate the emergency response system and get AED/defibrillator – if second rescuer is available send her or him to do this.Adults / Adolescents Basic Life Support (BLS) for Healthcare Providers • The rescuer recognizes that the patient is unresponsive – no breathing or no normal breathing. 12 . 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.

give 1 shock and resume CPR immediately for 2 minutes. ©2011 Children’s Healthcare of Atlanta Inc. The AED will automatically prompt you to perform the above actions. begin CPR starting with 30 compressions. • • • If rhythm is shockable. When the AED/defibrillator arrives. Then open the airway and give 2 breaths.Adult BLS for Healthcare Providers • If there is no pulse. If rhythm is not shockable. check rhythm. All Rights Reserved. check rhythm every 2 minutes and continue until advanced life support providers take over or the patient starts to move. 13 • 05/24/2011 . resume CPR for 2 minutes.

All Rights Reserved. 14 .Chest Compressions in Adults Rescuers should focus on delivery of high quality CPR – Push Hard and Push Fast • • Provide chest compressions at an adequate rate (at least 100/min) Provide Chest compressions to adequate depth o o Adults: Compression depth of at least 2 inches (5cm) Allow complete chest recoil after each compression • • • Minimize interruptions in compressions Avoid excessive ventilations If multiple rescuers are available. they should rotate the task of compressions every 2 minutes 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.

15 . • • 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. All Rights Reserved. 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.Pulse Checks • Studies have shown that healthcare providers and lay rescuers have difficulty detecting pulses.

All Rights Reserved. 16 .Rescue Breaths • The 2010 AHA Guidelines recommend the initiation of compressions before ventilations. • 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. Once compressions have been started. a trained rescuer should deliver rescue breaths by mouth-to-mouth or bag/mask.

• 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. 17 . Give sufficient tidal volume to produce visible chest rise. All Rights Reserved. If there is a pulse give 1 breath every 5-6 seconds.Rescue Breaths • • • Rescue breaths should be delivered over 1 second. Use compression to ventilation ratio of 30 compressions to 2 ventilations.

All of these positions are equally effective. and anterior-right infrascapular.AED/Defibrillation Defibrillation sequence • Turn on the AED. 18 . Pad placement • The 4 pad positions are anterolateral. 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. anteroposterior. All Rights Reserved. • Resume chest compressions immediately after the shock. anterior-left infrascapular. minimize interruptions. • Follow the AED prompts.

05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.Adult BLS for Healthcare Providers The following slide displays a flow chart of the steps to follow when providing Adult BLS. All Rights Reserved. 19 .

* Indicates a change to AHA protocol High Quality CPR •Rate at least 100/minute •Compression depth at least 2 inches (5cm) •Allow complete chest recoil after each compression. 5 AED/defibrillator arrives.1 Victim is unresponsive. only gasping). No 8 No shockable rhythm: Resume CPR immediately for 2 mins. 6 Shockable rhythm? YES 7 Shockable rhythm: Give 1 shock and resume CPR for 2 mins.? No Pulse 3a Give 1 breath every 5 to 6 secs. Check rhythm every 2 mins. •Minimize interruptions in chest compressions. * 4 Begin cycles of 30 compressions and 2 breaths. •Avoid excessive ventilations.e. Re-check pulse every 2 mins. . Adult / Adolescent BLS for Healthcare Providers 3 Pulse Check pulse: DEFINITE pulse within 10 secs.. 2 Activate the emergency response system and get AED/defibrillator. Continue until ALS providers take over or victim starts to move. No breathing or no normal breathing (i.

21 . All Rights Reserved. In the next lesson information about BLS for children and infants is presented.Lesson 2: Adult Basic Life Support for Healthcare Providers 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. 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.

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. All Rights Reserved. 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.Lesson 3: Child and Infant CPR This lesson presents information about revisions to the CPR procedures for infants and children. 22 .

• • 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. All Rights Reserved.Child and Infant CPR • Infant BLS guidelines apply to infants less than approximately 1 year of age. Child BLS guidelines apply to children approximately 1 year of age until puberty. puberty is defined as breast development in females and presence of axillary hair in males. 23 . For teaching purposes.

Child and Infant CPR The AHA recommends that the sequence of CPR for adults and infants/children be the same Rationale for making the changes in CPR sequence to C-A-B in infants and children: •The majority of victims who require CPR are adults. • All rescuers should be able to start chest compressions almost immediately. All Rights Reserved. They have a better outcome if compressions are started as early as possible. 24 . Whereas positioning the head and making sure there is a seal for mouth-to–mouth or bagmask resuscitation takes time and delays the initiation of chest compressions This also offers the advantage of consistency in education whether the victims are adult. children or infants. •Beginning CPR with compressions rather than ventilations leads to a shorter delay to the first compression. • 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.

Pediatric Chain of Survival • • Make sure the area is safe for you and the infant/child Assess the need for CPR and start compressions – lone rescuers should give about 5 cycles of compressions and ventilations before leaving the child to activate the emergency response Activate emergency response system and get the AED Effective advanced life support Integrated post-cardiac care ©2011 Children’s Healthcare of Atlanta Inc. 25 • • • 05/24/2011 . All Rights Reserved.

05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.Chest Compressions in Infants and Children Rescuers should focus on delivery of high quality CPR – Push Hard and Push Fast. All Rights Reserved. •Provide chest compressions to adequate rate (at least 100/minute) •Provide chest compressions of adequate depth – Infants and children: a depth of at least one third the anterior-posterior (AP) diameter of the chest or about 1 ½ inches (4cm) in infants and about 2 inches (5cm) in children •Allow compete chest recoil after each compression •Minimize interruptions in compressions •Avoid excessive ventilation If multiple rescuers are available they should rotate the task of compressions every 2 minutes. 26 .

– AEDs have now been approved for use with infants. Check pulse – if definite pulse within 10 seconds give 1 breath every 3 seconds.Pediatric BLS for Healthcare Providers in Infants and Children • If second rescuer is available send him or her to activate the emergency response and obtain AED/defibrillator. Recheck pulse every 2 minutes. All Rights Reserved. Add compressions if pulse remains less than 60/min with poor perfusion despite adequate oxygenation and ventilation. 27 . • • • 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.

If rhythm is not shockable. resume CPR immediately for 2 minutes. ©2011 Children’s Healthcare of Atlanta Inc. Check rhythm every 2 minutes. Continue until Advanced Life Support providers take over or victim starts to move. All Rights Reserved. activate the emergency response system if not already done. give 1 shock and resume CPR immediately for 2 minutes. Use an AED as soon as available.Pediatric BLS for Healthcare Providers in Infants and Children • If no pulse is detected. begin cycles of 30 compressions and 2 breaths for one rescuer. If rhythm is shockable. For 2 rescuers begin cycles of 15 compressions and 2 breaths. after about 2 minutes. If lone rescuer. 28 • • • 05/24/2011 .

All Rights Reserved.Pediatric BLS for Healthcare Providers The following slide displays a flow chart of the steps to follow when providing pediatric BLS. 29 . 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.

Add compressions if pulse remains < 60/min with poor perfusion despite adequate oxygenation and ventilation RE-check pulse every 2 mins * High Quality CPR •Rate at least 100/minute •Compression depth at least 1/3 anterior-posterior diameter of chest.1 Victim is unresponsive. •Minimize interruptions in chest compressions. Send someone to activate The emergency response system and get an AED/defibrillator. Not breathing or gasping. Pediatric BLS for Healthcare Providers 2 One rescuer: For SUDDEN COLLAPSE activate the emergency response system and get AED/defibrillator 2 TWO rescuers: For SUDDEN COLLAPSE send someone to activate the emergency response system and get AED/defibrillator 3 Pulse Check pulse: DEFINITE pulse within 10 secs.? No Pulse 3a Give 1 breath every 3 secs. No 8 No shockable rhythm: Resume CPR immediately for 2 mins. •Avoid excessive ventilations. Continue until ALS providers take over or victim starts to move. about 1 ½ inches (4cm) in infants and 2 inches (5cm) in children •Allow complete chest recoil after each compression. 6 Shockable rhythm? YES 7 Shockable rhythm: Give 1 shock and resume CPR for 2 mins. 4 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 5 After about 2 mins. activate emergency response system and get AED (if not already done). Check rhythm every 2 mins. . Use AED ASAP to check rhythm.

encircle the infant’s chest with both hands. To do this. The 2-thumb encircling hands technique is recommended when CPR is provided by 2 rescuers.Chest Compressions for Healthcare Provider of Infants • For infants. the single rescuer should use the 2-finger chest compression technique. • • 05/24/2011 31 . Forcefully compress the sternum with your thumbs. All Rights Reserved. ©2011 Children’s Healthcare of Atlanta Inc. Spread your fingers around the thorax. and place your thumbs together over the lower third of the sternum.

All Rights Reserved. 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. 32 .Inadequate Breathing with Pulse If there is a palpable pulse > 60 per minute but there is inadequate breathing: Give rescue breaths at a rate of about 12-20 breaths per minute – 1 breath every 3-5 seconds until spontaneous breathing resumes.

All Rights Reserved.Bradycardia with Poor Perfusion If the pulse is less than 60 beats per minute and there are signs of poor perfusion ( i.. pallor. cyanosis) begin compressions. mottling.e. 33 . 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.

If neither is available an AED without a dose attenuator may be used.AED/Defibrillators in Children and Infants • If a manual defibrillator is unavailable then an AED that has a pediatric dose attenuator (pediatric pads) is preferred for infants. • AED’s that do not have pediatric dose attenuators have been used in infants with no clear adverse effects. ©2011 Children’s Healthcare of Atlanta Inc. 34 05/24/2011 . manual defibrillators are preferred. All Rights Reserved. If a manual defibrillator is not available then one with a pediatric dose attenuator (pediatric pads) is preferred. An AED with a pediatric dose attenuator is also preferred for children under 8 years of age. • • • In infants.

BLS for Adults vs. Children In this lesson we discussed Basic Life Support (BLS) for children and Infants. All Rights Reserved. The next slide displays a table taken from the AHA 2010 Guidelines summarizing these differences. 35 . 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. In the previous lesson Adult BLS was presented. It may be helpful to compare the differences of these groups.

Summary of Key BLS Components for Adults. 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 ½ AP diameter About 2 inches (5cm) At least ½ AP diameter About 1½ 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. and Infants* Recommendations Component Adults Children Unresponsive (for all ages) Recognition No breathing or no normal breathing (i. Minimize interruptions in chest compressions before and after shock. only gasping) No breathing or only gasping Infants *Excluding the newly born.e. Source: Highlights of the 2010 AHA Guidelines for CPR & ECC Defibrillation . Children. resume CPR beginning with compressions immediately after each shock.. in whom the etiology of an arrest is nearly always asphyxiate.

05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. Lesson 3: Child and Infant CPR •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. All Rights Reserved.In this lesson you learned about. 37 .

38 . 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. All Rights Reserved.Lesson 4: Foreign Body Obstruction (Choking) 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.

the adult or child cannot cough or make any sound. the adult and children can cough and make some sounds. • • When it is mild. Foreign body obstruction can be either mild or severe. 39 . All Rights Reserved.Foreign Body Airway Obstruction (Choking) • Greater than 90% of childhood deaths from foreign body aspiration occur in children under 5 years old. When it is severe. • 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.

Relief of Foreign Body Obstruction • If the foreign body obstruction is mild. do not interfere. 40 . All Rights Reserved. If the foreign body obstruction is severe you must act to relieve the obstruction. • • 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. Allow the victim to clear airway by coughing while you observe for signs of severe foreign body obstruction. deliver repeated cycles of 5 back blows followed by 5 chest compressions until the object is expelled or the victim becomes unresponsive. For infant. • For adults and children. perform abdominal thrusts until the object is expelled or the victim becomes unresponsive.

All Rights Reserved. activate the emergency response system. •If you see a foreign body. Look for the object after each round of compressions and sweep if seen. 41 . if no one has done so. After 2 minutes. • Attempt to give 2 breaths and continue with cycles of chest compressions and ventilations until the object is expelled. •After 30 chest compressions open the airway.Relief of Foreign Body Obstruction (Unresponsive) If the victim becomes unresponsive: • •Start CPR with chest compressions – do not perform a pulse check. 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. remove it but do not perform blind finger sweeps because they may push the objects further into the pharynx.

it is still recommended that the rescuer perform both compressions and ventilations. Survival rates from cardiac arrest are similar for Hands-only CPR and CPR using both compressions and ventilations. 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. this CBT has focused primarily on CPR for Healthcare Providers. . All Rights Reserved. It is easier for emergency response personnel to instruct lay rescuers how to perform chest compressions when they are untrained. If the lay rescuer is trained.Hands-only CPR Because we are in a healthcare setting. 42 • • 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.

43 .Lesson 4: Foreign Body Obstruction (Choking) 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. 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc. All Rights Reserved.

You have completed this module. In it you learned about the changes to the AHA’s new recommendations for providing CPR. 44 . These changes impact providing basic life support for: •Adult victims •Infant and child victims •Victims with foreign body obstructions in their airways 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.

www. 45 . Supplement to Circulation November 2. Issue 18.2010. Volume 122. Supplement 3.org 05/24/2011 ©2011 Children’s Healthcare of Atlanta Inc.heart.References 2010 American Heart Association Guidelines for CPR and ECC. All Rights Reserved.

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